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Clinical characteristics and magnetic resonance imaging findings in nine patients with nonalcoholic Wernicke’s encephalopathy: a retrospective study

Authors Liu YL, Xiao WM, Liang MQ, Wu ZQ, Wang YZ, Qu JF, Chen YK

Received 27 May 2019

Accepted for publication 3 August 2019

Published 26 August 2019 Volume 2019:15 Pages 2433—2441

DOI https://doi.org/10.2147/NDT.S217237

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Professor Jun Chen


Yong-Lin Liu,1 Wei-Min Xiao,1 Man-Qiu Liang,2 Zhi-Qiang Wu,1 Ya-Zhi Wang,1 Jian-Feng Qu,1 Yang-Kun Chen1

1Department of Neurology, Affiliated Dongguan People’s Hospital, Southern Medical University (Dongguan People’s Hospital), Dongguan, Guangdong Province, People’s Republic of China; 2Department of Radiology, Affiliated Dongguan People’s Hospital, Southern Medical University (Dongguan People’s Hospital), Dongguan, Guangdong Province, People’s Republic of China

Correspondence: Yang-Kun Chen
Department of Neurology, Affiliated Dongguan People’s Hospital, Southern Medical University (Dongguan People’s Hospital), 3 South Wandao Road, Wanjiang District, Dongguan City, Guangdong Province 523059, People’s Republic of China
Tel +86 7 692 863 6830
Fax +86 07 692 222 2353
Email cykun78@163.com

Purpose: Wernicke’s encephalopathy (WE) is a severe neurological disorder caused by thiamine deficiency. The most common cause of WE is alcoholism. However, there is a significant paucity of information in the existing literature relating to nonalcoholic WE. In this study, we investigated the clinical characteristics and neuroimaging findings of nine patients with nonalcoholic WE.
Patients and methods: We retrospectively collated clinical data from nine patients who had been diagnosed with WE in accordance with established criteria including age, gender, risk factors and clinical manifestations. We also collated initial hematological and neuroimaging findings.
Results: The mean age of the nine patients was 54.0±17.1 years; four of these patients (44.4%) were male. All nine patients had a history of fasting (range, 5–47 days) prior to WE. Four of the nine patients (44.4%) exhibited the classical triad, and eight (88.9%) showed alterations in mental status. Magnetic resonance imaging (MRI) scans showed that all nine patients had symmetric lesions of the medial thalamus. MRI also revealed other WE-related lesions in mammillary bodies (22.2%), the periaqueductal region (55.6%), the tectal plate of the midbrain (77.8%), cranial nerve nuclei (77.8%) and in the symmetric subcortical white matter (11.1%).
Conclusion: Our analysis showed that fasting is a common cause of WE in nonalcoholic patients and that MRI is a useful tool for the diagnosis of WE. The most common MRI findings were symmetrical lesions of the medial thalamus lesions, followed by the tectal plate of the midbrain and cranial nerve nuclei.

Keywords: Wernicke’s encephalopathy, altered mental status, magnetic resonance imaging, fasting, thiamine, alcoholism

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