A 60-year-old man presented with bilateral gaze evoked nystagmus, severe ataxia, and memory impairment. Brain MRI showed concurrent cytotoxic and vasogenic edema patterns (figure). This case shows both cytotoxic and vasogenic edema that may occur at the same time in Wernicke encephalopathy. These findings may be due to the different vulnerability of brain regions to thiamine deprivation and the corresponding time lag between the development of lesions.1,2
Figure FLAIR weighted MRI
FLAIR weighted MRI showing typical high signal intensities (SIs) in the medial thalamus (A), periaqueductal gray (B), mamillary bodies (C), cerebellar vermis (B, C, D), and paravermian superior cerebellum (D). All the lesions represent high SIs on the DWI (E–H). The ADC images of the cerebellar vermis (K, L) and paravermian superior cerebellum (L) show low SIs (arrowheads), whereas other described areas (I, J) show iso-SIs (arrows).
Footnotes
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Disclosure: The authors report no conflicts of interest.
Series editor: Mitchell S.V. Elkind MD, MS, Section Editor
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