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NEUROLOGY 2009;72:e115
© 2009 American Academy of Neurology
Resident and Fellow Section

Teaching NeuroImages: The full-blown neuroimaging of Wernicke encephalopathy

M. Luigetti, MD, S. De Paulis, MD, P. Spinelli, MD, M. Sabatelli, MD, P. Tonali, MD, C. Colosimo, MD and A. Cianfoni, MD

From the Departments of Neurology (M.L., P.S., M.S., P.T.), Cardiovascular Medicine (S.D.P.), and Radiology (C.C.), Catholic University of Sacred Heart, Rome; Don Carlo Gnocchi ONLUS Foundation (P.T.), Rome, Italy; and Neuroradiology Section (A.C.), Radiology Department, Medical University of South Carolina, Charleston.

Address correspondence and reprint requests to Dr. Marco Luigetti, Institute of Neurology, Largo F. Vito 1, 00168 Rome, Italy mluigetti{at}gmail.com.

A 55-year-old man presented in a global confusional state and after 24 hours fell into deep coma. Laboratory findings, including alcohol level, were normal. MRI showed abnormalities typical of Wernicke encephalopathy (figure).1,2 Thiamine was administered immediately, but the patient died 2 weeks later. The diagnosis was confirmed by measurement of blood thiamine level (19.3 ng/mL; normal range 27.2–42.2), obtained after initiation of treatment. Nonalcoholic Wernicke encephalopathy is probably underestimated; typical radiologic manifestations allow diagnosis.2 Cortical involvement is indicative of irreversible lesions with poor prognosis.2 Thiamine should be administered to reduce risk of clinical worsening.


Figure 118
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  		Figure Brain MRI

Axial T2–fluid-attenuated inversion recovery images show abnormal high signal distributed symmetrically in the floor of fourth ventricle (arrows on A), periaqueductal gray matter and colliculi (arrows on B), hypothalamus and mammillary bodies (arrowheads on B), splenium (arrow on C), mesial thalami (arrowheads on C), and perirolandic cortex (arrowheads on D).

 

Disclosure: The authors report no disclosures.


   REFERENCES
Top.
 REFERENCES
 

  1. Sechi G, Serra A. Wernicke's encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol 2007;6:442–455.[Medline]
  2. Fei GQ, Zhong C, Jin L, et al. Clinical characteristics and MR imaging features of nonalcoholic Wernicke encephalopathy. AJNR Am J Neuroradiol 2008;29:164–169.[Abstract/Free Full Text]



Correspondence:

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Teaching NeuroImages: The full-blown neuroimaging of Wernicke encephalopathy
Giulio Zuccoli, et al.
Neurology Online, 2 Sep 2009 [Full text]
Reply from the authors
Marco Luigetti, et al.
Neurology Online, 2 Sep 2009 [Full text]
This Article
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