Severe Wernicke's Encephalopathy Associated with Cortical Ribboning and Intracranial Hemorrhage.
Daniel DePoloStefan GillenKyle MardenSwarna RajagopalanOlga R ThonJames E SieglerJesse M ThonPublished in: The Neurohospitalist (2022)
Wernicke's encephalopathy (WE) is a neurological emergency that results from thiamine deficiency. It is most commonly associated with chronic alcohol consumption but can result from any cause of impaired thiamine absorption or dietary intake. The classic triad of ophthalmoparesis, ataxia, and altered sensorium is rarely seen in toto, and while certain radiographic findings strongly correlate with the disease, one should have a low threshold to suspect (and promptly treat) patients in order to mitigate the risk of morbidity and mortality. However, atypical presentations can result in delayed or missed diagnoses. In this report, we describe a case of severe non-alcoholic WE associated with atypical brain Magnetic resonance imaging (MRI) manifestations of both cortical diffusion restriction and intracranial hemorrhage, which have previously been associated with poor outcomes. Early treatment with high-dose parenteral thiamine resulted in rapid improvement in ocular motility and reversal of MRI abnormalities, and on long-term follow up, the patient had made a marked functional improvement. This case highlights the importance of recognizing these unusual imaging features of WE in a patient with a compatible clinical syndrome in order to make a timely diagnosis and initiate treatment, as there is potential for a good clinical outcome despite these imaging findings.
Keyphrases
- magnetic resonance imaging
- early onset
- alcohol consumption
- high dose
- case report
- contrast enhanced
- high resolution
- end stage renal disease
- public health
- healthcare
- emergency department
- computed tomography
- chronic kidney disease
- newly diagnosed
- diffusion weighted imaging
- optic nerve
- peritoneal dialysis
- white matter
- magnetic resonance
- multiple sclerosis
- drug induced
- combination therapy
- liver injury
- pseudomonas aeruginosa
- photodynamic therapy
- brain injury
- escherichia coli
- mass spectrometry
- staphylococcus aureus
- blood brain barrier
- subarachnoid hemorrhage