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NEUROLOGY 2008;70:e48
© 2008 American Academy of Neurology
Resident and Fellow Section

Teaching NeuroImage: Diverse MRI signal intensities with Wernicke encephalopathy

J. H. Roh, MD, J. H. Kim, MD, Y. Koo, MD, W.-K Seo, MD, J.-M Lee, MD, Y. H. Lee, MD, PhD and M. H. Park, MD, PhD

From the Departments of Neurology (J.H.R., J.H.K., Y.K., W.-K.S., J.-M.L., M.H.P.) and Radiology (Y.H.L.), Korea University College of Medicine, Ansan, Republic of Korea.

Address correspondence and reprint requests to Dr. Moon Ho Park, Department of Neurology, Korea University College of Medicine, Korea University Ansan Hospital, Gojan-1-dong, Danwon-gu, Ansan-city, Gyeonggi-do [425-707], Republic of Korea parkmuno{at}yahoo.co.kr

A 60-year-old man presented with bilateral gaze evoked nystagmus, severe ataxia, and memory impairment. Brain MRI showed concurrent cytotoxic and vasogenic edema patterns (figure). This case shows both cytotoxic and vasogenic edema that may occur at the same time in Wernicke encephalopathy. These findings may be due to the different vulnerability of brain regions to thiamine deprivation and the corresponding time lag between the development of lesions.1,2


Figure 116
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  		Figure FLAIR weighted MRI

FLAIR weighted MRI showing typical high signal intensities (SIs) in the medial thalamus (A), periaqueductal gray (B), mamillary bodies (C), cerebellar vermis (B, C, D), and paravermian superior cerebellum (D). All the lesions represent high SIs on the DWI (E–H). The ADC images of the cerebellar vermis (K, L) and paravermian superior cerebellum (L) show low SIs (arrowheads), whereas other described areas (I, J) show iso-SIs (arrows).

 

Disclosure: The authors report no conflicts of interest.


   REFERENCES
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 REFERENCES
 

  1. Sechi G, Serra A. Wernicke’s encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol 2007;6:442–455[Medline]
  2. Hazell AS, Todd KG, Butterworth RF. Mechanisms of neuronal cell death in Wernicke’s encephalopathy. Metab Brain Dis 1998;13:97–122[Medline]



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