Neuroimaging Findings in Acute Wernicke's Encephalopathy: Review of the Literature

Abstract

Wernicke's encephalopathy is characterized by a quite distinct pattern of MR alterations, which include symmetrical alterations in the thalami, mamillary bodies, tectal plate, and periaqueductal area, but atypical alterations may also been seen. A thorough knowledge of the neuroimaging findings of Wernicke's encephalopathy will assist in arriving at an early diagnosis, thus reducing the morbidity and mortality associated with this disease.

Nonalcoholic Wernicke’s encephalopathy

“…2,3,5 The literature has noted that the most common presentation is mental status abnormalities. Patients may exhibit profound disorientation, indifference, and inattentiveness.…”

“…5 In most cases, these eye signs occur together. Gait abnormalities can range from mild to severe; in mild cases, it can be seen on tandem gait, and, in severe cases, patients are unable to walk.…”

“…Thiamine levels can be determined by chromatography; however, patients should be treated immediately with thiamine if WE is suspected, and treatment should not wait or be based on laboratory tests. 2,5 A similar urgency to treatment is important when considering imaging studies, and treatment should not be delayed pending such studies. 2 Imaging studies can be useful in both ruling out other medical conditions that may mimic WE as well as showing characteristics consistent with WE.…”

“…2,3 MRI is considered more sensitive in detecting specific changes associated with WE. 3 Imaging shows typically reversible cytotoxic edema, with symmetric increased T2 and decreased T2 signal around the aqueduct and third ventricle as well as within the medial thalamus, tectal plate, and mammillary bodies 2,5 ( Figure 1). Atrophy is not seen in nonalcoholic patients; however, it is present in alcoholism.…”

“…In addition, atypical findings on MRI may be seen in nonalcoholic patients, but not in alcoholic patients. 5 …”