Clinical characteristics and MRI features of nonalcoholic Wernicke encephalopathy

Abstract:

Objective：To investigate the clinical and magnetic resonance imaging（MRI） characteristics of nonalcoholic Wernicke encephalopathy（nWE）. Methods：We conducted a review on clinical characteristics and MRI features of 10 nWE cases. Results：Among 10 patients with varying degrees of central nervous system symptoms，only 2 had a typical triad. On MRI，6 out of 10 patients had evidences of symmetric lesions in the medial thalami，periaqueductal area and periventricular gray matter located anteriorly to the fourth ventricle；among the 6 patients，signal-intensity alterations were appeared in the medial vestibular nuclei in 3 patients，in the facial nuclei and the prepositus hypoglossal nuclei in 2 patients，in the mamillary bodies in 1 patient. Lesions were enhanced by differ－ent degrees on enhanced T1WI，periaqueductal gray matter showing characteristic ‘Ω’ shape. One patient with cortical damage died. Dynamic observations suggested that internal lesions of bilateral thalamus developed a little bleeding in 1 patient. Diffusion weighted imaging can’t find more abnormal regions. In 1 patient，3D proton magnetic vesonance spectroscopy showed low levels of N-acetylas－partate/creatine and a lactate peak in the medial thalami and periaqueductal area. In all patients，no atrophy of the mammillary bodies and cerebellar vermis was found. Conclusions：MRI is an effective method to investigate neurologic complications associated with nWE. The medial thalami，periaqueductal area，periventricular gray matter located anteriorly to the fourth ventricle and the cranial nerve nuclei involvement are characteristic findings of nWE. Cortical involvement in patients with nonalcoholic WE may be indicative of a poor prognosis.