1. A 57-year-old male who was brought to the ER unresponsive
Leonidas Arvanitis, M.D.
Neuropathology Fellow, PGY-6

2. History
The patient was a 57 year old male who was brought to ER due to unresponsiveness after heavy drinking
Lab tests showed severe metabolic acidosis (pH of 7.01), acute pancreatitis and hepatic failure
He was transferred to the ICU and was put on pressors and fluids
The patient further deteriorated, developed DIC and died the next day

3. Autopsy
An autopsy was performed and showed the following (describe):

4. Autopsy
Bilateral mamillary body hemorrhages

5. This is a section from the mamillary bodies. What do you see?
Mamillary bodies. Click here for H&E section

6. This is a section from the mamillary bodies. What do you see?

7. This is a section from the mamillary bodies. What do you see?
Bilateral mamillary bodies showing multifocal confluent hemorrhages

8. This is a section from the mamillary bodies. What do you see?
Neurons do not show significant hypoxic changes. No gliosis or hemosiderin is identified.

9. Question:
What is the most likely diagnosis?

10. Answer
Acute Wernicke’s-type encephalopathy

11. Question:
What is the cause of this disease?

12. Answer
Thiamine deficiency