Neurological Sciences

, Volume 39, Issue 4, pp 789–790 | Cite as

Antecedent diffuse cerebellar lesions on diffusion-weighted MRI in nonalcoholic Wernicke’s encephalopathy

  • Taro Shigekiyo
  • Hiroki Tani
  • Hideto Nakajima
  • Fumiharu Kimura
Letter to the Editor

Dear Editor,

Wernicke’s encephalopathy is an acute neurologic disorder caused by thiamine (vitamin B1) deficiency. The cause of thiamine deficiency is mainly chronic alcoholism. A variety of other conditions such as malnutrition, sepsis, malignancy, chemotherapy, and hyperemesis gravidarum can also lead to Wernicke’s encephalopathy. In patients with this disorder, magnetic resonance imaging (MRI) is the useful test to support the diagnosis of Wernicke’s encephalopathy, with a sensitivity and specificity of 53 and 93%, respectively [1]. MRI typically shows altered signal intensity in the medial thalami, mammillary bodies, tectal plate, and periaqueductal area because these periventricular regions are possibly more sensitive to the oxidative and glucose metabolisms associated with thiamine. Wernicke’s encephalopathy is typically characterized by ocular signs, ataxia, and altered mental state/memory impairment. However, this clinical triad is present in only approximately 30% of...


Conflict of interest

The authors declare that they have no conflict of interest.

Authors’ contributions

TS and HN examined and wrote the manuscript. HT and FK helped to draft the manuscript and performed the analyses. All authors read and approved the final manuscript.


  1. 1.
    Antunez E, Estruch R, Cardenal C, Nicolas JM, Fernandez-Sola J, Urbano-Marquez A (1998) Usefulness of CT and MR imaging in the diagnosis of acute Wernicke’s encephalopathy. AJR Am J Roentgenol 171:1131–1137CrossRefPubMedGoogle Scholar
  2. 2.
    Manzo G, De Gennaro A, Cozzolino A, Serino A, Fenza G, Manto A (2014) MR imaging findings in alcoholic and nonalcoholic acute Wernicke’s encephalopathy: a review. Biomed Res Int 2014:503596CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Zuccoli G, Santa Cruz D, Bertolini M, Rovira A, Gallucci M, Carollo C, Pipitone N (2009) MR imaging findings in 56 patients with Wernicke encephalopathy: nonalcoholics may differ from alcoholics. AJNR Am J Neuroradiol 30:171–176CrossRefPubMedGoogle Scholar
  4. 4.
    Chamorro AJ, Rosón-Hernández B, Medina-García JA et al (2017) Differences between alcoholic and nonalcoholic patients with Wernicke encephalopathy: a multicenter observational study. Mayo Clin Proc 92:899–907CrossRefPubMedGoogle Scholar
  5. 5.
    Ruiz Bajo B, Moreno García MP, Rueda Mena E, González Chinchón G (2016) Atypical presentation of Wernicke syndrome with magnetic resonance imaging showing cerebellar involvement and no changes in typical regions. Neurologia 31:495–496CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia S.r.l., part of Springer Nature 2017

Authors and Affiliations

  1. 1.Division of Neurology, Department of Internal Medicine IVOsaka Medical CollegeOsakaJapan

Personalised recommendations