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Academia Mexicana de Neurología, A.C.

2009, Number 3

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Rev Mex Neuroci 2009; 10 (3)

Acute Wernicke’s encephalopathy. Comparison among the clinical features, magnetic resonance images and neuropathology findings

Escobar A, González M, Aguayo G, García-Ramos GS

Language: English
References: 26
Page: 224-231
PDF size: 310.36 Kb.


ABSTRACT

An acute case of Wernicke’s encephalopathy (AWE ) is here reported in a 24 year old woman who vomited all ingested food. Onset of AWE was insidious with muscular weakness and a progressive motor disturbance evolving to total paralysis until the patient was unable to stand up or even keep her head up. Associated language disturbance and confusional state developed, followed by oculomotor paresis and nystagmus in all directions. A magnetic resonance study on day 56th showed hyperintensities in periventricular regions, including ventromedial thalamic area and mammillary bodies, mesencephalic tegmenta at quadrigeminal and periaqueductal regions. Though the pontine tegmentum also showed periventricular hyperintensity, the latter tapered down to the upper third of the medulla oblongata near the vestibular nuclei. Patient died on day 60th. The brain displayed severe hemorrhage associated to capillary endothelial swelling, total necrosis of the neuropil and myelin loss in all the affected areas. The lesions in this case are characteristic of the acute phase of Wernicke’s encephalopathy due to thiamine deficiency. The lesional intensity seems to be the most relevant among the extense series of cases of AWE described in the scientific literature. Moreover, it is the only case in which the clinical features, the magnetic resonance and the neuropathological findings permit a strict and precise comparison.


REFERENCES

  1. Wernicke C. Die akute haemorrhagische Polioencephalitis superioris. In: Wernicke C (ed.). Lehrbuch der Gehirnkrankheiten für Aerzte und Studierende. Fischer, Kassel und Berlin: Zweite Band; 1881, p. 229- 42 (Quoted in reference 2).

  2. Wilkins RH, Brody IA. Neurological Classics. New York: Johnson Reprint Corp.; 1973, p. 44-8 (Wernicke’s Encephalopathy).

  3. Adams RD, Victor M. Diseases of the nervous system due to nutritional deficiency. In: Adams RD, Victor M. Principles of Neurology. 4th Ed. Chapt. 39. New York: McGraw Hill; 1985, p. 820-45.

  4. Alexander L, Pigoan M, Myerson A. Beriberi and scurvy. Trans Amer Neurol Assoc 1938; 64: 135 (Quoted in reference 3 ).

  5. Reuler JB, Girard DE, Cooney TG. Current concepts. Wernicke’s encephalopathy. New Engl J Med 1985; 312: 1035-9.

  6. Suzuki S, et al. Acute Wernicke’s encephalopathy: comparison of magnetic resonance images and autopsy findings. Internal Med 1996; 35: 831-4.

  7. Gallucci M, et al. Wernicke encephalopathy: MR findings in five patients. Am J Neuroradiol 1990; 11: 867-92.

  8. D’Aprile P, et al. Enhanced MR in the acute phase of Wernicke’s encephalopathy. Am J Neuroradiol 1994; 15: 591-3

  9. Shogry ME, Curnes JT. Mammillary body enhancement on MR as the only sign of acuteWernicke encephalopathy. Am J Neuroradiol 1994; 15: 172-4.

  10. Kim JE, et al. Diffusion-weighted MRI in recurrent Wernicke’s encephalopathy: a remarkable cerebellar lesion. J Clin Neurol 2006; 2: 141-5.

  11. Zuccoli G, et al. Wernicke’s encephalopathy: MR findings at clinical presentation in twenty-six alcoholic and nonalcoholic patients. Am J Neuroradiol 2007; 28: 1328-31.

  12. Fei, G.-q, et al. Clinical characteristics and MR imaging features of nonalcoholic Wernicke’s encephalopathy. Am J Neuroradiol 2008; 29: 164-9.

  13. Zuccoli G, et al. MR imaging findings in 56 patients with Wernicke encephalopathy: nonalcoholic may differ from alcoholics. Am J Neuroradiol 2009; 30: 171-6.

  14. Sang B, et al. Wernicke’s encephalopathy: atypical manifestation at MR imaging. Am J Neuroradiol 2001; 22: 1480-2.

  15. Mascalchi M, et al. Proton MR spectroscopy of Wernicke encephalopathy. Am J Neuroradiol 2002; 23: 1803-6.

  16. Groen RH, Hoff HCW. Wernicke’s disease. A catamnestic study of 50 patients. Eur Neurol 1977; 15: 109-15.

  17. Kim E, et al. Mammillothalamic functional connectivity and memory function in Wernicke’s encephalopathy. Brain 2009; 132: 369376

  18. Abdel-Hadi Alvarez H, Rodríguez-Lafora Bastos M, Cantarero Gracia A. Encefalopatía de Wernicke como complicación de hiperemesis gravídica. An Med Interna (Madrid ) 2004; 21: 46-7.

  19. Gardian G, et al. Wernicke’s encephalopathy induced by hyperemesis gravidarum. Acta Neurologica Scand 1999; 99: 196 – 198

  20. Selitsky T, et al. Wernicke’s encephalopathy with hyperemesis and ketoacidosis. Obst & Gynecol 2006; 107 (2, part 2 ): 486-90.

  21. Serra A, et al. Wernicke encephalopathy after obesity surgery. A systematic review. Neurology 2007; 69: 615-16.

  22. Singh S, Kumar A. Wernicke encephalopathy after obesity surgery. A systematic review. Neurology 2007; 68: 807-11.

  23. Yamamoto T. Alcoholic and non-alcoholic Wernicke’s encephalopathy. Be alert to the preventable and treatable disease. ( Editorial ). Int Med 1996; 35: 754-5.

  24. Zimitat C, Nixon PF. Glucose loading precipitates acute encephalopathy in thiamine-deficient rats. Metab Brain Dis 1999; 14: 1-20.

  25. Goldstein K. Carl Wernicke (1845-1904). In: Haymaker W (ed.). The Founders of Neurology. Thomas CC, Springfield; 1953, p. 406-9.

  26. Kleist K. Carl Wernicke. In: Kolle K (ed.). Stuttgart: Grosse Nervenärzte II; 1959, p. 106-28.




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