Answer:
Nonalcoholic Wernicke`s Encephalopathy
Findings:1.Increased signal intensities on T2-weighted and FLAIR images in the periaqueductal area 2.Axial T2W MR & Coronal FLAIR images show symmetric FLAIR hyperintensities in the dorsomedial thalami 3.No atrophy of the cerebellar vermis and mammillary bodies
Discussion:Our patient was a 20 yr old primigravida with twin gestation admitted in casualty with coma and GCS of 7/15. She also had history of hyperemesis gravidarum since two weeks. Wernicke`s Encephalopathy is a life threatening emergency , prompt treatment of which by thiamine , saves the patient from amnesic deficits, Korsakoff Psychosis and even death. The typical sites involved include medial thalami, periaqueductal area, tectal plate and periventricular region of the third ventricle. It differs from alcoholic Wernicke encephalopathy by the relative sparing of Cerebellar vermis and mammillary bodies ( susceptible to thiamine deficiency in alcoholic patients) and by the absence of sequelae of prior injur y(multiple attacks common in alchoholics)
Reference: MR Imaging of Nonalcoholic Wernicke Encephalopathy: A Follow-Up Study AJNR 2005 26: 2301-2305
Contributed By:
Dr. Babu Peter, Dr. Shyamala, Dr Sudha, Dr. Priyadarshini
Barnard Institute of Radiology, Chennai
Nonalcoholic Wernicke`s Encephalopathy
Findings:1.Increased signal intensities on T2-weighted and FLAIR images in the periaqueductal area 2.Axial T2W MR & Coronal FLAIR images show symmetric FLAIR hyperintensities in the dorsomedial thalami 3.No atrophy of the cerebellar vermis and mammillary bodies
Discussion:Our patient was a 20 yr old primigravida with twin gestation admitted in casualty with coma and GCS of 7/15. She also had history of hyperemesis gravidarum since two weeks. Wernicke`s Encephalopathy is a life threatening emergency , prompt treatment of which by thiamine , saves the patient from amnesic deficits, Korsakoff Psychosis and even death. The typical sites involved include medial thalami, periaqueductal area, tectal plate and periventricular region of the third ventricle. It differs from alcoholic Wernicke encephalopathy by the relative sparing of Cerebellar vermis and mammillary bodies ( susceptible to thiamine deficiency in alcoholic patients) and by the absence of sequelae of prior injur y(multiple attacks common in alchoholics)
Reference: MR Imaging of Nonalcoholic Wernicke Encephalopathy: A Follow-Up Study AJNR 2005 26: 2301-2305
Contributed By:
Dr. Babu Peter, Dr. Shyamala, Dr Sudha, Dr. Priyadarshini
Barnard Institute of Radiology, Chennai