A 60-year-old man presented with bilateral gaze evoked nystagmus, severe ataxia, and memory impairment. Brain MRI showed concurrent cytotoxic and vasogenic edema patterns (figure). This case shows both cytotoxic and vasogenic edema that may occur at the same time in Wernicke encephalopathy. These findings may be due to the different vulnerability of brain regions to thiamine deprivation and the corresponding time lag between the development of lesions. From the Departments of Neurology

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