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Magnetic resonance reflects the pathological evolution of Wernicke encephalopathy
Background And Purpose:
Wernicke encephalopathy (WE) is an acute phase of Wernicke-Korsakoff syndrome. Pathologic findings change between acute and chronic phases. Only a few magnetic resonance imaging (MRI) studies have been done to date.
Methods:
To correlate the MRI findings in acute and chronic stages of WE with the known pathologic information, 15 consecutive patients with WE were examined with MRI: 3 before thiamine treatment, 7 within 24 hours of thiamine treatment, 4 between the second and sixth day after thiamine treatment, and 1 fifty-five days after thiamine treatment. Nine of the patients had follow-up MRI between 2 days and 33 months. T1-weighted, proton, and T2-weighted axial images were obtained with additional 5-mm-thick T1-weighted sagittal and coronal images to better visualize the mammillary bodies.
Results:
In the acute WE, MRI showed high signal intensityon T2-weighted images in periaqueduct and medial thalamic regions. In a few patients with alcoholism, vermian and mammillary body atrophies and third ventricular enlargements were noted. In the chronic phase of WE, T2 hyperintensity disappeared but mammillary bodies and cerebellar vermis became atrophic and third ventricular enlargements were evident. High signal intensity on T2-weighted images disappeared as early as 2 days, and atrophic changes appeared as early as 1 week.
Conclusion:
MRI is useful for in vivo monitoring and reflects the pathological evolution in acute and chronic phases of WE.
Insights
Magnetic resonance imaging (MRI) effectively monitors Wernicke encephalopathy (WE) progression. Acute WE shows T2 hyperintensity, while chronic WE reveals atrophy, reflecting pathological changes.
Area of Science:
- Neurology
- Radiology
- Pathology
Background:
- Wernicke encephalopathy (WE) is the acute phase of Wernicke-Korsakoff syndrome.
- Pathological changes in WE differ between acute and chronic stages.
- Limited magnetic resonance imaging (MRI) studies exist for WE.
Observation:
- 15 consecutive WE patients underwent MRI, with scans performed before, during, and after thiamine treatment.
- Follow-up MRI scans were obtained for nine patients over periods ranging from 2 days to 33 months.
- T1-weighted, proton, and T2-weighted axial images were acquired, along with sagittal and coronal views for mammillary body visualization.
Findings:
- Acute WE demonstrated T2-weighted MRI hyperintensity in periaqueductal and medial thalamic regions.
- Chronic WE showed resolution of T2 hyperintensity, with developing atrophy in mammillary bodies and cerebellar vermis, and third ventricular enlargement.
- Atrophic changes were evident as early as one week, while T2 hyperintensity resolved within two days of thiamine treatment.
Implications:
- MRI is a valuable tool for in vivo monitoring of Wernicke encephalopathy.
- MRI findings correlate with the pathological evolution of WE in both acute and chronic phases.
- This study enhances understanding of WE's dynamic changes using advanced imaging techniques.