Cerebellar restricted diffusion in Wernicke’s encephalopathy

• DOI: 10.25259/jnrp-2022-3-51
• Publication Date: 2022-11-08T08:36:53Z
• Authors: Narenraj Arulprakash; Vishank Shah
• Keywords: Mammillary body; Fluid-attenuated inversion recovery; Wernicke's encephalopathy; Wernicke Encephalopathy

A 50-year-old woman presented to an outside hospital for acute onset bilateral lower limb pain. She was diagnosed with aortoiliac stenosis and underwent stent placement. Post-procedure, she noted have altered mental status, truncal ataxia, neck titubation, incomplete external ophthalmoplegia. rapidly declined a stuporous state. had history of uterine cancer treated chemoradiation which complicated by chronic radiation enteritis. also reported poor oral intake, recurrent emesis, weight loss month before her presentation. After extensive work up, arrived at our facility where MRI the brain showed restricted diffusion T2-FLAIR sequence hyperintensities cerebellum. dorsomedial thalami, fornix, post-contrast-enhancement mammillary bodies were noted. The clinical picture imaging findings concerning possible thiamine deficiency. In Wernicke's encephalopathy, diffusion, hyperintensities, contrast enhancement may be seen in bodies, tectal plate, periaqueductal grey matter, rarely cerebellum as well. Her level 70 nmol/l (reference range: 70-180 nmol/l). Thiamine levels can falsely elevated patients who are on enteral feeds, case patient. started high dose replacement. At time discharge, repeat revealed resolution cerebellar changes mild atrophy patient subtle neurological improvement including consistent eye opening, tracking, attending examiner, well mumbling words.