Alcohol Induced Wernicke Encephalopathy with Atypical MRI Findings

Wernicke encephalopathy is a neurological complication of thiamine deficiency, usually in the setting of poor diet, classically with alcoholism. Patients present with acute onset of encephalopathy, oculomotor dysfunction, gait ataxia and memory impairment. If untreated, the disorder can result in severe morbidity and possibly death; patient outcomes are entirely dependent on prompt diagnosis and administration of parenteral thiamine. Although diagnosed clinically, the radiologist may be able to alert the referring clinician to the possibility of the disease when imaging features are observed, thereby improving the chance of treatment success. Although various imaging features have been ascribed to alcohol and non-alcohol related forms of Wernicke encephalopathy, recent literature suggests that such a distinction is not reliable, and that the causes of Wernicke encephalopathy are not readily distinguishable on MRI, as in the index case presented here.