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N. Du Ha and Y. Cheol Weon
American Journal of Neuroradiology June 2012, 33 (6) E93; DOI: https://doi.org/10.3174/ajnr.A3164
N. Du Ha
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Y. Cheol Weon
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We thank Dr. Zuccoli and Dr. Pipitone for their interest in our article.1 In our study, we evaluated the MR (1.5T or 3T) imaging findings of 23 patients with Wernicke encephalopathy (WE) at a university hospital: 13 nonalcoholic (NA) and 10 alcoholic (AL) patients. Although only 17% of the patients showed the classic symptom triad of WE, this percentage did not differ from that reported by other authors (16%–19%).2,3 Thus, MR imaging could be an important tool for early diagnosis and thus help reduce the associated morbidity and mortality, particularly when patients present with unclear clinical manifestations.4

We agree that the difference in the mean interval between symptom onset and MR imaging in the 2 studies may be responsible for some of the differences in brain MR imaging findings; in our study, the mean interval was 4.5 days,1 whereas in the study by Zuccoli et al, MR imaging was performed during the acute stage of WE.5 In our study, 14 patients underwent MR imaging within 3 days, 6 patients between 4 and 7 days, and 3 patients after 8 days following symptom onset. The involvement of typical and atypical sites, however, did not differ between the NA and AL groups at these time intervals. Little is known regarding the temporal progression in WE observed on MR images; in this regard, a large prospective study is warranted.

Although cranial nerve nuclei (CNN) are located in the dorsal medulla, we could not specifically differentiate each nucleus from the parts of the dorsal medulla that were involved; therefore, we simply reported signal alteration in the dorsal medulla. In our study, the involvement of the dorsal medulla and the periventricular gray matter of the fourth ventricle—the sites of many CNN—was observed in 14 NA patients and 10 AL patients, and Zuccoli et al5 reported that CNN involvement was observed in 32% of NA patients but in none of the AL patients. Thus, CNN involvement may by more common in NA patients, but our study did not show a statistical difference between NA and AL patients in this regard. Furthermore, in our study, the involvement of other atypical sites, such as cortical involvement, was observed in both groups. These results are concordant with those of some other studies.6,7

We agree with Zuccoli et al4,5 that atypical MR imaging findings usually occur in association with the typical MR imaging findings of WE and that prompt treatment with thiamine can avoid a dismal prognosis. Therefore, radiologists need to be aware of the spectrum of both typical and atypical findings. Although the MR imaging findings did not differ between AL and NA patients with WE in our study, MR imaging could still be a helpful tool for supporting the early diagnosis of WE in both the AL and NA groups.

References

  1. 1.↵
    1. Ha ND,
    2. Weon YC,
    3. Jang JC,
    4. et al
    . Spectrum of MR imaging findings in Wernicke encephalopathy: are atypical areas of involvement only present in nonalcoholic patients? AJNR Am J Neuroradiol 2012 Mar 1 [Epub ahead of print]
  2. 2.↵
    1. Harper CG,
    2. Giles M,
    3. Finlay-Jones R
    . Clinical signs in the Wernicke-Korsakoff complex: a retrospective analysis of 131 cases diagnosed at necropsy. J Neurol Neurosurg Psychiatry 1986; 49: 341– 45
    Abstract/FREE Full Text
  3. 3.↵
    1. Vasconcelos MM,
    2. Silva KP,
    3. Vidal G,
    4. et al
    . Early diagnosis of pediatric Wernicke's encephalopathy. Pediatr Neurol 1999; 20: 289– 94
    CrossRefPubMed
  4. 4.↵
    1. Zuccoli G,
    2. Pipitone N
    . Neuroimaging findings in acute Wernicke's encephalopathy: review of the literature. AJR Am J Roentgenol 2009; 192: 501– 08
    CrossRefPubMed
  5. 5.↵
    1. Zuccoli G,
    2. Santa Cruz D,
    3. Bertolini M,
    4. et al
    . MR imaging findings in 56 patients with Wernicke encephalopathy: nonalcoholics may differ from alcoholics. AJNR Am J Neuroradiol 2009; 30: 171– 76
    Abstract/FREE Full Text
  6. 6.↵
    1. Hygino da Cruz LC Jr.,
    2. Domingues RC,
    3. Vilanova I,
    4. et al
    . MR imaging findings in Wernicke encephalopathy: nonalcoholics may be similar to alcoholics. AJNR Am J Neuroradiol 2010; 31: E54– 55; author reply E56
    FREE Full Text
  7. 7.↵
    1. Sugai A,
    2. Kikugawa K
    . Atypical MRI findings of Wernicke encephalopathy in alcoholic patients. AJR Am J Roentgenol 2010; 195: W372– 73
    CrossRefPubMed
  • © 2012 by American Journal of Neuroradiology
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American Journal of Neuroradiology: 33 (6)
American Journal of Neuroradiology
Vol. 33, Issue 6
1 Jun 2012
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American Journal of Neuroradiology Jun 2012, 33 (6) E93; DOI: 10.3174/ajnr.A3164

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N. Du Ha, Y. Cheol Weon
American Journal of Neuroradiology Jun 2012, 33 (6) E93; DOI: 10.3174/ajnr.A3164
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