No abstract

Wernicke encephalopathy (WE) is an acute neurological disease resulting from dietary thiamine (vitamin B1) deficiency. WE is characterized by changes in consciousness, ocular dysfunction, and ataxia. Neuroradiologic findings usually show symmetric signal intensity alterations in the mammillary bodies, medial thalami, tectal plate, and periaqueductal area. Selective involvement of the cranial nerve nuclei, cerebellum, red nuclei, dentate nuclei, fornix, splenium, cerebral cortex, and basal ganglia characterize nonalcoholic WE patients. Furthermore, symmetric basal ganglia alterations with involvement of the putamen have only been observed in children. The incidence of WE is underestimated in both adult and pediatric patients. Interestingly, the frequency of WE in children appears to be similar to that observed in adults. The prognosis of the disease largely depends on the time from diagnosis to thiamine supplementation. The aim of this pediatric literature review is to provide an update on neuroradiologic findings in children affected by WE in an effort to determine pertinent clinical and imaging findings that can improve the detection and early identification of the disease. A thorough knowledge of the MRI findings of WE will assist in arriving at an early diagnosis, thereby reducing the morbidity and mortality associated with this disease in children.

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Spontaneous pneumomediastinum (SPM) is a rare, generally benign condition in young children caused by alveolar rupture and dissection of air into the mediastinum and hilum. In children, SPM is seen most commonly in asthmatics but may also occur in any patient who induces a Valsalva maneuver, including coughing, forceful vomiting, or first-time wheezing. There are limited reports on SPM in first-time wheezing episodes. We report a case of a 4-year-old girl with no history of wheezing who presents with wheezing, mild respiratory distress, and salient radiographic findings of pneumomediastinum, including spinnaker sail sign and continuous diaphragm sign. The SPM is generally a benign entity that requires supportive care, and resolution occurs spontaneously. This article will allow the clinician to become familiar with the specific clinical and radiological signs associated with SPM.