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AJNR - American Journal of Neuroradiology

Published ahead of print on June 19, 2008
doi: 10.3174/ajnr.A1145

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American Journal of Neuroradiology 29:e85, October 2008
© 2008 American Society of Neuroradiology

Letter

Reply:

D.G. Na^a

^a Human Medical Imaging and Intervention Center
Seoul National University Hospital

E. Kim^b

^b Seoul National University Hospital
Seoul, Korea

We thank Drs. Zuccoli, Pipitone, and Cruz for their interest in our recent article regarding MR imaging features of metronidazole-induced encephalopathy (MIE).¹ Although the exact mechanisms of MIE and Wernick encephalopathy (WE) are not elucidated, we agree with the opinion that MIE may be mediated by pathogenic pathways similar to those thought to be operating in WE.

In our article, we reported that the brain lesions of MIE were typically located at the cerebellar dentate nucleus, midbrain, dorsal pons, medulla, and splenium of the corpus callosum. The recently published case reports of WE show lesions in the cerebellar dentate^2,3 and focal tegmental lesions of low pons,^3,4 which we described as characteristic lesion locations of MIE and controversial atypical MR features of WE in the article.¹ These recent reports^2–4 suggest that the MR imaging feature of bilateral symmetric involvement of dentate nuclei and cranial nerve nuclei may be found in WE, as well as in MIE. However, in these WE cases,^2–4 there was involvement of at least one of medial thalamus, mammillary body, or pericentral cortices, which were well-documented MR features in WE but were not reported in MIE. Therefore, although 2 diseases of MIE and WE may share the similar pathogenic pathways for metabolic pathology and similar MR features in the cerebellum and brain stem, the analysis of lesion distribution on MR images may still be useful in distinguishing MIE from WE.

References

1. Kim E, Na DG, Kim EY, et al. MR imaging of metronidazole-induced encephalopathy: lesion distribution and diffusion-weighted imaging findings. AJNR Am J Neuroradiol 2007;28:1652–58[Abstract/Free Full Text]

2. Liu YT, Fuh JL, Lirng JF, et al. Correlation of magnetic resonance images with neuropathology in acute Wernicke's encephalopathy. Clin Neurol Neurosurg 2006;108:682–87[CrossRef][Medline]

3. Zuccoli G, Motti L. Atypical Wernicke's encephalopathy showing lesions in the cranial nerve nuclei and cerebellum. J Neuroimaging 2008;18:194–97[Medline]

4. Nolli M, Barbieri A, Pinna C, et al. Wernicke's encephalopathy in a malnourished surgical patient: clinical features and magnetic resonance imaging. Acta Anaesthesiol Scand 2005;49:1566–70[CrossRef][Medline]

This Article Full Text (PDF) All Versions of this Article: ajnr.A1145v1 ajnr.A1145v2 ajnr.A1145v3 29/9/e85    most recent Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Na, D.G. Articles by Kim, E. Search for Related Content PubMed Articles by Na, D.G. Articles by Kim, E.