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Clinical Characteristics and MR Imaging Features of Nonalcoholic Wernicke Encephalopathy

G.-q. Feia, C. Zhonga, L. Jina, J. Wangb, Yuhao Zhanga, X. Zhenga, Yuwen Zhanga and Z. Hongb

a Department of Neurology, Zhongshan Hospital and Shanghai Medical College, Fudan University, Shanghai, China
b Department of Neurology, Huashan Hospital and Shanghai Medical College, Fudan University, Shanghai, China


Figure 1
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  		Fig 1. Typical MR imaging features of nonalcoholic Wernicke encephalopathy. Axial T1-weighted images (A, F, K) show that no abnormal signal intensity was found. Axial T2-weighted (B, G, L), and FLAIR (C, H, M) images show increased signal intensity symmetric within the medial thalami (B, C), periaqueductal area (G, H), and floor of the fourth ventricle (L, M). DWI (D, I, N) imaging shows only slightly increased signal intensities within the bilateral thalami and periacqueductal area but no abnormal signal intensity in the other brain regions. (The ADC values of sites 1, 2, and 3 in the D image were 620.19 ± 27.39, 513.29 ± 9.60, and 381.92 ± 25.73, respectively; the ADC values of sites 1, 2, and 3 in the I image were 657.00 ± 43.13, 442.23 ± 15.43, and 494.94 ± 12.66, respectively.) Contrasting images (E, J, O) show that enhancement of the mammillary bodies and at the floor of the fourth ventricle by gadolinium contrast medium is found (J). No atrophy of the mammillary bodies (F, G, I, J) and cerebellar vermis (K, L, M, N, O) was found.


Figure 2
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  		Fig 2. MR imaging manifestations in patients with drowsiness or without disturbances of consciousness. FLAIR images show that only regional damage surrounding the aqueduct (B, C) and the floor of fourth ventricle (D, enhanced by gadolinium contrast) is observed, and no abnormal signal intensity was found in the bilateral medial thalami (A). Arrowheads indicate cavernous hemangioma in the pons (C, E; E was a CT).


Figure 3
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  		Fig 3. MR imaging images demonstrating cortical damage in patients with deep coma.


Figure 4
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  		Fig 4. MR imaging follow-up of a patient with mild coma. Axial images show symmetric T2-weighted and FLAIR increased signal intensity in the medial thalami in the acute phase of WE (A, B) and normal signal intensities 1 year after thiamine supplementation (C,D).


Figure 5
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  		Fig 5. MR imaging follow-up of a patient with deep coma. The images show progressive atrophy 2 years after the onset of WE.





Copyright © 2009 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X