Resident & Fellow Section
Featured Commentaries
-
September 19 | Video e-Pearl | Upbeat Nystagmus in Wernicke's Encephalopathy
e-Pearls archive | Video e-Pearls archive |Submit an e-Pearl
Case
A 33-year-old man with stomach carcinoma presented with sudden-onset diplopia preceded by vomiting, anorexia, and weight loss for 3 months. He had upbeat nystagmus (UBN) and mild gait ataxia. Magnetic resonance imaging (MRI) showed bilateral medial thalami involvement suggesting Wernicke's encephalopathy (WE). UBN is an important diagnostic clue for WE and frequently results from the damage to the perihypoglossal complex (nucleus intercalatus and nucleus of Roller) in the dorsal medulla. UBN in WE may switch to downbeat nystagmus during convergence, change in the direction of gaze, or with vestibular stimuli.1 MRI typically shows T2 hyperintensity in medial thalamus, hypothalamus, periaqueductal region, floor of the fourth ventricle and mammillary bodies with/without diffusion restriction.2
Video Legend
Upbeat nystagmus (UBN) in the primary position (straight ahead gaze), right, left, up and down gaze; suppressed by convergence. After treatment with high dose intravenous thiamine, his UBN improved.
Figure 1
MR imaging of the patient. T2W coronal (A), diffusion weighted image (DWI) coronal (B) and DWI axial (C) showing bilateral symmetric medial thalami hyperintensity with low values in apparent diffusion coefficient (ADC) maps (D) suggesting diffusion restriction.
References
- Kattah JC, McClelland C, Zee DS. Vertical nystagmus in Wernicke's encephalopathy: pathogenesis and role of central processing of information from the otoliths. J Neurol. 2019;266(Suppl 1):139-145; doi: 10.1007/s00415-019-09326-9
- Ota Y, Capizzano AA, Moritani T, Naganawa S, Kurokawa R, Srinivasan A. Comprehensive review of Wernicke encephalopathy: pathophysiology, clinical symptoms and imaging findings. Jpn J Radiol. 2020;38(9):809-820; doi: 10.1007/s11604-020-00989-3
Authors
Asish Vijayaraghavan, Comprehensive Neuro-Intensive Care Program, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India; Lakshmi J Nair, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India; Soumya Sundaram, Comprehensive Neuro-Intensive Care Program, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
Disclosures
The authors report no disclosures.
Latest Articles
- Resident & Fellow SectionPearls & Oy-sters: Whole-Genome Sequencing in Critically Ill Neurologic Patient Leads to Diagnosis With Treatment ImplicationsJonathan Read Gaillard, Zachary Whitt, Linda M. Selwa, et al.Neurology July 17, 2023
- Resident & Fellow SectionTeaching NeuroImage: New Pattern of Periventricular Nodular Heterotopia in Twins With a Pathogenic Variant in the MAP1B GeneHuihui Xue, Chao Zhang, Lei Xiang, et al.Neurology July 17, 2023
- Resident & Fellow SectionTeaching NeuroImage: Pictures of Health in Pediatric EEGLara Basovic, Katherine Walsh, Catherine J. ChuNeurology July 24, 2023
- Resident & Fellow SectionBridging the Gap: Immunotherapy in Progressive Multifocal LeukoencephalopathyA New Hope?Tristan Born, Paola Vassallo, Dela Golshayan, et al.Neurology July 05, 2023
-
Browse by Subcategory
All Subcategory Descriptions
- Bridging the Gap
- Child Neurology
- Clinical Reasoning
- Education Research
- e-Pearls
- Emerging Subspecialties in Neurology
- International Issues
- Journal Club
- Media and Book Reviews
- Mystery Cases
- Opinion & Special Articles
- Pearls & Oy-sters
- Residency Training
- Right Brain
- Teaching NeuroImage
- Teaching Video NeuroImage
-
Meet the Resident & Fellow Team
-
Resources
- Complete Archives
- R&F Publications
- Resident & Fellow Writing Award
- AAN Information for Residents and Fellows
Dr. Babak Hooshmand and Dr. David Smith
► Watch
- Neurology PodcastDr. Neha Dangayach talks Drs. Susanne Muehlschlegel and Adeline Goss about characterizing the prognostic language clinicians use in critical neurologic illness. September 26, 2023.Neurology, Journal, Podcast