Thiamine Deficiency in Infants: MR Findings in the Brain
Liora Kornreicha,
Efrat Bron-Harlevb,
Chen Hoffmannd,
Michael Schwarza,
Osnat Konena,
Tommy Schoenfeldb,
Rachel Straussbergc,
Elhanan Nahumb,
Abu-Kishk Ibrahime,
Gideon Eshele and
Gadi Horeva
a Department of Imaging, Schneider Children’s Medical Center of Israel, Petah Tiqva
b Intensive Care Unit, Schneider Children’s Medical Center of Israel, Petah Tiqva
c Neurology Clinic, Schneider Children’s Medical Center of Israel, Petah Tiqva
d Department of Imaging, the Chaim Sheba Medical Center, Tel Hashomer
e Pediatric Intensive Care Unit, Assaf Harofeh Medical Center, Zerifin, Sackler Faculty of Medicine, Tel Aviv University, Israel
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FIG 1. Patient 1. Images at presentation (A) and follow-up 5 (B–E) and 45 (F) days later.
A, Axial T2-weighted image shows abnormal hyperintensity in the mammillary bodies (arrow) and tectum.
B–D, Axial T2-weighted images show abnormal hyperintensity in the periaqueductal region, thalami, basal ganglia, and frontal area. Lesions are bilateral and symmetric.
E, DWI (ADC) shows restricted diffusion in the basal ganglia. Thalami have hypointensity and hyperintensity, which are presumed to represent cytotoxic and vasogenic edema, respectively.
F, Axial T2-weighted image shows diffuse parenchymal loss, severe atrophy of the caudate nuclei, and necrosis of the putamina.
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FIG 2. Patient 2. Axial T2-weighted images.
A, At presentation, large area of hyperintensity is present in the pons.
B, Involvement of the frontal region, up to the motor cortex, is extensive.
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FIG 3. Patient 4. Axial images at presentation.
A, T2-weighted image.
B, T1-weighted contrast-enhanced image shows extensive frontal injury. Note enhancement of both cortex and white matter.
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FIG 4. Patient 5.
A, T2-weighted image shows subtle abnormal findings, slight hyperintensity of the anterior frontal region, and localized areas of blurring of the cortical stripe.
B, DWI (ADC) indicates restricted diffusion compatible with cytotoxic edema.
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FIG 5. Patient 6. Proton MRS image from the periaqueductal region (TR/TE = 1500/144).
A, At presentation. Note the negative doublet of lactate. NAA/Cr ratio is reduced 1.11.
B, Five weeks later, the lactate doublet is no longer seen. NAA peak is higher than before.
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