Wernicke encephalopathy: MR findings in two patients

Abstract

Wernicke encephalopathy is a serious neurologic disorder caused by vitamin-B1 or thiamine deficiency. In the literature the characteristic symmetric paraventricular lesions of Wernicke encephalopathy are hyperintense on T2-weighted sequences spin-echo (SE) and enhance on T1-weighted SE sequences after intravenous gadolinium administration in the acute phase. We present two patients in the acute phase of Wernicke encephalopathy with special reference to the MR imaging. One of our reported cases is special because of the MR demonstration of a hemorrhagic focus in the caput of the right nucleus caudatus. The other case demonstrates no enhancement on SE T1-weighted sequences after intravenous gadolinium administration.

Diffusion-Weighted MRI in Recurrent Wernicke's Encephalopathy: a Remarkable Cerebellar Lesion

“…In our patient, ophthalmoplegia and confusion rapidly improved after thiamine supplementation, although cerebellar symptoms and Korsakoff's syndrome persisted. MRI intensity changes around the third and fourth ventricles, Sylvian aqueduct, mammillary bodies, medial thalami, and tectum are typical of Wernicke's encephalopathy 8,9. However, in our patient the cerebellar lesion was more prominent than those in the thalamus, periaqueductal area, mamillary body, and tectum.…”

Alcohol-induced changes in the brain as assessed by MRI and CT

“…The incidence in random autopsies is reported to be 0.8-2% [16,17]. The classic clinical triad of WE including ocular dysfunction (nystagmus, conjugate gaze palsies, ophthalmoplegia), ataxia and altered mental status is only observed in 30% of patients [18]. If left untreated, patients may develop Korsakoff psychosis, a form of severe amnesia, characterised by memory loss and confabulation, which may occur without other symptoms of WE.…”

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

“…The involvement of the caudate nuclei, in particular of the capita, may be due to their adjacent position to the lateral ventricles. Opdenakker et al reported a case of hemorrhagic focus in the caput of the right nucleus caudatus of a patient with WE [75]. According to Zhong et al, the presence of lesions of the caudate nuclei, frequently observed in patients in comatose state, is a sign of pathologic evolution [76].…”