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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 28:1328-1331, August 2007
DOI 10.3174/ajnr.A0544
© 2007 American Society of Neuroradiology

BRAIN

Wernicke Encephalopathy: MR Findings at Clinical Presentation in Twenty-Six Alcoholic and Nonalcoholic Patients

G. Zuccoli^a, M. Gallucci^f, J. Capellades^e, L. Regnicolo^g, B. Tumiati^b, T. Cabada Giadás^h, W. Bottari^c, J. Mandrioliⁱ and M. Bertolini^d

^a Department of Radiology, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
^b Division of Internal Medicine, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
^c Intensive Care Unit, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
^d Department of Physics, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
^e Magnetic Resonance Unit, University Hospital of Badalona, Barcelona, Spain
^f Department of Radiology, University Hospital S. Salvatore, L’Aquila, Italy
^g Department of Radiology, Hospital Umberto I, Ancona, Italy
^h Department of Radiology, Hospital of Navarra, Spain
ⁱ Department of Neurology, University of Modena and Reggio Emilia, Italy

Address correspondence to Dr. Giulio Zuccoli, Radiology Department, Arcispedale Santa Maria Nuova, Viale Risorgimento 80, 42100, Reggio Emilia, Italy; e-mail: giulio.zuccoli{at}asmn.re.it

BACKGROUND AND PURPOSE: Wernicke encephalopathy is a severe neurologic disorder that results from a dietary vitamin B1 deficiency. It is characterized by changes in consciousness, ocular abnormalities, and ataxia. This study was undertaken to analyze and compare findings on MR imaging and neurologic symptoms at clinical presentations of patients with Wernicke encephalopathy with and without a history of alcohol abuse.

MATERIALS AND METHODS: A multicenter study group retrospectively reviewed MR brain imaging findings, clinical histories, and presentations of 26 patients (14 female, 12 male) diagnosed between 1999 and 2006 with Wernicke encephalopathy. The age range was 6–81 years (mean age, 46 .6 ± 19 years).

RESULTS: Fifty percent of the patients had a history of alcohol abuse, and 50% had no history of alcohol abuse. Eighty percent showed changes in consciousness, 77% had ocular symptoms, and 54% had ataxia. Only 38% of the patients showed the classic triad of the disease at clinical presentation. At MR examination, 85% of the patients showed symmetric lesions in the medial thalami and the periventricular region of the third ventricle, 65% in the periaqueductal area, 58% in the mamillary bodies, 38% in the tectal plate, and 8% in the dorsal medulla. Contrast enhancement of the mamillary bodies was statistically positively correlated with the alcohol abuse group.

CONCLUSIONS: Our study confirms the usefulness of MR in reaching a prompt diagnosis of Wernicke encephalopathy to avoid irreversible damage to brain tissue. Contrast enhancement in the mamillary bodies is a typical finding of the disease in the alcoholic population.