Which neuropathologic findings are most consistent with this patient’s symptoms?

A 57-year-old man is brought to the emergency department because of blurry vision, difficulty standing, and mental confusion. On physical examination the patient appears malnourished, he had diffuse crackles bilaterally, and on standing his gait is wide-based and unsteady. The patient’s friend, who accompanies him, says the patient “hasn’t been himself lately,” and is having difficulty remembering to do everyday tasks. Which neuropathologic findings are most consistent with this patient’s symptoms?

(A) Atrophy of the caudate nucleus
(B) Depigmentation within the substantia nigra pars compacta
© Neurofi brillary tangles and widening of ventricles
(D) No neuropathologic findings
(E) Symmetric lesions in the paraventricular regions of the thalamus and hypothalamus, mammillary bodies, and periaqueductal region of the midbrain