Pathophysiological Evaluation in a Case of Wernicke's Encephalopathy by Multimodal MRI

To report a patient with Wernicke's encephalopathy (WE) using multimodal magnetic resonance imaging (MRI) including conventional MRI, diffusion-weighted MRI (DWI), arterial spin labeling (ASL), and proton MR spectroscopy (MRS). A 50-year-old woman of WE with a history of cholecystectomy and acute pancreatitis was given MRI scans including DWI, MRS, and ASL pre- and post-thiamine treatment. Two weeks after admission, the patient's condition rapidly improved. The typical MRI findings and lesions in the frontal cortex at baseline disappeared or resolved partially. The reduced apparent diffusion coefficient value in part of the thalamus lesion, the elevated cerebral blood flow in the frontal cortex, the lactate doublet peak in the right thalamus lesion, and in cerebral spinal fluid, all resolved after treatment. The combination of conventional MRI with DWI, proton MRS, and ASL, offers a powerful diagnostic tool and a better understanding of the pathophysiological and hemodynamic mechanisms.