Medical image of the week: MRI of Wernicke's encephalopathy

A 61 year old male presented to the ED with altered mental status after being found down at home with several beer cans around him. He was noted to have horizontal nystagmus on hospital day 2 and a MRI was performed. MRI showed bilateral thalamic enhancement (Figure 1, arrows) on flair imaging consistent with Wernicke’s encephalopathy. His thiamine dose was increased with improvement in his mental status.