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Isolated Mammillary Bodies Damage-An Atypical Presentation of Wernicke Syndrome

Samar A Abbas1, Halim Abboud2, Moussa A Chalah3,4

  • 1Department of Neurology, Hôtel-Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University, Beirut 1104-2020, Lebanon. samar.abbas@net.usj.edu.lb.

Behavioral Sciences (Basel, Switzerland)
|November 15, 2018
PubMed

Insights

Wernicke encephalopathy can present with unusual MRI findings, specifically contrast enhancement of mammillary bodies. Prompt thiamine treatment led to full memory recovery in this case.

Area of Science:

  • Neurology
  • Radiology
  • Nutritional Neuroscience

Background:

  • Wernicke encephalopathy (WE) is a neurological emergency often associated with thiamine deficiency.
  • Classic MRI findings include hyperintensities in the periaqueductal gray matter and thalami.
  • WE can manifest with diverse clinical symptoms, including memory impairment.

Observation:

  • A patient developed isolated anterograde amnesia after surgery complicated by peritonitis.
  • Standard MRI sequences (FLAIR, T2) showed no abnormalities.
  • T1 gadolinium-enhanced MRI revealed bilateral contrast enhancement of the mammillary bodies.

Findings:

  • Thiamine deficiency was confirmed via blood tests.
  • The observed MRI findings were atypical for WE, with normal FLAIR/T2 sequences.
  • Contrast enhancement of mammillary bodies on T1-weighted images was the key radiological sign.

Implications:

  • This case highlights the importance of considering WE even with atypical MRI presentations.
  • Mammillary body contrast enhancement may serve as a sensitive indicator for WE.
  • Early diagnosis and thiamine supplementation are crucial for reversing cognitive deficits in WE.
Keywords:
Wernicke encephalopathyamnesiaatypical Wernicke encephalopathybrain MRImammillary bodiesmemory loss

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