Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Feb 28, 2017; 9(2): 72-78
Published online Feb 28, 2017. doi: 10.4329/wjr.v9.i2.72
Magnetic resonance imaging in the assessment of brain involvement in alcoholic and nonalcoholic Wernicke’s encephalopathy
Gianvincenzo Sparacia, Andrea Anastasi, Claudia Speciale, Francesco Agnello, Aurelia Banco
Gianvincenzo Sparacia, Andrea Anastasi, Claudia Speciale, Francesco Agnello, Aurelia Banco, Department of Radiology, University of Palermo, 90127 Palermo, Italy
Author contributions: Sparacia G contributed to guarantor of integrity of entire study, study design, text editing, literature research; Anastasi A, Speciale C and Agnello F contributed to imaging data collecting, drafting the article, literature research; Banco A contributed to imaging data collecting.
Institutional review board statement: This was a retrospective study approved by the Institutional Review Board of the University of Palermo, Department of Radiology, Palermo, Italy.
Informed consent statement: All patients had given written consent for this retrospective study.
Conflict-of-interest statement: All authors have no conflict-of-interest.
Data sharing statement: Participants gave informed consent for data sharing and the presented data are anonymized to avoid the risk of identification. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Gianvincenzo Sparacia, MD, Department of Radiology, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy. sparacia@yahoo.com
Telephone: +39-091-6552385 Fax: +39-091-6552302
Received: August 24, 2016
Peer-review started: August 26, 2016
First decision: October 8, 2016
Revised: December 6, 2016
Accepted: December 27, 2016
Article in press: December 28, 2016
Published online: February 28, 2017
Processing time: 187 Days and 0.3 Hours
Abstract
AIM

To present the typical and atypical magnetic resonance (MR) imaging findings of alcoholic and non-alcoholic Wernicke’s encephalopathy.

METHODS

This study included 7 patients with Wernicke’s encephalopathy (2 men, 5 women; mean age, 52.3 years) that underwent brain MR examination between January 2012 and March 2016 in a single institution. Three patients were alcoholics and 4 patients were non-alcoholics. MR protocol included a T2-weighted sequence, a fluid attenuation inversion recovery (FLAIR) sequence, a diffusion-weighted sequence (b = 0 and 1000 s/mm2), and a contrast-enhanced MR sequence. All MR images were retrospectively reviewed at baseline and follow-up by two radiologists.

RESULTS

All patients with Wernicke’s encephalopathy had bilateral areas showing high signal intensity on both T2-weighted and FLAIR MR images in the typical sites (i.e., the periaqueductal region and the tectal plate). Signal intensity abnormalities in the atypical sites (i.e., the cerebellum and the cerebellar vermis) were seen in 4 patients, all of which had no history of alcohol abuse. Six patients had areas with restricted diffusion in the typical and atypical sites. Four patients had areas showing contrast-enhancement in the typical and atypical sites. Follow-up MR imaging within 6 mo after therapy (intravenous administration of thiamine) was performed in 4 patients, and demonstrated a complete resolution of all the signal intensities abnormalities previously seen in all patients.

CONCLUSION

MR imaging is valuable in the diagnosis of Wernicke’s encephalopathy particularly in patients presenting with atypical clinical symptoms, or with no history of alcohol abuse.

Keywords: Brain; Magnetic resonance imaging; Neurodegenerative disorder; Wernicke’s encephalopathy

Core tip: The purpose of this study was to describe the typical and atypical magnetic resonance (MR) imaging findings of alcoholic and nonalcoholic Wernicke’s encephalopathy. Bilateral increased T2-weighted and fluid attenuation inversion recovery MR signal intensity in the typical areas were seen in all patients. Signal-intensity alterations in atypical sites were seen only in nonalcoholic patients. This study demonstrated that MR imaging was useful in supporting the diagnosis of Wernicke’s encephalopathy.