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The medial vestibular nuclei, a vulnerable target in thiamine deficiency

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Abstract

Background

Bilateral medial vestibular nuclei (MVN) is a common target in thiamine depletion and results in acute vestibular failure. Involvement of the MVN was present in 27 out of 38 brainstem sections reported in the largest thiamine deficiency autopsy cohort with Wernicke’s encephalopathy.

Method

Serial clinical, imaging and vestibulo-ocular reflex gain measured with the video head impulse (vHIT) in one patient with acute thiamine deficiency.

Results

Low horizontal VOR gain correlated with an abnormal manual head impulse and with MRI evidence of MVN in an alcohol-dependent patient with low thiamine levels. The vertical VOR gain was either normal or mildly abnormal. Thiamine replacement and normal diet restored the VOR gain and MRI signal changes to normal.

Conclusion

This single case study provides clinical-imaging correlation for symmetric MVN compromise in thiamine deficiency, its effect on the VOR gain and the favorable response to thiamine and diet replacement when identified early.

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Fig. 1

References

  1. Choi KD et al (2007) The vestibulo-ocular reflexes during head impulse in Wernicke’s encephalopathy. J Neurol Neurosurg Psychiatry 78(10):1161–1162

    Article  PubMed  PubMed Central  Google Scholar 

  2. Kattah JC, Dhanani S, Pula JH, Mantokoudis G, Saber Therani AS, Newman Toker DE (2013) Vestibular signs of thiamine deficiency during the early phase of suspected Wernicke encephalopathy. Neurol Clin Pract 3:460–467

    Article  Google Scholar 

  3. Akdal G et al (2016) Selective impairment of horizontal vestibulo-ocular reflexes in acute Wernicke’s encephalopathy. J Neurol Sci 365:167–168

    Article  CAS  PubMed  Google Scholar 

  4. Victor M, Adams RD, Collins GH (1971) Wernicke Korsakoff’s syndrome. Contemporary neurology series. F. A. Davis, Philadelphia, p 193

    Google Scholar 

  5. Janssen JC et al (1998) Upbeat nystagmus: clinicoanatomical correlation. J Neurol Neurosurg Psychiatry 65(3):380–381

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Kim HA, Lee H (2010) Isolated vestibular nucleus infarction mimicking acute peripheral vestibulopathy. Stroke 41(7):1558–1560

    Article  PubMed  Google Scholar 

  7. Galvin R et al (2010) EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy. Eur J Neurol 17(12):1408–1418

    Article  CAS  PubMed  Google Scholar 

  8. Chung SP et al (2003) Magnetic resonance imaging as a diagnostic adjunct to Wernicke encephalopathy in the ED. Am J Emerg Med 21(6):497–502

    Article  PubMed  Google Scholar 

  9. Sechi G, Serra A (2007) Wernicke’s encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol 6(5):442–455

    Article  CAS  PubMed  Google Scholar 

  10. Kattah JC (2017) The spectrum of vestibular and ocular motor abnormalities in thiamine deficiency. Curr Neurol Neurosci Rep 17(5):40

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Professor David S Zee, M.D. from The Johns Hopkins University. Department of Neurology for his critical review of the manuscript.

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Authors and Affiliations

  1. Illinois Neurologic Institute, University of Illinois College of Medicine, Peoria, USA

    Jorge C. Kattah, Cindy Guede & Bahareh Hassanzadeh

Authors
  1. Jorge C. Kattah
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  2. Cindy Guede
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  3. Bahareh Hassanzadeh
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Corresponding author

Correspondence to Jorge C. Kattah.

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The authors declare that they have no competing interests.

Electronic supplementary material

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415_2017_8670_MOESM1_ESM.tif

Supplemental Figure 2. Video head Impulse recording on presentation. The top left panel shows horizontally decreased gain: Left (blue) > than right (red). The arrow points to an overt corrective rightward saccade in response to a hypoactive left head impulse. The vertical canal gain showed mildly decreased right posterior and normal left anterior canal gain (LARP: Left middle panel). The right anterior, left posterior canals was normal (RALP: Left lower panel). (TIFF 1272 kb)

415_2017_8670_MOESM2_ESM.tif

Supplemental Figure 3 Axial FLAIR MRI of the brain shows increased signal in the MVN, periaqueductal gray, medial thalamus and corpus callosum (panels A-E). Restricted diffusion was noted in the CC (Panels FG) and adjusted coefficient map (panel H). (TIFF 2579 kb)

415_2017_8670_MOESM3_ESM.tif

Supplemental Figure 4 Axial DWI MRI and Adjusted Coefficient Map (ADC). There is restricted DWI signal in the Splenium of the Corpus Callosum (left image) with true restriction diffusion verified with the ADC map (TIFF 270 kb)

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Kattah, J.C., Guede, C. & Hassanzadeh, B. The medial vestibular nuclei, a vulnerable target in thiamine deficiency. J Neurol 265, 213–215 (2018). https://doi.org/10.1007/s00415-017-8670-1

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  • DOI: https://doi.org/10.1007/s00415-017-8670-1

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