Wernicke-Korsakoff encephalopathy.

Congress:

ECR 2020

Poster Number:

C-10211

Type:

Educational Exhibit

Keywords:

Not applicable, Education and training, Education, MR, CT, Neuroradiology brain, Neuro

Authors:

S. G. Rizzo¹, A. A. Montes Tome¹, M. oñate¹, M. Diez Blanco¹, M. Hernandez Herrero¹, C. sales¹, M. �. De la Fuente Bobillo¹, V. Jiménez Coronel², M. D. M. Velasco Casares¹; ¹Valladolid/ES, ²Valladolid, Valladolid/ES

DOI:

10.26044/ecr2020/C-10211

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-10211

Fig. 1: A 67-year-old male with a personal history of heavy drinking presented to the...

Fig. 2: Axial Diffusión-weighted MRI shows bithalamic and periaqueductal...

Fig. 3: Axial and coronal T2-FLAIR brain MRI shows bilateral paramedian thalamic...

Fig. 4: Diffusion-weighted imaging with high intensity (ADC was low), representing...

Learning objectives

- To describe the radiological findings of Wernicke's encephalopathy. - To make a differential diagnosis of the ischemic, infectious/inflammatory and toxic pathologies that can simulate a Wernicke encephalopathy.

Background

Wernicke's encephalopathy is an acute thiamine or vitamin B1 deficiency neurological syndrome. In most cases, it is related to alcohol consumption, although some cases have been reported in children and adults secondary to pathologies that alter the absorption of thiamine such as starvation, postbariatric surgery, and anorexia/bulimia. [1-2] Under normal conditions, thiamine maintains the intracellular osmotic gradient, and its deficiency generates cytotoxic oedema in astrocytes and neurons, with the subsequent development of vasogenic oedema and neuronal death. [2] Its classic triad is ataxia, ophthalmoplegia, and...

Findings and procedure details

Artery of Percheron infarction: Synchronous infarction of both thalamus, with or without rostral mesencephalic involvement. Prevalence unknown and usually secondary to cardiac embolism. The classic triad of Percheron artery occlusion includes vertical gaze paralysis (65 %), memory impairment (58 %), and coma (42 %). There are four distinct patterns of Percheron artery infarction: The pattern I: bilateral paramedian thalamic with rostral midbrain (43 %), Pattern II: bilateral paramedian thalamic without midbrain (38 %) ( Fig. 3, Fig. 4 ), Pattern III: bilateral paramedian and anterior...

Conclusion

Wernicke's encephalopathy is an underdiagnosed pathology that shares clinicoradiological findings with other pathologies with which the radiologist should be familiar for timely diagnosis and treatment.

Personal information and conflict of interest

C. Sales; Valladolid/ES - nothing to disclose S. G. Rizzo; Valladolid/ES - nothing to disclose A. A. Montes Tome; Valladolid/ES - nothing to disclose M. Oñate; Valladolid/ES - nothing to disclose M. Diez Blanco; Valladolid/ES - nothing to disclose M. D. L. O. Hernández Herrero; Valladolid/ES - nothing to disclose M. Á. de la Fuente Bobillo; Valladolid/ES - nothing to disclose M. D. M. Velasco Casares; Valladolid/ES - nothing to disclose V. Jiménez Coronel; Valladolid, VALLADOLID/ES - nothing to disclose

References

Aaron B. Paul.Wernicke Encephalopathy. Neuroradiology: Spectrum and Evolution of Disease. 2019; 5, 41-46. Tae Eun Kim, Eun Ja Lee, Jeong Bo Young, Dong Jae Shin, Ji Hoon Kim. Wernicke Encephalopathy and ethanol-related syndromes. Moroy S, Orozco L, Cely N, Salcedo J. Infarto talámico bilateral por obstrucción de la arteria de Percherón, reporte de un caso. Acta Neurol Colomb. 2017; 33(2): 104-114. Nadgir R, Yousem D. Neurodegenerative Disease and Hydrocephalus. Neuroradiology: The Requisites. Fourth edition. Elsevier 2017.230-263. González N, Rojo A, Martínez E, González D, et...

Wernicke-Korsakoff encephalopathy. ​