Presentation
Semiconscious, visual disturbance, ataxia
Patient Data
T2WI and FLAIR hyperintense signal changes are seen in both posteromedial thalamus, around 3rd ventricle, periaqueductal regions, mammillary bodies, and fronto-parietal cortex. Moderate to intense diffusion restrictions are seen in fronto-parietal cortex surrounding the central sulcus and columns of the fornix.
EEG report
Interpretation: the EEG is abnormal due to the presence of Continuous generalized low-voltage activity on a disorganized background.
Clinical correlation: the findings are consistent with diffuse encephalopathy. The clinician might correlate with the clinical findings.
Case Discussion
The patient is about 24 weeks pregnant and underwent parathyroidectomy about 20 days back due to parathyroid adenoma. She suffered from severe vomiting in the post operative period. Suddenly she developed ophthalmoplegia, altered consciousness and ataxia about 15 days back and was admitted into the ICU. Her CSF study was unremarkable. She was then advised MRI of brain to find out the cause.
The MRI findings were consistent with Wernicke encephalopathy. Her condition improved significantly after administering high dose of thiamin. Wernicke encephalopathy is an acute neurological disorder caused by vitamin B1 deficiency and characterized by ophthalmoplegia, ataxia and confusion.
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