Wernicke-Korsakoff syndrome Quiz: Ace Your Exams

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A 48-year-old man comes to the clinic with generalized fatigue, numbness, and weakness in his lower limbs over the last 2 weeks. Notable past medical history includes Crohn disease, for which he underwent an ileocecal resection 6 months ago and has been receiving total parenteral nutrition (TPN) since the procedure. He additionally has a history of chronic alcohol use and has been drinking 6-7 beers daily for the past 25 years. Temperature is 37.0°C (98.6°F), pulse is 80/min, respirations are 20/min, and blood pressure is 135/85 mmHg. BMI is 19 kg/m2. He is alert, cooperative, and oriented to time, place, and person. Neurological examination reveals symmetrical peripheral neuropathy in the upper and lower extremities with defective perception of touch and vibration sensation. Motor strength is 3/5 in the lower limbs and 5/5 in the upper limbs bilaterally. Symmetrical muscle wasting is noted on both lower limbs. Deep tendon reflexes are absent at the ankles bilaterally. Romberg test is negative. Laboratory investigations are shown below:

 
 Laboratory value  Result 
Complete blood count 
 Hemoglobin  12 g/dL 
 Hematocrit  40% 
 Leukocyte count  9,100/mm3 
 Platelet count  150,000/mm3 
 MCV                 82 fL 

This patient’s condition is most likely associated with which of the following additional findings?

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