Non-alcoholic Wernicke’s encephalopathy

Case Discussion

WE is still diagnosed according to the history of the disease and therapeutic effect of thiamine supplementation. Therotically, the determination of blood transketolase activity and thiamine phosphate or pyrophosphate can reflect the status of thiamine existing in human body and be an accurate index in the diagnosis of WE. However, no study has clearly described the sensivity, specificity and accuracy of thiamine levels in relation to active disease.MRI is helpful in making a definitive diagnosis of WE, though absence of findings does not rule it out. The sensitivity of MRI is 53%, whereas the specificity is 93%. Some case studies have reported that typical MR findings in WE include increased T2-weighted and FLAIR signals symmetrically surrounding the aqueduct and third ventricle, at the floor of fourth ventricle, in the medial thalami which is consistent with the MR findings in our patient. A few studies have reported atypical MR manifestations in the form of cortical involvement, which was also present in our patient. Thus, the history, clinical findings, typical MR imaging features and response to thiamine administration allowed us to make a conclusive diagnosis of WE.

Reference

Nordentoft M, Timm S, Hasselbalch E, et al. Thiamine pyrophosphate effect and erythrocyte transketolase activity during severe alcohol withdrawal syndrome. Acta Psychiatr Scand 1993;88:80–84. Antunez E, Estruch R, Cardenal C, et al. Usefulness of CT and MR imaging in the diagnosis of acute Wernicke's encephalopathy. Am J Roentgenol 1998;171(4):1131-7. Gallucci M, Bozzao A, Splendiani A, et al. Wernicke encephalopathy: MR findings in five patients. Am J Neuroradiol 1990;11:887–92. Chung SP, Kim SW, Yoo IS, et al. Magnetic resonance imaging as a diagnostic adjunct to Wernicke encephalopathy in the ED. Am J Emerg Med 2003;21:497–502. Doss A, Mahad D, Romanowski CA. Wernicke encephalopathy: unusual findings in nonalcoholic patients. J Comput Assist Tomogr 2003;27:235–40.

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