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J Neurocrit Care 2013;6(1): 43-46.
A Case of Atypical Wernicke’s Encephalopathy Showing Symmetric Cortical Lesions on MRI
Sook Young Roh, MD, PhD, Hyun-Jeung Yu, MD, Ku-Eun Lee, MD and Hyun Seok Kang, MD
Department of Neurology, Bundang Jesaeng General Hospital, Seongnam, Korea
ABSTRACT
Background: Magnetic resonance imaging (MRI) is currently considered the gold standard in confirming the diagnosis of Wernicke encephalopathy (WE), with classic findings including symmetric involvement of medial thalami, mammillary bodies and periaqueductal gray matter.
Case Report:A 58-year-old alcoholic male presented to our hospital with an altered state of consciousness, unsteady gait and dysmetria. Brain MRI revealed symmetric hyperintense lesions in the bilateral frontal cortex on fluid attenuated inversion recovery. A follow up MRI of the brain obtained 13 days after thiamine supplementation showed regression of these signal hyperintensities that involved cerebral cortex. Clinically, the patient’s symptoms recovered rapidly.
Conclusions: The spectrum of MRI changes was broader than those of classic WE. We believe that clinicians should remain aware that WE may present with both typical and atypical findings on MRI.
Key Words: Wernicke encephalopathy · Atypical MRI finding · Cerebral cortex
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