Imaging of Wernicke's encephalopathy

The article is professionally consulted by Master, Doctor Tong Diu Huong - Radiologist - Diagnostic Imaging Department - Vinmec Nha Trang International General Hospital.

Wernicke encephalopathy, also known as Wernicke-Korsakoff syndrome, is an acute-onset disorder with clinical manifestations such as nystagmus, partial ophthalmoplegia, confusion, etc. Vitamin B1 deficiency is common in alcoholics.

Wernicke encephalopathy, also known as Wernicke-Korsakoff syndrome, is a form of thiamine (aka vitamin B1) deficiency and is commonly seen in alcoholics.

Is encephalopathy caused by thiamine (vitamin B1) deficiency. Thiamine is a cofactor for several enzymes in the Krebs cycle and the pentose phosphate pathway. Thiamine deficiency leads to a decrease in several substrates important in energy production, causing severe metabolic imbalances. This leads to neurological complications including neuronal cell death.

Prevalence of Wernicke encephalopathy varies by region, with higher prevalence in developing countries due to vitamin deficiency and malnutrition. In the developed world, prevalence data come mainly from autopsy studies, with prevalence ranging from 1% to 3% of the population.

The classic triad of Wernicke encephalopathy includes altered mental status, eye movement abnormalities (eye pain or nystagmus), and ataxia. Other features include delirium, hypotension, fatigue, and abdominal discomfort.
Classically, Wernicke encephalopathy occurs in the setting of severe alcohol abuse. However, many other important causes have been noted such as severe malnutrition, gastrointestinal surgery, dialysis, hematuria, recurrent vomiting/diarrhea, prolonged parenteral nutrition, tumors malignancy, immunodeficiency syndrome, liver disease, hyperthyroidism and severe anorexia.

In the acute stage may hemorrhage, necrosis, edema. In the chronic stage, atrophic changes may appear, especially in relation to the nervous organs.

CT is not sensitive to detect Wernicke encephalopathy and usually has a normal image.
Below is a CT Scan of a 44-year-old female patient with a history of hypertension, gastritis, migraine, and previous heavy alcohol use, who presented to the emergency department with diffuse lower extremity weakness and confusion. The CT scan showed no abnormalities. The patient then underwent brain MRI, which was consistent with Wernicke encephalopathy.

MRI is the imaging modality of choice.
MRI shows edematous or inflammatory changes, characterized by T2 and FLAIR hyperintensity in the mammary body, perianal and periventricular gray matter, quadrilateral tubercle, and thalamus. Atrophy of these brain structures can also be seen. Contrast-enhanced and diffuse-limited lesions may be seen, but are not required for diagnosis. Contrast enhancement is commonly seen in the mammary body.

Although potentially life-threatening, Wernicke encephalopathy is reversible with immediate parenteral thiamine. It is important to take thiamine before or with glucose solutions, as glucose oxidation can lead to a temporary decrease in thiamine levels and worsening of symptoms. Because thiamine deficiency often occurs in the presence of other nutritional deficiencies, substances such as magnesium and other vitamins and metabolites are often used.
Wernicke encephalopathy causes many serious health effects, so when there are signs of the onset of the disease, patients should go to the hospital for examination and early indications from a specialist. Vinmec International General Hospital is a quality medical address when the hospital has a full team of doctors and experts from many major hospitals across the country, with many years of experience. Along with that is a system of modern equipment with advanced CT - Scan or MRI scanners, helping to serve the examination process with accurate results, saving patient waiting time. Currently, Vinmec Hospital is always highly appreciated and trusted by professionals and customers for its quality of service and medical care.