A combined case of wernicke and metronidazole induced encephalopathy? Overlapping pathophysiologic pathways and MR imaging features

Mach, John C; Russell, J. Matthew

doi:10.1016/j.clineuro.2020.106034

Cited by 3 publications

(3 citation statements)

References 4 publications

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“…The signal abnormality of the periaqueductal grey matter and dorsal midbrain may be indistinguishable from WE; however, lesions of the mammillary bodies and medial thalami are extremely rare in MIE, while lesions of the dentate nuclei are quite unusual for WE. Cases of possible combined WE and MIE have also been described [ 50 , 51 ].…”

Section: Pathology Predominantly Affecting the Thalamimentioning

confidence: 99%

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Bilateral lesions of the basal ganglia and thalami (central grey matter)—pictorial review

et al. 2020

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The basal ganglia and thalami are paired deep grey matter structures with extensive metabolic activity that renders them susceptible to injury by various diseases. Most pathological processes lead to bilateral lesions, which may be symmetric or asymmetric, frequently showing characteristic patterns on imaging studies. In this comprehensive pictorial review, the most common and/or typical genetic, acquired metabolic/toxic, infectious, inflammatory, vascular and neoplastic pathologies affecting the central grey matter are subdivided according to the preferential location of the lesions: in the basal ganglia, in the thalami or both. The characteristic imaging findings are described with emphasis on the differential diagnosis and clinical context.

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Section: Pathology Predominantly Affecting the Thalamimentioning

confidence: 99%

“…Patients present with progressive drowsiness and seizures, secondary to brain oedema and intracranial hypertension. Acute hyperammonaemic encephalopathy can progress to coma and death or lead to long-term sequelae, including intellectual impairment [ 50 ].…”

Section: Pathology Predominantly Affecting the Thalamimentioning

confidence: 99%

Bilateral lesions of the basal ganglia and thalami (central grey matter)—pictorial review

et al. 2020

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“…Alcoholic Wernicke's encephalopathy (WE) often involves symmetrically the medial thalami, periaqueductal gray matter, quadrigeminal plate, and mammillary bodies ( 8 ). The radiologic appearance of metronidazole-induced encephalopathy may mimic that of WE, but the bilateral cerebellar dentate nuclei are its characteristic location ( 9 , 10 ). Acute hyperammonemic encephalopathy (AHE) symmetrically involves the bilateral cortex of the insula and cingulate gyrus, usually accompanied by thalamic involvement, with the basal ganglia and occipital cortex spared ( 11 , 12 ).…”

Section: Introductionmentioning

confidence: 99%

Volume mismatch indicates tumors in paramedial bithalamic diseases: a retrospective study

Lu¹,

Gao²

2023

Front. Neurol.

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ObjectiveThis study aimed to investigate the diagnostic performance of volume mismatch sign on discriminating paramedial bithalamic tumors from non-tumors.MethodsIn this study, we recruited patients with tumors or non-tumors of the paramedial bithalamus. We confirmed the diagnosis by pathology, laboratory tests documented in medical records, medical imaging at the baseline, or through at least 1 year of follow-up. Cases with paramedial thalamic lesions on only one side or purely midbrain illnesses were excluded. Additionally, any case without involvement of the medial thalami (i.e., those with one or both-sided anterior, lateral, or posterior thalamic lesions) was excluded. Two neuroradiologists were trained independently to evaluate volume mismatch sign on magnetic resonance T2-weighted images or T2 fluid-attenuated inversion recovery images. A positive volume mismatch sign means that the ratio of the larger-sided lesion volume to the smaller-sided lesion volume is >150%. The volume of each lesion was calculated by multiplying the anteroposterior diameter by the left-right diameter and by the height of the lesion and then dividing by 2. The kappa value was calculated to show the consistency between the two observers. The chi-square test was used to evaluate differences in volume mismatch sign between the bilthalamic midline tumor and non-tumor groups. The positive (PPV) and negative (NPV) predictive values, sensitivity, and specificity were calculated to evaluate the ability of volume mismatch sign to differentiate paramedial bilateral thalamus tumors from non-tumors. A two-tailed P ≤ 0.05 was considered to be statistically significant. The analyses were performed using the statistical software SPSS version 26.ResultsA total of 96 patients were enrolled in this study between March 2012 and October 2022. A high agreement between the two observers on the volume mismatch sign of bilateral paramedian thalamic diseases was found, and the Kappa value was 0.828. A statistically significant difference was observed for the volume mismatch sign between the paramedial bithalamic tumor and the non-tumorous groups (χ2 = 35.465, P < 0.001). The presence of volume mismatch sign in paramedial bithalamic illnesses predicted the presence of tumors with a sensitivity and specificity of 69.2% and 90.9%, respectively, and PPV and NPV were 90.0% and 71.4%.ConclusionVolume mismatch sign may indicate tumors in paramedian bithalamic diseases.

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Metronidazole

2020

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A combined case of wernicke and metronidazole induced encephalopathy? Overlapping pathophysiologic pathways and MR imaging features

Cited by 3 publications

References 4 publications

Bilateral lesions of the basal ganglia and thalami (central grey matter)—pictorial review

Bilateral lesions of the basal ganglia and thalami (central grey matter)—pictorial review

Volume mismatch indicates tumors in paramedial bithalamic diseases: a retrospective study

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