Korean J Med.  2013 Apr;84(4):602-607.

Case of Atypical Wernicke's Encephalopathy in a GB Cancer Patient

• Jung YH
• Yu HA
• Youn GJ
• Lee JI
• Woo IS
• Han CW

Abstract

Wernicke's encephalopathy (WE) is an acute neuropsychiatric syndrome resulting from thiamine deficiency. Traditionally, diagnosis of WE rests on a clinical symptom triad consisting of ocular signs, altered consciousness, and ataxia. However, the complete triad is only present in a fraction of cases, which means that WE tends to be under-diagnosed, especially in nonalcoholic patients. Brain MRI of WE patients usually shows symmetrical signal intensity alterations in the thalami, mammillary bodies, and periaqueductal area, because of cytotoxic edema in the same region. These typical findings are useful diagnostic leads in WE patients with atypical symptoms. However, atypical findings can occasionally be seen in the vermis of cerebellum and cerebellar nuclei. Notably, alterations of signal intensity in the cerebellar dentate nuclei, which is a typical finding of metronidazole-induced encephalopathy (MIE), need to be distinguished according to medication history and response to thiamine.

Keyword

Wernicke's encephalopathy; Metronidazole; Cerebellar nuclei

MeSH Terms

Ataxia
Brain
Cerebellar Nuclei
Cerebellum
Consciousness
Edema
Humans
Mamillary Bodies
Metronidazole
Thiamine
Thiamine Deficiency
Wernicke Encephalopathy
Metronidazole
Thiamine