52 year old male with history of altered sensorium post endoscopic biopsy of the pyloric mass. Admitted in view of vomiting and weight loss since 2 weeks.
52 year old male with history of altered sensorium post endoscopic biopsy of the pyloric mass. Admitted in view of vomiting and weight loss since 2 weeks.
FINDINGS
Bilateral symmetrical FLAIR and DWI hyperintensity in bilateral dorsomedial thalami, mamillary bodies, periaqueductal grey matter and dorsal medulla. All these regions demonstrate mild post-contrast enhancement.
DIAGNOSIS:
Wernicke’s encephalopathy
DISCUSSION:
- Wernicke’s encephalopathy (WE) is an acute neurologic disorder resulting from thiamine (vitamin B1) deficiency.
- Thiamine is needed by the cell membranes to sustain osmotic gradients but is also involved in glucose metabolism and in neurotransmitter synthesis. When deficient it leads to cytotoxic edema (T2/FLAIR hyperintensities) and blood brain barrier disruption (post contrast enhancement).
- WE is frequently associated with chronic alcohol abuse, tumors of the gastrointestinal tract, gastroplasty for obesity, hyperemesis gravidarum, anorexia nervosa, prolonged infectious-febrile disease, voluntary food starvation, chronic uremia, and parenteral therapy.
- Traditionally, the clinical diagnosis of WE rests on the classical triad consisting of ophthalmoplegia (most commonly horizontal nystagmus and conjugate gaze palsies), altered consciousness, and ataxia.
- Wernicke encephalopathy can evolve into the chronic form of thiamine deficiency known as Korsakoff psychosis, characterized by memory loss and confabulation.
- Typical MRI findings are symmetric alterations in the dorsomedial thalami, mammillary bodies, tectal plate, and periaqueductal area.
- Treatment is with intravenous thiamine hydrochloride and treatment of the underlying cause (e.g. alcohol cessation)
References:
- Zuccoli G, Pipitone N. Neuroimaging findings in acute Wernicke’s encephalopathy: review of the literature. American Journal of Roentgenology. 2009 Feb;192(2):501-8.
- Zuccoli G, Gallucci M, Capellades J, Regnicolo L, Tumiati B, Giadás TC, Bottari W, Mandrioli J, Bertolini M. Wernicke encephalopathy: MR findings at clinical presentation in twenty-six alcoholic and nonalcoholic patients. American Journal of Neuroradiology. 2007 Aug 1;28(7):1328-31.
Dr. Sriram Patwari
MD, PDCC (Neuroradiology), EDiNR
Consultant Radiologist
Manipal Hospital, Yeshwanthpur, Bengaluru
Dr Vikas H P
Radiology resident
Manipal Hospital, Yeshwanthpur, Bengaluru
