Three-Dimensional Mapping of Local Cerebral Perfusion in Alcoholic Encephalopathy with and without Wernicke-Korsakoff Syndrome

Abstract

Seventeen severe chronic alcoholic patients with and without Wernicke-Korsakoff syndrome (WKS) were examined prospectively after being treated by withdrawal from alcohol. The WKS patients also received thiamine supplements. Three-dimensional measurements of local cerebral blood flow (LCBF) and local partition coefficients (L lambda) were made utilizing xenon contrast computed tomography (Xe CT-CBF). Results were displayed as color-coded brain maps before and after treatment and these were correlated with neurological and cognitive examinations. Before treatment chronic alcoholics without WKS (n = 10) showed diffuse reductions of LCBF values throughout all gray matter including hypothalamus, vicinity of nucleus basalis of Meynert, thalamus, and basal ganglia. Similar, but more severe, reductions were seen in patients with WKS (n = 7), however, white matter perfusion was also reduced. In WKS, most prominent reductions of LCBF were also seen in hypothalamus and basal forebrain nuclei but thalamus, basal ganglia, and limbic systems were severely reduced. After treatment, both groups with alcoholic encephalopathy showed marked clinical improvement and cerebral perfusion was restored toward normal. Chronic alcohol abuse, in the absence of thiamine deficiency, reduces CBF by direct neurotoxic effects. If thiamine deficiency is also present, more severe and localized hemodynamic reductions are superimposed.

Cerebral blood flow and cerebrovascular response to acetazolamide in patients with chronic alcoholism

“…Cerebral blood flow has been reported to be decreased in patients with chronic alcoholism1-4 but only one study used the xenon CT method 12. The main advantage of this method is that it provides relatively high resolution and quantitative information on regional cerebral blood flow coupled with anatomy by CT 8.…”

“…The main advantage of this method is that it provides relatively high resolution and quantitative information on regional cerebral blood flow coupled with anatomy by CT 8. Hata et al 12 reported that local cerebral blood flows were reduced throughout all grey matter in patients with chronic alcoholism without Wernicke-Korsakoff syndrome. However, the present study showed that the blood flow in the cerebral cortex, thalamus, and putamen were reduced but that in the caudate nucleus was normal.…”

Functional Neuroimaging of Cortical Dysfunction in Alcoholic Korsakoff's Syndrome

“…However, these patients were apparently still in acute stages of the disease. Xenon contrast CT (Hata et al, 1987) and measures of total cerebral metabolism and blood flow (Shimojyo, Scheinberg, & Reinmuth, 1967) have also revealed reductions in relatively acute stages.…”

Aspectos clínicos e neuropatológicos da síndrome de Wernicke-Korsakoff

“…O tempo de trânsito vascular cerebral dos pacientes com doença de Alzheimer e psicose de Korsakoff é lentificado 23 . Fluxo sangüíneo cerebral diminuído foi encontrado em pacientes alcoolistas crônicos, com melhora em todas as estruturas corticais e subcorticais de pacientes com psicose de Korsakoff após tratamento com tiamina e abstinência alcoólica 20 .…”