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Reversible MRI abnormalities in an unusual paediatric presentation of Wernicke's encephalopathy
G Sparacia1, A Banco, R Lagalla
1Institute of Radiology "P. Cignolini", University of Palermo, Via del Vespro, 127, I-90 127 Palermo, Italy. sparacia@unipa.it
Background:
We report an unusual paediatric presentation of acute Wernicke's encephalopathy in a 12-year-old boy affected by chronic gastrointestinal disease. MRI demonstrated, in addition to the typical diencephalic and mesencephalic signal abnormalities on T2-weighted images, enhancement of the mammillary bodies and the floor of the hypothalamus.
Materials And Methods:
Following parenteral administration of thiamine for 4 days, the patient recovered from his neurological deficits and on follow-up enhanced MRI 1 month later, no signal abnormalities were found nor was there diencephalic or mesencephalic atrophy, as is usual in the chronic phase of the disease.
Results:
MRI provides crucial information in the diagnosis of Wernicke's encephalopathy, either in the acute or chronic phases of the disease.
Conclusion:
Our report provides an additional clue for recognition of the acute phase of the disease; enhancement of the floor of the hypothalamus has not previously been described despite its recorded involvement at autopsy.
Insights
This case study highlights an unusual pediatric Wernicke
Area of Science:
- Neurology
- Pediatrics
- Radiology
Background:
- Presents an unusual pediatric case of acute Wernicke's encephalopathy in a 12-year-old boy with chronic gastrointestinal disease.
- Highlights the diagnostic utility of Magnetic Resonance Imaging (MRI) in identifying neurological signal abnormalities.
Observation:
- MRI revealed typical diencephalic and mesencephalic signal abnormalities on T2-weighted images.
- Observed enhancement of the mammillary bodies and floor of the hypothalamus, an atypical finding in the acute phase.
Findings:
- Parenteral thiamine administration led to rapid neurological recovery.
- Follow-up MRI showed resolution of signal abnormalities and absence of atrophy, contrasting with typical chronic Wernicke's encephalopathy.
- Hypothalamic floor enhancement is a novel indicator for acute Wernicke's encephalopathy.
Implications:
- Enhancement of the hypothalamic floor offers a new diagnostic clue for acute Wernicke's encephalopathy in pediatric cases.
- Early recognition and treatment of Wernicke's encephalopathy are crucial to prevent long-term neurological sequelae.
- This finding expands the understanding of MRI findings in Wernicke's encephalopathy.
