CT and MRI of Wernicke’s encephalopathy

TC e RM dell’encefalopatia di Wernicke

Abstract

The purpose of this pictorial essay is to present the computed tomography (CT) and magnetic resonance imaging (MRI) findings of Wernicke’s encephalopathy, a rare, severe, acute neurological syndrome due to thiamine (vitamin B1) deficiency, associated with high morbidity and mortality. The classical clinical triad, which includes ocular signs, altered consciousness and ataxia, can be found in only one-third of patients. Although chronic alcoholic patients are the most commonly affected, Wernicke’s encephalopathy may complicate malnutrition conditions in nonalcoholic patients, in whom it is greatly underestimated. CT and above all MRI of the brain play a fundamental role in diagnosing the condition and ruling out other diseases. MRI is the most sensitive technique and is required in all patients with a clinical suspicion of Wernicke’s encephalopathy. Medial thalami, mamillary bodies, tegmentum, periaqueductal region, and tectal plate are typical sites of abnormal MRI signal. The dorsal medulla, red nuclei, cranial nerve nuclei, cerebellum, corpus callosum, frontal and parietal cerebral cortex are less common sites of involvement although they are more frequently affected in nonalcoholic patients. Paramagnetic contrast material may help to identify lesions not otherwise visible.

Riassunto

Lo scopo di questa rassegna iconografica è presentare i possibili reperti alla tomografia computerizzata (TC) e alla risonanza magnetica (RM) dell’encefalopatia di Wernicke, una rara grave sindrome neurologica acuta da deficit di tiamina (vitamina B1), con elevate morbilità e mortalità. La triade sintomatologica classica comprende disturbi oculari, alterazioni della coscienza e atassia, ma si presenta soltanto in un terzo dei pazienti. L’encefalopatia di Wernicke colpisce più frequentemente soggetti etilisti cronici, ma può complicare molte condizioni di malnutrizione in soggetti non-etilisti cronici, nei quali è spesso sottostimata. Lo studio dell’encefalo mediante TC e, soprattutto, RM riveste un ruolo fondamentale nell’orientamento diagnostico e nell’esclusione di altra patologia. La RM presenta elevata sensibilità e deve quindi essere eseguita in tutti i pazienti con sospetto clinico di encefalopatia di Wernicke. Le sedi tipiche di alterazione del segnale RM sono nuclei mediali del talamo, corpi mammillari, tegmento, sostanza grigia periacqueduttale e lamina quadrigemina. Sedi meno tipiche di interessamento, e più frequentemente coinvolte nei pazienti non-etilisti, sono la porzione dorsale del bulbo, il nucleo rosso e i nuclei dei nervi cranici, il cervelletto, il corpo calloso e la corteccia fronto-parietale. Il mezzo di contrasto paramagnetico può mostrare la presenza di lesioni non altrimenti evidenti.

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Correspondence to A. Cerase.

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Cerase, A., Rubenni, E., Rufa, A. et al. CT and MRI of Wernicke’s encephalopathy. Radiol med 116, 319–333 (2011). https://doi.org/10.1007/s11547-011-0618-x

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Keywords

  • Wernicke’s encephalopathy
  • Computed tomography
  • Magnetic resonance

Parole chiave

  • Encefalopatia di Wernicke
  • Tomografia computerizzata
  • Risonanza magnetica