A 43-year-old man is referred from the emergency department with memory loss and difficulty walking. He was brought in by his wife who has noticed personality changes, truancy from work, and lack of personal care over the past 2 years. On examination, he appears unkempt, smells of urine, and is uncooperative. He cannot recall the date or season and gets angry when asked questions. His answers are often fabricated when checked with his wife. His gait is wide-based, and there is the loss of sensation in his feet up to the shins. His motor strength and reflexes are normal. His ocular movements are normal and there is no nystagmus. In the past, he has had multiple admissions for alcohol withdrawal. Which of the following is the most likely diagnosis?
The combination of symptoms is typical of chronic alcohol abuse. The mental symptoms are suggestive of Wernicke-Korsakoff syndrome. A distal limb sensory-motor neuropathy is also typical of alcoholism. Confusion, tremulousness, and disorientation are typical for acute alcohol intoxication. Wernicke’s encephalopathy is a symptom complex of ophthalmoplegia, ataxia, nystagmus, and acute confusional state.