1. MRI findings of Acute Wernicke's Encephalopathy
Session Type: Electronic Excerpta (EE)
Control #: 2236 Poster #: EE-13
SubSession ID: 2407

2. MRI findings of Acute Wernicke's Encephalopathy
Yonca Anik, Bayram Yildirim, Ahmet Kaya
Kocaeli University, School of Medicine, Radiology Department,
Umuttepe, Kocaeli, Turkey, 41380
The authors have no disclosure

3. Purpose
Wernicke's encephalopathy is an acute neurologic disorder that results from thiamine (vitamin B1) deficiency.
Classical clinical triad consist of
ocular signs,
altered consciousness, and
ataxia,

4. Purpose New clinical diagnostic criteria require 2 of 4 items;
dietary deficiencies,
oculomotor abnormalities,
cerebellar dysfunction, and
an altered mental state or mild memory impairment.

5. Purpose Classical MRI findings include symmetric SI alterations
typical locations
atypical locations
thalami,
cerebellum,
mamillary bodies,
cerebellar vermis,
tectal plate, and
cranial nerve nuclei,
periaqueductal area
red nuclei,
dentate nuclei,
caudate nuclei,
splenium, and
cerebral cortex

6. Purpose
Magnetic resonance imaging (MRI) findings of acute Wernicke's encephalopathy in a 51-year-old woman with t-cell lymphoma who developed clinical alterations in consciousness and ataxia are presented

7. Case Report
A 51-year-old woman developed alterations in consciousness and ataxia.
She has been under chemotherapy treatment for t-cell lymphoma.
Cranial MRI was ordered to identify her mental impairment.

8. Case Report
On cranial MRI there were symmetric increased signal intensity on T2-weighted and decreased signal on T1-weighted images in the
thalami,
mamillary bodies,
periventricular region of third ventricle,
tectal plate, and
periaqueductal area .
No enhancement was seen following contrast media injection.

9. Coronal FLAIR image demonstrates symmetric increased signal periventricular region of third ventricle and in mamillary bodies.

10. Increased signal intensity is seen in the periaqueductal gray matter and tectal plate on sagital T2-weighted images.

11. Increased signal intensity is seen in the thalami and mamillary bodies, on sagital T2-weighted images.

12. Case Report
Diagnosis of acute Wernicke's encephalopathy was made according to MRI findings.
Following treatment with thiamine, the patient's altered consciousness normalized gradually.

13. Summary
The pathogenesis of Wernicke's encephalopathy is proposed to be related to thiamine deficiency.
Many clinical conditions can cause impaired absorption of thiamine, -like in our patient- including prolonged vomiting, chemotherapy.
The prognosis depends on the time of onset of thiamine supplementation.

14. Summary Prompt diagnosis and treatment are required.
Neuroimaging studies especially MRI findings are powerful in supporting the diagnosis and distinguishing from other neurologic disorders.
T2-weighted images are the most sensitive sequences.
Demonstration of symmetric signal alterations in the thalami, mamillary bodies, tectal plate, and periaqueductal area are typical.

15. References
1. Zuccoli G, Pipitone N. Neuroimaging Findings in Acute Wernicke’s Encephalopathy: Review of the Literature. AJR 2009; 192:501– Wernicke C. Die akute hämorrhagische polioencephalitis superior. Fischer Verlag, Kassel. Lehrbuch der Gehirnkrankheiten für Ärzte und Studierende 1881; II:229– Zuccoli G, Gallucci M, Capellades J, et al. Wernicke encephalopathy: MR findings at clinical presentation in twenty-six alcoholic and nonalcoholic patients. Am J Neuroradiol 2007; 28:1328– Caine D, Halliday GM, Kril JJ, Harper CG. Operational criteria for the classification of chronic alcoholics: identification of Wernicke’s encephalopathy. J Neurol Neurosurg Psychiatry 1997; 62: 51–60