in lateral gaze. A Romberg test is positive, and his gait is severely ataxic. He develops hemorrhaging geal varices and dies 5 days later. The brain at autopsy is shown in the photograph. Which of the he most likely diagnosis? montine myelinolysis encephalopathy enticular degeneration (Wilson disease)

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63. A 35-year-old man is admitted to the hospital because of confusion, indifference, and lethargy for 3 months.
Ophthalmologic examination shows sluggish pupillary responses and horizontal nystagmus; neither eye moves past
the midline on lateral gaze. A Romberg test is positive, and his gait is severely ataxic. He develops hemorrhaging
from esophageal varices and dies 5 days later. The brain at autopsy is shown in the photograph. Which of the
following is the most likely diagnosis?
A) Central pontine myelinolysis
B) Hepatic encephalopathy
C) Hepatolenticular degeneration (Wilson disease)
D) Ruptured cerebral aneurysm
E) Traumatic injury
F) Wernicke encephalopathy
Transcribed Image Text:63. A 35-year-old man is admitted to the hospital because of confusion, indifference, and lethargy for 3 months. Ophthalmologic examination shows sluggish pupillary responses and horizontal nystagmus; neither eye moves past the midline on lateral gaze. A Romberg test is positive, and his gait is severely ataxic. He develops hemorrhaging from esophageal varices and dies 5 days later. The brain at autopsy is shown in the photograph. Which of the following is the most likely diagnosis? A) Central pontine myelinolysis B) Hepatic encephalopathy C) Hepatolenticular degeneration (Wilson disease) D) Ruptured cerebral aneurysm E) Traumatic injury F) Wernicke encephalopathy
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