Department of Neuroradiology, University of Naples "Federico II", Naples, Italy.
Eur J Radiol. 2012 Dec;81(12):4099-104. doi: 10.1016/j.ejrad.2012.08.006. Epub 2012 Sep 3.
Acute Wernicke's encephalopathy (WE) is a severe neurological disorder caused by thiamine deficiency, most commonly found in chronic alcoholics. It is not so easy to suspect acute WE when the clinical picture does not include all the typical symptoms and alcohol abuse is not reported. Three rare cases of Wernicke's encephalopathy (WE) in non-alcoholic patients are reported.
Two patients developed the disease following prolonged intravenous feeding, the third was carrying a gastric lymphoma. None of them presented with the classic clinical triad of WE (ophtalmoplegia/nystagmus, ataxia and consciousness disturbance), showing just one or two of the typical symptoms. Brain Magnetic Resonance Imaging (MRI) represented the key tool to suspect and define WE diagnosis, showing a picture characterized by bilaterally altered signal of the thalamic pulvinar, mesencephalic cup, mammillary bodies, periaqueductal grey matter and floor of fourth ventricle. All patients dramatically improved within 48 h after administration of thiamine.
We emphasize that WE should be suspected in all patients showing typical MRI features presenting with at least one of the clinical triad of WE.
急性 Wernicke 脑病（WE）是一种由硫胺素缺乏引起的严重神经系统疾病，最常见于慢性酗酒者。当临床表现不包括所有典型症状且未报告酒精滥用时，急性 WE 并不容易被怀疑。报告了三例非酒精性患者的罕见 Wernicke 脑病（WE）病例。
两名患者在接受长时间静脉输液后出现疾病，第三名患者患有胃淋巴瘤。他们均未出现 WE 的典型三联征（眼球运动障碍/眼球震颤、共济失调和意识障碍），仅表现出一两个典型症状。脑磁共振成像（MRI）是怀疑和确定 WE 诊断的关键工具，显示出特征性的丘脑髓质、中脑被盖、乳头体、导水管周围灰质和第四脑室底双侧信号改变。所有患者在给予硫胺素后 48 小时内均显著改善。
我们强调，在出现 WE 典型 MRI 特征且至少有 WE 三联征之一的所有患者中，应怀疑存在 WE。
