EC Cancer

Wernicke encephalopathy (WE) is a neurologic emergency resulting from thiamine deficiency, typically associated with chronic alcoholism. Standard MRI findings include lesions in the thalami, mammillary bodies, and periaqueductal gray matter; however, atypical manifestations such as cortical and hemorrhagic lesions are uncommon and underrecognized. We report a 55-year-old male with chronic alcohol use disorder admitted to ICU following traumatic brain injury. Initial CT was unremarkable, but persistent altered mental status prompted MRI, revealing diffusion and FLAIR hyperintensities in the mammillary bodies, periaqueductal region, cortex, and pons. Susceptibility-weighted imaging indicated hemorrhagic transformation in the pons. Markedly reduced thiamine levels confirmed WE. Despite intravenous thiamine administration, the patient rapidly deteriorated and died within 48 hours. This case highlights a rare presentation of WE with diffuse cortical involvement and pontine hemorrhage, signaling advanced disease and poor prognosis. Early identification of atypical imaging features is crucial to prevent treatment delays and reduce morbidity and mortality.

 Keywords: Wernicke Encephalopathy; Thiamine Deficiency; MRI; Cortical Involvement; Hemorrhagic Pons; SWI; Alcohol Use Disorder

1. Ota Y., et al. “Comprehensive review of Wernicke encephalopathy: pathophysiology, clinical symptoms and imaging findings”. Japanese Journal of Radiology 9 (2020): 809-820.
2. Habas E., et al. “Wernicke encephalopathy: an updated narrative review”. Saudi Journal of Medicine and Medical Sciences 3 (2023): 193-200.
3. Kohnke S and Meek CL. “Don’t seek, don’t find: The diagnostic challenge of Wernicke’s encephalopathy”. Annals of Clinical Biochemistry 1 (2020): 38-46.
4. Isen DR and Kline LB. “Neuro-ophthalmic manifestations of Wernicke encephalopathy”. Eye and Brain 12 (2020): 49-60.
5. Chandrakumar A., et al. “Review of thiamine deficiency disorders: Wernicke encephalopathy and Korsakoff psychosis”. Journal of Basic and Clinical Physiology and Pharmacology 2 (2018): 153-162.
6. Ouchen K., et al. “Intracerebral hematoma secondary to Wernicke’s encephalopathy: A case report with a review of literature”. Cureus2 (2025): e78330.
7. Zuccoli G and Pipitone N. “Neuroimaging findings in acute Wernicke's encephalopathy: review of the literature”. American Journal of Roentgenology2 (2009): 501-508.
8. Berhoumi AE., et al. “[Gayet-Wernicke encephalopathy with normal thiamine level: a case report]”. Pan African Medical Journal 38 (2021): 16.
9. Bouchal S., et al. “L’encéphalopathie de Gayet Wernicke: aspects Cliniques et anomalies radiologiques”. Pan African Medical Journal 36 (2020): 259.
10. Benzalim M., et al. “Gayet Wernicke's encephalopathy with cortical damage following a subtotal gastrectomy: An uncommon association”. Radiology Case Reports 1 (2020): 94-97.
11. Pereira DB., et al. “Nonalcoholic Wernicke encephalopathy with extensive cortical involvement: cortical laminar necrosis and hemorrhage demonstrated with susceptibility-weighted MR phase images”. American Journal of Neuroradiology 2 (2011): E37-E38.
12. Zuccoli G., et al. “Wernicke encephalopathy: MR findings at clinical presentation in twenty-six alcoholic and nonalcoholic patients”. American Journal of Neuroradiology 7 (2007): 1328-1331.
13. Attaluri P., et al. “Thiamine deficiency: An important consideration in critically ill patients”. American Journal of the Medical Sciences 4 (2018): 382-390.
14. Whitfield KC., et al. “Thiamine deficiency disorders: diagnosis, prevalence, and a roadmap for global control programs”. Annals of the New York Academy of Sciences 1 (2018): 3-43.
15. Sechi G and Serra A. “Wernicke's encephalopathy: new clinical settings and recent advances in diagnosis and management”. Lancet Neurology 5 (2007): 442-455.
16. Oudman E., et al. “Preventing Wernicke's encephalopathy in anorexia nervosa: A systematic review”. Psychiatry and Clinical Neurosciences 10 (2018): 774-779.
17. Galvin R., et al. “EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy”. European Journal of Neurology 12 (2010): 1408-1418.