A 48-year-old man presented to the emergency department with a 3-day history of an unsteady gait and double vision when looking to the right. He had severe vomiting over the past ten days and had lost significant weight over the past few months. Medical history He underwent partial gastrectomy for carcinoma of the stomach twelve years ago. He had no previous medical or psychiatric history except alcohol dependence. Mental state examination Eye contact: Variable He was disoriented but was able to recognize his wife who accompanied him.
He was drowsy, had poor concentration, but was readily rousable. Mini-mental state examination score: 14/30 Physical examination Appearance: Confused Blood pressure: 90/60 mmHg Pulse: 120 beats/min Oxygen saturation: 96% He had palmar erythema, hepatomegaly and nystagmus. Neurological examination: Reduced power and sensation in both lower limbs. Deep…
