Wernicke encephalopathy, also referred as Wernicke-Korsakoff syndrome, is a form of thiamine (vitamin B1) deficiency, and is typically seen in alcoholics.
On imaging, it is commonly seen on MRI as areas of symmetrical increased T2/FLAIR signal involving the mammillary bodies, dorsomedial thalami, tectal plate, periaqueductal area and/or around the third ventricle.
It was originally described as characterized by the triad of:
Wernicke encephalopathy can evolve into the chronic form of thiamine deficiency known as Korsakoff psychosis, characterized by:
The two terms are often concatenated to form Wernicke-Korsakoff syndrome.
Thiamine deficiency results from malnutrition or malabsorption, which can occur for a number of reasons :
- alcohol abuse (up to 90% in industrialised countries )
- prolonged total parenteral nutrition without supplementation
- postbariatric surgery
- hyperemesis gravidarum
- gastrointestinal malignancy
- chronic dialysis
In acute stages, hemorrhage, necrosis, and edema may be present. In chronic stages, atrophic changes may be present especially involving the mamillary bodies.
- T2/FLAIR: symmetrically increased signal intensity in the
- T1 C+ (Gd): contrast enhancement can also be seen in the same regions, most commonly of the mammillary bodies
- DWI/ADC: restricted diffusion can also be seen in the same regions
- MR spectroscopy: may show decreased or normal NAA with the notable presence of lactate
Treatment and prognosis
Treatment of acute Wernicke-Korsakoff syndrome is with intravenous thiamine hydrochloride, along with other vitamins/minerals, and treatment of the underlying cause (e.g. alcohol cessation). Untreated, there is high mortality of up to 20% .
History and etymology
It is named after:
- Carl Wernicke: German neurologist and psychiatrist (1848-1905)
- Sergei Korsakoff: Russian neuropsychiatrist (1854-1900)
General imaging differential considerations include:
- Leigh disease: mammillary bodies not involved
- metronidazole-induced encephalopathy: dentate nuclei, cranial nerve nuclei and splenium also involved