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Wernicke encephalopathy, also known as Wernicke-Korsakoff syndrome, or alcoholic encephalopathy, if trying to avoid eponyms, is a form of thiamine (vitamin B1) deficiency and is typically seen in alcoholics.
On imaging, it is commonly seen on MRI as areas of symmetrical increased T2/FLAIR signal involving the mammillary bodies, dorsomedial thalami, tectal plate, periaqueductal area and/or around the third ventricle.
It was originally described as characterized by the triad of:
ophthalmoplegia (most commonly horizontal nystagmus and conjugate gaze palsies)
Wernicke encephalopathy can evolve into the chronic form of thiamine deficiency known as Korsakoff psychosis, characterized by:
memory loss (global amnesia)
The two terms are often concatenated to form Wernicke-Korsakoff syndrome.
Thiamine deficiency results from malnutrition or malabsorption, which can occur for a number of reasons 6,7:
alcohol abuse (up to 90% in industrialised countries 5)
prolonged total parenteral nutrition without supplementation
In acute stages, hemorrhage, necrosis, and edema may be present. In chronic stages, atrophic changes may be present especially involving the mamillary bodies.
T2/FLAIR: symmetrically increased signal intensity in the
T1 C+ (Gd): contrast enhancement can also be seen in the same regions, most commonly of the mammillary bodies 4
DWI/ADC: restricted diffusion can also be seen in the same regions 4
MR spectroscopy: may show decreased or normal NAA with the notable presence of lactate 4
Treatment and prognosis
Treatment of acute Wernicke-Korsakoff syndrome is with intravenous thiamine hydrochloride, along with other vitamins/minerals, and treatment of the underlying cause (e.g. alcohol cessation). Untreated, there is high mortality of up to 20% 9.
History and etymology
It is named after:
Carl Wernicke: German neurologist and psychiatrist (1848-1905) 2
Sergei Korsakoff: Russian neuropsychiatrist (1854-1900) 2
General imaging differential considerations include:
- 1. Zuccoli G, Gallucci M, Capellades J et-al. Wernicke encephalopathy: MR findings at clinical presentation in twenty-six alcoholic and nonalcoholic patients. AJNR Am J Neuroradiol. 2007;28 (7): 1328-31. doi:10.3174/ajnr.A0544 - Pubmed citation
- 2. Richard Langton Gregory. The Oxford Companion to the Mind. (2018) ISBN: 9780198662242
- 3. Zuccoli G, Pipitone N. Neuroimaging findings in acute Wernicke's encephalopathy: review of the literature. AJR Am J Roentgenol. 2009;192 (2): 501-8. doi:10.2214/AJR.07.3959 - Pubmed citation
- 4. Degnan AJ, Levy LM. Neuroimaging of rapidly progressive dementias, part 2: prion, inflammatory, neoplastic, and other etiologies. AJNR Am J Neuroradiol. 2014;35 (3): 424-31. doi:10.3174/ajnr.A3455 - Pubmed citation
- 6. Thomson AD, Marshall EJ. The natural history and pathophysiology of Wernicke's Encephalopathy and Korsakoff's Psychosis. Alcohol Alcohol. 2006;41 (2): 151-8. doi:10.1093/alcalc/agh249 - Pubmed citation
- 7. Hegde AN, Mohan S, Lath N et-al. Differential diagnosis for bilateral abnormalities of the basal ganglia and thalamus. Radiographics. 2011;31 (1): 5-30. Radiographics (full text) - doi:10.1148/rg.311105041 - Pubmed citation
- 8. Nelson JS, Mena H, Parisi JE et-al. Principles and Practice of Neuropathology. Oxford University Press, USA. ISBN:B005LQBYFI. Read it at Google Books - Find it at Amazon
- 8. Loh Y, Watson WD, Verma A, Krapiva P. Restricted diffusion of the splenium in acute Wernicke's encephalopathy. (2005) Journal of neuroimaging : official journal of the American Society of Neuroimaging. 15 (4): 373-5. doi:10.1177/1051228405279037 - Pubmed
- 9. Sabatini J, Schutz-Pereira G, Feltrin F, Teive H, Camargo C. Wernicke's Encephalopathy with Chorea: Neuroimaging Findings. Dement Neuropsychol. 2016;10(4):370-2. doi:10.1590/s1980-5764-2016dn1004020 - Pubmed