Cervical cord lesions in Wernicke's encephalopathy

Area of Science:

• Neurology
• Radiology
• Internal Medicine

Background:

• Wernicke's encephalopathy (WE) is a serious neurological disorder often associated with alcoholism and malnutrition.
• It typically presents with a triad of symptoms: confusion, ataxia, and ophthalmoplegia, but presentations can vary.
• Spinal cord involvement in WE is rare and often overlooked.

Observation:

• A 30-year-old woman with an eating disorder and alcoholism presented with a 2-week history of progressive gait disturbance, impaired ocular motility, and trunk ataxia.
• Brain MRI revealed hyperintensities in the dorsal brainstem, aqueduct, thalamus, and cerebral cortex.
• Cervical spinal cord MRI showed a T2-weighted hyperintense signal in the central gray matter, suggestive of vasogenic edema.

Findings:

• The patient was diagnosed with Wernicke's encephalopathy based on clinical presentation and neuroimaging findings.
• Treatment with vitamin supplementation (thiamine) was initiated promptly.
• Following treatment, the patient experienced rapid clinical improvement, and follow-up MRI demonstrated normalization of brain and spinal cord signals.

Implications:

• This case highlights that Wernicke's encephalopathy can manifest with spinal cord vasogenic edema.
• Early diagnosis and prompt thiamine supplementation are crucial for reversing neurological deficits and imaging abnormalities.
• Recognizing spinal cord involvement in WE is important for timely intervention and improved patient outcomes.