Wernicke's encephalopathy in a rectal cancer patient with atypical radiological features: A case report

Abstract

BACKGROUND

Wernicke's encephalopathy is a disease caused by thiamine deficiency. The lesions usually involve the periphery of the aqueduct, midbrain, tectum, third ventricle, papillary body, and thalamus. It is very rare to affect the vermis and cerebellar hemispheres.

CASE SUMMARY

We report a 77-year-old female patient admitted to the emergency department of our hospital for 2 d of unconsciousness. Brain magnetic resonance imaging showed increased diffusion weighted imaging signals in the bilateral thalamus, periventricular regions of the third ventricle, corpora quadrigemina, vermis, and cerebellar hemispheres. Wernicke's encephalopathy was considered. She was given thiamine therapy and became conscious after the treatment.

CONCLUSION

Wernicke's encephalopathy may have various imaging manifestations. Clinicians should keep in mind that Wernicke’s encephalopathy may occur in patients who experience prolonged periods of malnutrition.

Keywords: Wernicke's encephalopathy; Atypical radiological features; Vermis; Cerebellar hemispheres; Case report

Core Tip: Wernicke's encephalopathy is a disease caused by thiamine deficiency. Wernicke's encephalopathy may have various imaging manifestations. Typically, the lesions are distributed symmetrically in the thalamus, mammillary bodies, corpora quadrigemina, and periaqueductal areas. Lesions can also be found atypically in the cerebellum, cranial nerve nucleus, red nucleus, caudate nucleus, cerebral cortex, and other atypical areas. We report a female patient with atypical lesions involving the vermis and cerebellar hemispheres. She was given thiamine therapy and became conscious after the treatment.