MR Imaging Findings in 56 Patients with Wernicke Encephalopathy: Nonalcoholics May Differ from Alcoholics

• Published in: American journal of neuroradiology : AJNR 2009-01, Vol.30 (1), p.171-176
• Main Authors: Zuccoli, G, Santa Cruz, D, Bertolini, M, Rovira, A, Gallucci, M, Carollo, C, Pipitone, N
• Format: Article
• Language: English
• Subjects: Alcoholism - complications; Alcoholism - pathology; Biological and medical sciences; Brain; Female; Human viral diseases; Humans; Infectious diseases; Investigative techniques, diagnostic techniques (general aspects); Magnetic Resonance Imaging - methods; Male; Mammillary Bodies - pathology; Medical sciences; Middle Aged; Nervous system; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Thalamus - pathology; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Wernicke Encephalopathy - complications; Wernicke Encephalopathy - pathology
• ISSN: 0195-6108; 1936-959X
• DOI: 10.3174/ajnr.A1280

Wernicke encephalopathy (WE) is a severe neurologic disorder resulting from dietary vitamin B(1) deficiency. This study was undertaken to analyze and compare MR imaging findings and neurologic manifestations at clinical presentations of patients with WE with and without a history of alcohol abuse. WE patients were identified using diagnostic neurologic data bases. Fifty-six patients (29 females, 27 males) diagnosed between 1999 and 2008 with WE who improved within 1 month from the onset of thiamine administration were included in the analysis. Patients' records were reviewed for clinical manifestations and imaging studies' findings. MR imaging was performed in the acute phase of the disease at a field strength of 1T (16 patients) and 1.5T (40 patients). All MR images were of acceptable to good quality and were retrospectively reviewed. We compared imaging findings and clinical presentation in the alcoholic (AL) group versus the non-alcoholic (NA) group using the 2-tailed Fisher exact test and the Phi coefficient as appropriate. Forty-three percent of the patients were in the AL group, whereas 57% were in the NA group. Eighty-nine percent showed changes in consciousness, 75% had ocular manifestations, and 54% had ataxia. On MR imaging, 80% of the patients had evidence of symmetric lesions in the medial thalami and in the periventricular region of the third ventricle; 59%, in the periaqueductal area; 45%, in the mamillary bodies; 36%, in the tectal plate; and 7%, in the periventricular gray matter located anteriorly to the fourth ventricle. Signal-intensity alterations in areas considered atypical for the disease were noted only in the NA group and always in association with the typical findings. Contrast enhancement of the thalamus and mamillary bodies was significantly associated with alcohol abuse. Contrast enhancement in the mamillary bodies and thalamus is a typical finding of the disease in AL patients. Atypical MR imaging findings characterize NA patients.