Spectrum of MR Imaging Findings in Wernicke Encephalopathy: Are Atypical Areas of Involvement Only Present in Nonalcoholic Patients?

Ha, Nam-Du; Weon, Young Cheol; Jang, Jong Chang; Kang, Bo-Kyeong; Choi, Seung Hyun

doi:10.3174/ajnr.a2979

Cited by 39 publications

(26 citation statements)

References 26 publications

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“…As an answer to this hypothesis, in 2010, Hygino da Cruz and his collaborators reported two cases of nonalcoholic WE demonstrating that both typical and atypical MR imaging findings may coexist [83]; in the same year, Sugai and Kikugawa added their experience describing atypical MRI findings in two patients with WE, both of whom were alcoholic [84]. In 2012, Ha et al reported MR imaging findings of twenty-four patients (13 AL and 11 NA) with WE showing that the atypical MR imaging findings, including cerebral cortex and cranial nerve nuclei lesions, were present both in the AL group and in the NA group [85]. Few months later, Liou et al described an interesting case of an AL patient affected by WE that showed lesions in olivary bodies, brain stem cranial nerve nuclei, and the dentate nuclei of cerebellum in absence of hyperintense lesions in the typically affected areas [86].…”

Section: Mr Imaging Findingsmentioning

confidence: 99%

MR Imaging Findings in Alcoholic and Nonalcoholic Acute Wernicke’s Encephalopathy: A Review

Manzo

Gennaro

Cozzolino

et al. 2014

BioMed Research International

130

150

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Wernicke's encephalopathy (WE) is a severe neurological syndrome caused by thiamine (vitamin B1) deficiency and clinically characterized by the sudden onset of mental status changes, ocular abnormalities, and ataxia. Apart from chronic alcoholism, the most common cause of WE, a lot of other conditions causing malnutrition and decreasing thiamine absorption such as gastrointestinal surgical procedures and hyperemesis gravidarum must be considered as predisposing factors. Due to its low prevalence and clinical heterogeneity, WE is often misdiagnosed, leading to persistent dysfunctions and, in some cases, to death. Nowadays, MR imaging of the brain, showing T2 and FLAIR hyperintensities in typical (thalami, mammillary bodies, tectal plate, and periaqueductal area) and atypical areas (cerebellum, cranial nerve nuclei, and cerebral cortex), is surely the most important and effective tool in the diagnostic assessment of WE. The aim of this paper is to propose a state of the art of the role of MR imaging in the early diagnosis of this complex disease.

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Section: Mr Imaging Findingsmentioning

confidence: 99%

MR Imaging Findings in Alcoholic and Nonalcoholic Acute Wernicke’s Encephalopathy: A Review

Manzo

Gennaro

Cozzolino

et al. 2014

BioMed Research International

130

150

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“…The presence of diffusion restriction most strongly suggests arterial stroke, toxicity, infection, or, to a lesser degree, lymphoma or deep venous thrombosis. 1,2,4, [25][26][27]35,39,42,45,50,57,60,70,90 Conversely, diffusion restriction has not been found in patients with dAVF-induced thalamic dementia. Strong gadolinium enhancement is most consistent with a high-grade neoplasm; 26,27,58 however, other conditions including dAVFs can also have some degree of gadolinium enhancement.…”

Section: Thalamic Dementia Syndrome: Differential Diagnosis and Workupmentioning

confidence: 99%

Dural arteriovenous fistula-induced thalamic dementia: report of 4 cases

Holekamp

Mollman

Murphy

et al. 2016

JNS

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Nonhemorrhagic neurological deficits are underrecognized symptoms of intracranial dural arteriovenous fistulas (dAVFs) having cortical venous drainage. These symptoms are the consequence of cortical venous hypertension and portend a clinical course with increased risk of neurological morbidity and mortality. One rarely documented and easily misinterpreted type of nonhemorrhagic neurological deficit is progressive dementia, which can result from venous hypertension in the cortex or in bilateral thalami. The latter, which is due to dAVF drainage into the deep venous system, is the less common of these 2 dementia syndromes. Herein, the authors report 4 cases of dAVF with venous drainage into the vein of Galen causing bithalamic edema and rapidly progressive dementia. Two patients were treated successfully with endovascular embolization, and the other 2 patients were treated successfully with endovascular embolization followed by surgery. The radiographic abnormalities and presenting symptoms rapidly resolved after dAVF obliteration in all 4 cases. Detailed descriptions of these 4 cases are presented along with a critical review of 15 previously reported cases. In our analysis of these 19 published cases, the following were emphasized: 1) the clinical and radiographic differences between dAVF-induced thalamic versus cortical dementia syndromes; 2) the differential diagnosis and necessary radiographic workup for patients presenting with a rapidly progressive thalamic dementia syndrome; 3) the frequency at which delays in diagnosis occurred and potentially dangerous and avoidable diagnostic procedures were used; and 4) the rapidity and completeness of symptom resolution following dAVF treatment.http://thejns.org/doi/abs/10.3171/2015.5.JNS15473Key words dural arteriovenous fistula; cortical venous hypertension; thalamic edema; nonhemorrhagic neurological deficit; thalamic dementia; vascular disorders ©AANS, 2016 davF-induced thalamic dementiaBorden-Shucart classification system-based not only on angiographic appearance but also mode of presentationto permit more accurate risk stratification and assist with clinical decision making for the type and timing of dAVF treatment (Table 1). 68,91One relatively underappreciated type of NHND is progressive dementia resulting from dAVF-induced cortical venous hypertension, though correct diagnosis and treatment is increasing, thanks to improved imaging techniques.18,79 Dural AVF-induced progressive dementia can be differentiated as either cortical or thalamic in origin-2 categories that have relatively distinct patterns of clinical symptomatology 18,54,62,80,85 and highly specific venous outflow patterns.18,80 Of the two, dAVFinduced thalamic dementia is less frequent, with only 15 published cases reported in the literature to date. All were individual case reports, and several lacked adequate clinical, radiographic, and/or treatment specifics to permit detailed assessment as to manner of presentation, underlying hemodynamic pathophysiology, and long-term outcome. 18,[21][22][23]...

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“…In WE, signal-intensity alterations in the cranial nerve nuclei are less common. 1 To our knowledge, this is the first report of WE with an abducens nucleus-confined lesion on magnetic resonance imaging. When Miller-Fisher syndromelike symptoms are encountered, physicians should consider the possibility of WE and carefully evaluate the presence of signal intensity alterations in the cranial nerve nuclei.…”

mentioning

confidence: 70%

“…In WE, signal‐intensity alterations in the cranial nerve nuclei are less common . To our knowledge, this is the first report of WE with an abducens nucleus‐confined lesion on magnetic resonance imaging.…”

mentioning

confidence: 99%

Case of Wernicke's encephalopathy with isolated abducens nucleus lesion

Yagi

Kimura

Koide

2015

Neurology & Clinical Neurosc

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Case of Wernicke's encephalopathy with isolated abducens nucleus lesionA 46-year-old man presented with diplopia and gait instability that had been preceded by diarrhea 4 days before the onset of neurological symptoms. On admission, he was alert, and neurological examinations revealed bilateral abducens nerve palsies (Fig. 1a), decreased tendon reflexes and gait ataxia. Findings of routine laboratory tests and nerve conduction studies were normal. Initially, a diagnosis of Miller-

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Spectrum of MR Imaging Findings in Wernicke Encephalopathy: Are Atypical Areas of Involvement Only Present in Nonalcoholic Patients?

Cited by 39 publications

References 26 publications

MR Imaging Findings in Alcoholic and Nonalcoholic Acute Wernicke’s Encephalopathy: A Review

MR Imaging Findings in Alcoholic and Nonalcoholic Acute Wernicke’s Encephalopathy: A Review

Dural arteriovenous fistula-induced thalamic dementia: report of 4 cases

Case of Wernicke's encephalopathy with isolated abducens nucleus lesion

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