Wernicke encephalopathy with cerebellar involvement

Case contributed by Dr Alexandra Murphy

Presentation

Two-week history of weakness, ataxia and dysarthria. On examination, there was bilateral nystagmus (vertical and horizontal). Background of heavy alcohol intake.

Patient Data

Age: 45 years
Gender: Male

There is increased FLAIR signal in the superior cerebellum bilaterally including the vermis. This is associated with high signal on the B value imaging and mild associated low signal on the ADC map. Additionally, there is high signal on the B value imaging in the medial thalami.

Case Discussion

Given the clinical presentation, alcohol history and low thiamine levels, the patient was diagnosed with Wernicke's encephalopathy with atypical imaging features. The patient was treated with thiamine and clinically and radiologically improved. MRI 10 days after the initial study showed no progression, with some mild improvement. 

Wernicke's encephalopathy affecting the cerebellum is an atypical presentation. Typically Wernicke's affects the medial thalami, mamillary bodies, tectal plate and periaqueductal areas.

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Case information

rID: 86305
Published: 4th May 2021
Last edited: 5th May 2021
Inclusion in quiz mode: Included
Institution: Mater Misericordiae University Hospital

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