Wernicke Encephalopathy: Typical and Atypical Findings in Alcoholics and Non-Alcoholics and Correlation with Clinical Symptoms

• Published in: Clinical neuroradiology (Munich) 2024-12, Vol.34 (4), p.881-897
• Main Authors: Arendt, C. T., Uckermark, C., Kovacheva, L., Lieschke, F., Golbach, R., Edwin Thanarajah, S., Hattingen, E., Weidauer, S.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Alcoholism; Alcoholism - complications; Alcoholism - diagnostic imaging; Biomarkers; Female; Humans; Magnetic Resonance Imaging - methods; Male; Medicine; Medicine & Public Health; Middle Aged; Neurology; Neuroradiology; Neurosurgery; Original Article; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Wernicke Encephalopathy - diagnostic imaging; Wernicke Encephalopathy - etiology
• ISSN: 1869-1439; 1869-1447; 1869-1447
• DOI: 10.1007/s00062-024-01434-y

Purpose Clinical diagnosis of Wernicke encephalopathy (WE) can be challenging due to incomplete presentation of the classical triad. The aim was to provide an update on the relevance of standard MRI and to put typical and atypical imaging findings into context with clinical features. Methods In this two-center retrospective observational study, the local radiology information system was searched for consecutive patients with clinical or imaging suspicion of WE. Two independent raters evaluated T2-weighted imaging (WI), fluid-attenuation inversion recovery (FLAIR), diffusion WI (DWI), T2*WI and/or susceptibility WI (SWI), and contrast-enhanced (CE)-T1WI, and noted the involvement of typical (i.e., mammillary bodies (MB), periaqueductal grey (PAG), thalamus, hypothalamus, tectal plate) and atypical (all others) lesion sites. Unusual signal patterns like hemorrhages were also documented. Reported clinical features together with the diagnostic criteria of the latest guidelines of the European Federation of Neurological Societies (EFNS) were used to test for relationships with MRI biomarkers. Results 47 patients with clinically confirmed WE were included (Jan ’99–Apr ’23; mean age, 53 yrs; 70% males). Interrater reliability for imaging findings was substantial (κ = 0.71), with lowest agreements for T2WI (κ = 0.85) compared to all other sequences and for PAG (κ = 0.65) compared to all other typical regions. In consensus, 77% ( n  = 36/47) of WE cases were rated MRI positive, with FLAIR ( n  = 36/47, 77%) showing the strongest relation (χ 2  = 47.0; P