Alcohol use disorder Quiz: Ace Your Exams

A 59-year-old woman with a history of alcohol use disorder is brought to the emergency department to evaluate worsening forgetfulness and frequent falls. The patient cannot recall the address of the house where she has been living for the past 30 years. Temperature is 36.9°C (98.5°F), pulse is 120/min, respirations are 16/min, and blood pressure is 103/61 mmHg. Physical examination shows an unkempt female with an ataxic gait. Ophthalmoplegia is noted on cranial nerve testing, and there is decreased vibration sensation in the bilateral lower extremities. Laboratory results are shown below. An MRI of the brain demonstrates atrophy of the anterior thalamus and mammillary bodies. Deficiency of which of the following nutrients is responsible for this patient’s clinical presentation?