Learning objectives
Wernicke’s encephalopathy (WE) is an uncommon but severe neurological syndrome,
caused by thiamine (vitamin B1) deficiency.
It is characterized by the sudden onset of altered consciousness,
ophthalmoplegia and ataxia; however this classic clinical triad is present in only a minority of patients,
making this condition often misdiagnosed and,
consequently,
life-threatening.
Its prognosis depends on prompt early intravenous administration of thiamine.
MR imaging is an essential tool to get the right diagnosis,
especially when clinical presentation is incomplete.
The aim of this exhibit is to describe...
Background
WERNICKE'S ENCEPHALOPATHY
Etiopathogenesis
Role of thiamine (vitamin B1)
Thiamine is a water-soluble vitamin involved in the maintenance of membrane integrity and osmotic gradients across cell membranes.
It is stored in body tissues,
especially in the liver,
predominantly as thiamine diphosphate (TDP). TDP also plays an important role in the conversion of glucose into energy and,
in particular,
acts as an essential co-enzyme in the pentose phosphate pathway and in the Krebs cycle.
A healthy adult requires approximately 1-2 mg of thiamine daily,
depending on the...
Imaging findings OR Procedure details
In all patients (three chronic alcohol abusers,
a gravida 1 with hyperemesis,
a leukemic patient under chemical therapy,
a post-bariatric surgery patient) brain MRI (1,5 T scanner Philips Intera) revealed FLAIR and T2-weighted hyperintense symmetric areas at the level of periaqueductal gray matter [Fig.
1] and medial portions of the thalami [Fig.
2-3].
In nonalcoholic patients similar signal-intensity alterations were also observed at the level of the tectal plate (gravida) [Fig.
4],
bilateral fronto-parietal cortex (leukemic patient) [Fig.
5] and pons (post-bariatric surgery patient) [Fig....
Conclusion
Our experience conforms with the most recent literature results that consider atypical (signal-intensity alterations in cerebral cortex and pons in the described cases) MR imaging findings more frequent in nonalcoholic patients.
References
1)Cerase A,
Rubenni E,
Rufa A,
Vallone I,
Galluzzi P,
Coratti G,
Franchi F,
Giannini F,
Venturi C.
CT and MRI of Wernicke's encephalopathy.
Radiol Med.
2011 Mar;116(2):319-33.
2)Zuccoli G,
Pipitone N.
Neuroimaging findings in acute Wernicke's encephalopathy: review of the literature.
AJR Am J Roentgenol.
2009 Feb;192(2):501-8
3)Lough ME.
Wernicke's encephalopathy: expanding the diagnostic toolbox.
Neuropsychol Rev.
2012 Jun;22(2):181-94
4)Zuccoli G,
Santa Cruz D,
Bertolini M,
Rovira A,
Gallucci M,
Carollo C,
Pipitone N.
MR imaging findings in 56 patients with Wernicke encephalopathy: nonalcoholics...
Personal Information
Dr.
Gaetana Manzo,
MD
Department of Biomorphological and Functional Sciences,
Federico II University of Naples; Naples,
Italy
e-mail:
[email protected]
Dr.
Angela De Gennaro,
MD
Department of Biomorphological and Functional Sciences,
Federico II University of Naples; Naples,
Italy
e-mail:
[email protected]
Dr.
Antonietta Serino,
MD
Department of Neuroradiology,
Umberto I Hospital; Nocera Inferiore,
Salerno,
Italy
Dr.
Attilio Cozzolino,
MD
Department of Neuroradiology,
Umberto I Hospital; Nocera Inferiore,
Salerno,
Italy
Dr.
Giacomo Fenza,
MD
Department of Neuroradiology,
Umberto I Hospital; Nocera Inferiore,
Salerno,
Italy
Dr.
Andrea Manto,
MD
Department of...