wernicke encephalopathy

Development
of Wernicke’s encephalopathy long after subtotal stomach-preserving pancreatoduodenectomy: a case report. a–d Contrast-enhanced MRI of the head showing symmetrically abnormal hyperintense signal on FLAIR in the frontal horn of lateral ventricle (a, arrow), the medial thalami bordering the third ventricle (a, arrow head), the mammillary bodies (a, curved arrow), the periaqueductal region of the midbrain (b, arrow), and the bottom of the 4th ventricle (c, arrow). DWI imaging showing restricted diffusion corresponding to the FLAIR hyperintensities (d, arrows)
surgicalcasereports.springeropen.com • CC-by-4.0
Restrictive
diet in a patient with irritable bowel syndrome leading to Wernicke encephalopathy. Fluid-attenuated inversion recovery imaging demonstrating characteristic changes of Wernicke encephalopathy including hyperintense signal changes in the bilateral dorsomedial thalami (a), inferior tectal plate (b) and around the periaqueductal gray matter within the dorsal midbrain (c)
bmcgastroenterol.biomedcentral.com • CC-by-4.0
A case of
Gayet-Wernicke encephalopathy with misleading symptoms. Image of the brain showing symmetrical hyperintensity in bilateral pulvinar nuclei of the thalamus on the MRI
asja.springeropen.com • CC-by-4.0
Wernicke’s
encephalopathy and cranial nerve VII palsy in a 24-year-old patient with COVID-19. FLAIR axial images demonstrating high signal alterations in the mamillary bodies
intjem.biomedcentral.com • CC-by-4.0
Anorexia
nervosa and Wernicke-Korsakoff syndrome: a case report. Brain axial T2W magnetic resonance imaging at the level of the thalami and third ventricle. High signal foci in the medial regions of thalami (arrows).
jmedicalcasereports.biomedcentral.com • CC-by-2.0
Anorexia
nervosa and Wernicke-Korsakoff syndrome: a case report. Brain axial T2W magnetic resonance imaging at the level of the midbrain. High signal around the Aqueduct of Sylvius (arrow).
jmedicalcasereports.biomedcentral.com • CC-by-2.0
Anorexia
nervosa and Wernicke-Korsakoff syndrome: a case report. Brain axial T2W magnetic resonance imaging at the level of the pons. Widening of cerebellar sulci.
jmedicalcasereports.biomedcentral.com • CC-by-2.0
Anorexia
nervosa and Wernicke-Korsakoff syndrome: a case report. Brain axial T2W magnetic resonance imaging at the level of the lateral ventricles. Areas of high signal involving the periventricular white matter associated with enlargement of the lateral ventricles and widening of cerebral sulci.
jmedicalcasereports.biomedcentral.com • CC-by-2.0
Radiopaedia • CC-by-nc-sa 3.0 • de

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.

Clinical presentation

It was originally described as characterized by the triad of:

  • acute confusion
  • ataxia
  • ophthalmoplegia (most commonly horizontal nystagmus and conjugate gaze palsies)

    • Wernicke encephalopathy can evolve into the chronic form of thiamine deficiency known as Korsakoff psychosis, characterized by:

  • memory loss (global amnesia)
  • confabulation

    • The two terms are often concatenated to form Wernicke-Korsakoff syndrome.

    Pathology

    Etiology

    Thiamine deficiency results from malnutrition or malabsorption, which can occur for a number of reasons :

    • alcohol abuse (up to 90% in industrialised countries )
    • starvation/fasting
    • prolonged total parenteral nutrition without supplementation
    • postbariatric surgery
    • hyperemesis gravidarum
    • gastrointestinal malignancy
    • chronic dialysis

    Radiographic features

    In acute stages, hemorrhage, necrosis, and edema may be present. In chronic stages, atrophic changes may be present especially involving the mamillary bodies.

    CT

    Usually normal.

    MRI

    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)

    Differential diagnosis

    General imaging differential considerations include:

    Siehe auch:
    und weiter:
    Assoziationen und Differentialdiagnosen zu Korsakow-Syndrom:
    Leigh-Syndrom
     
    www.eurorad.org • CC by-nc-sa-4.0
    nicht durch
    Akohol induzierte Wernicke-Enzephalopathie
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