Department of Neurology, Mackay Memorial Hospital, Taipei 10449, Taiwan.
Am J Emerg Med. 2012 Nov;30(9):2086.e1-3. doi: 10.1016/j.ajem.2011.12.013. Epub 2012 Feb 4.
Wernicke encephalopathy (WE) is a medical emergency caused by thiamine (vitamin B1) deficiency. Typical clinical manifestations are mental change, ataxia, and ocular abnormalities. Wernicke encephalopathy is an important differential diagnosis in all patients with acute mental change. However, the disorder is greatly underdiagnosed. Clinical suspicion, detailed history taking, and neurologic evaluations are important for early diagnosis. Magnetic resonance imaging (MRI) is currently considered the diagnostic method of choice. Typical MRI findings of WE are symmetrical involvement of medial thalamus, mammillary body, and periaqueductal gray matter. Prompt thiamine supplement is important in avoiding unfavorable outcomes. Here, we report a case of alcoholic WE with typical clinical presentation but with atypical MRI. Axial fluid-attenuated inversion recovery images showing symmetrical hyperintensity lesions in dentate nuclei of cerebellum, olivary bodies, and dorsal pons. Although atypical MRI findings are more common in nonalcoholic WE, it can also occur in alcoholic WE. This article is aimed to highlight the potential pitfalls in diagnosing acute mental change, the importance of clinical suspicion, and early treatment in WE.
威尼克脑病（WE）是由于硫胺素（维生素 B1）缺乏引起的医学急症。典型的临床表现为精神改变、共济失调和眼部异常。威尼克脑病是所有急性精神改变患者的重要鉴别诊断。然而，这种疾病的诊断率大大低于预期。临床怀疑、详细的病史采集和神经系统评估对于早期诊断很重要。磁共振成像（MRI）目前被认为是首选的诊断方法。WE 的典型 MRI 表现为内侧丘脑、乳头体和导水管周围灰质的对称性受累。及时补充硫胺素对于避免不良结局非常重要。在此，我们报告一例酒精性 WE，具有典型的临床表现但 MRI 表现不典型。轴位液体衰减反转恢复图像显示小脑齿状核、橄榄体和脑桥背侧的对称性高信号病变。虽然非酒精性 WE 中更常见不典型 MRI 表现，但也可发生于酒精性 WE。本文旨在强调在诊断急性精神改变时可能存在的陷阱、临床怀疑的重要性以及 WE 的早期治疗。
