MR Imaging of nonalcoholic Wernicke encephalopathy: a follow-up study.

We investigated the correlation of MR imaging features with the pathological evolution and prognosis of nonalcoholic Wernicke encephalopathy. A retrospective review and analysis was conducted of 6 cases of nonalcoholic Wernicke encephalopathy, consisting of MR imaging features, clinical characteristics, and outcomes after thiamine administration. One patient died, 1 patient entered a persistent vegetative state, and the others recovered fully from Wernicke encephalopathy within 2 weeks to 1 year after thiamine administration. Typical MR imaging showed areas of increased T2-weighted and fluid-attenuated inversion recovery (FLAIR) signals symmetrically surrounding the aqueduct and the third ventricle, at the floor of fourth ventricle, in the medial thalami, and in the capita of caudate nuclei. Two patients presenting without coma showed increased T2-weighted and FLAIR signals of the periaqueductal area only. All 4 patients presenting with coma showed increased T2-weighted and FLAIR signals symmetrically in the medial thalami and in the capita of caudate nuclei. Of the 4 patients with coma, 2 patients with deep coma showed increased T2-weighted and FLAIR signals in the medial thalami and caudate nuclei as well as in the frontal and parietal cortices. According to the follow-up results, increased T2-weighted and FLAIR signals in the 4 patients without cortical damage decreased in intensity, consistent with clinical recovery within 2 weeks to 1 year. The patient in a persistent vegetative state exhibited progressive atrophy of the whole brain during the 2 years of the follow-up study. MR imaging is helpful not only to diagnose acute nonalcoholic Wernicke encephalopathy but also to evaluate the pathologic evolution and prognosis of the disorder.