Wernicke encephalopathy with cerebellar involvement
Two-week history of weakness, ataxia and dysarthria. On examination, there was bilateral nystagmus (vertical and horizontal). Background of heavy alcohol intake.
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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.
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.
- Shigekiyo T, Tani H, Nakajima H, Kimura F. Antecedent diffuse cerebellar lesions on diffusion-weighted MRI in nonalcoholic Wernicke's encephalopathy. Neurol Sci. 2018 Apr;39(4):789-790. doi: 10.1007/s10072-017-3190-4. Epub 2017 Nov 15. PMID: 29143148.