ejm Ege Tıp Dergisi 1016-9113 2147-6500 Ege University 10.19161/etd.418147 Health Care Administration Sağlık Kurumları Yönetimi Non-alkolik nedenlere bağlı gelişen Wernicke ensefalopatisinde manyetik rezonans görüntüleme bulguları Magnetic resonance imaging findings of Wernicke’s encephalopathy in non-alcoholic patients https://orcid.org/0000-0002-5762-6149 Eraslan Cenk Ege Üniversitesi Tıp Fakültesi, Radyodiagnostik Anabilim Dalı, İzmir https://orcid.org/0000-0003-4465-3743 Güler Ayşe Ege Üniversitesi Tıp Fakültesi, Nöroloji Anabilim Dalı, İzmir https://orcid.org/0000-0003-0016-0189 Kurt Erman Menemen Devlet Hastanesi, Radyoloji Kliniği, İzmir https://orcid.org/0000-0001-9295-2866 Çallı Cem Ege Üniversitesi Tıp Fakültesi, Radyodiagnostik Anabilim Dalı, İzmir https://orcid.org/0000-0003-4201-5449 Kitiş Ömer Ege Üniversitesi Tıp Fakültesi, Radyodiagnostik Anabilim Dalı, İzmir 06 28 2019 58 2 115 120 03 13 2018 04 09 2018 Copyright © 1962, Ege Journal of Medicine 1962 Ege Journal of Medicine

Amaç: Wernickeensefalopatisi (WE) tiamin (vitamin B1) eksikliğine bağlı olarak gelişennöropsikiyatrik bir hastalıktır. Sıklıkla kronik alkolizme bağlı olarakgörülmekle birlikte tiamin alım veya emilim eksikliğine neden olan her türlüdurumda ortaya çıkabilir. Bu çalışmanın amacı tedavi edilmediği takdirde ölümekadar giden ciddi sonuçlar doğurabilen bu hastalığın tanı ve izleminde manyetikrezonans görüntülemenin (MRG) önemini vurgulamaktır.Gereç veYöntem:Çalışmamıza kurumumuzda hospitalize edilen ve non-alkolik nedenlerle WE tanısıalan 10 hasta dahil edildi. Hastaların MRG tetkiklerinde tutulum yerlerininlokalizasyonuna göre tipik ve atipik bulguların varlığı değerlendirildi. Ayrıcaeşlik eden difüzyon kısıtlılığı varlığı araştırıldı.Bulgular: Kraniyal MRG’de tipiktutulum alanları 10 hastada bilateral talamus mediali, 8 hastada bilateralmamiller cisim, 7 hastada periakuaduktal alan/tektal plak olarak tespit edildi.Atipik tutulum alanları ise 5 hastada forniks, 4 hastada serebral korteks, 2hastada putamen, 1 hastada ise serebellum tutulumu şeklinde idi. 8 hastada bubulgulara difüzyon kısıtlılığı eşlik etmekteydi.Sonuç: Sunulan çalışmanın sonuçlarına göre, non-alkolik WE tanılı olgularda MRG’de, alkolik WE tanılı olgularla benzer bulgular gözlenmektedir. Bu hastalarıntanı ve tedavilerinin gecikmemesi amacıyla MR görüntülemenin kullanımınınönemli rol oynadığı sonucuna varılmıştır.

Aim: Wernickeencephalopathy (WE) is a neuropsychiatric disease that develops due to thedeficiency of thiamine (vitamin B1). It is often observed due to chronicalcoholism; however it can arise in any condition that causes deficiency in theintake or absorption of thiamine. The aim of this study is to emphasize theimportance of magnetic resonance imaging (MRI) in the diagnosis and follow-up ofthis disease which can even lead to death when it is not treated. Materialsand Methods: Ten patients, who had been hospitalized in our institution anddiagnosed as WE due to non-alcoholic reasons, were included in our study. Inthe MRI examinations of the patients, typical and atypical findings wereevaluated according to the localization of involvement areas. The existence ofaccompanying diffusion restriction was evaluated. Results: Typical involvementareas in cranial MRI were determined as bilateral medial thalamus in 10patients, bilateral mammillary bodies in 8 patients, periaqueductal area/tectalplate in 7 patients. Atypical involvement areas were determined as fornix in 5patients, cerebral cortex in 4 patients, putamen in 2 patients and cerebelluminvolvement in 1 patient. These findings were accompanied by diffusionrestriction in 8 patients. Conclusion: According to theresults of the presented study, cranial MRI has similar findings in alcoholicand non-alcoholic WE patients. We conclude that, the utilization of cranial MRIin these patients has an important role to prevent the latency of the diagnosisand treatment.

 Wernicke ensefalopatisi manyetik rezonans görüntüleme tiamin eksikliği. Wernicke encephalopathy magnetic resonance imaging thiamine deficiency. Saad L, Silva LF, Banzato CE, Dantas C, Garcia C. Anorexia nervosa and Wernicke-Korsakoff syndrome: A case report. J Med Case Rep 2010;4:217. Chiossi G, Neri I, Cavazzuti M, Basso G, Facchinetti F. Hyperemesis gravidarum complicated by Wernicke encephalopathy: background, case report, and review of the literature. Obstet Gynecol Surv 2006;61(4):255-68. Loh Y, Watson WD, Verma A, Chang ST, Stocker DJ, Labutta RJ. Acute Wernicke’s encephalopathy following bariatric surgery: Clinical course and MRI correlation. Obes Surg 2004;14(1):129-32. Sequeira Lopes da Silva JT, Almaraz Velarde R, Olgado Ferrero F, et al. Wernicke’s encephalopathy induced by total parental nutrition. Nutr Hosp 2010;25(6):1034-6. Azim W, Walker R. Wernicke’s encephalopathy: A frequently missed problem. Hosp Med 2003;64(6):326-7. Harper CG, Giles M, Finlay-Jones R. Clinical signs in the Wernicke-Korsakoff complex: A retrospective analysis of 131 cases diagnosed at necropsy. J Neurol. Neurosurg Psychiatry 1986;49(4):341-45. Zuccoli G, Gallucci M, Capellades J, et al. Wernicke encephalopathy: MR findings at clinical presentation in twenty-six alcoholic and nonalcoholic patients. AJNR Am J Neuororadiol 2007;28(7):1328-31. Harper C. The incidence of Wernicke’s encephalopathy in Australia-a neuropathological study of 131 cases. J Neurol Neurosurg Psychiatry 1983;46(7):593-8. Harper C, Butterworth R. Nutritional and metabolic disorders. In: Graham DI, Lantos PL (eds). Greenfield’s Neuropathology. Vol. 1, 6th ed. London: Hodder Arnold;1997:601-52. Zhong C, Jin L, Fei G. MR Imaging of nonalcoholic Wernicke encephalopathy: A follow-up study. AJNR Am J Neuroradiol 2005;26(9):2301-5. Thomson AD. Mechanisms of vitamin deficiency in chronicalcohol misusers and the development of the Wernicke Korsakoff syndrome. Alcohol Alcohol Suppl 2000;35(1):2-7. Park SH, Kim M, Na DL, Jeon BS. Magnetic resonance reflects the pathological evolution of Wernicke encephalopathy. J Neuroimaging 2001;11(4):406-11. Gui QP, Zhao WQ, Wang LN. Wernicke’s encephalopathy in nonalcoholic patients: Clincal and pathologic features of three cases and literature reviewed. Neuropathology 2006;26(3):231-5. Zuccoli G, Santa Cruz D, Bertolini M, et al. MR imaging findings in 56 patients with Wernicke encephalopathy: nonalcoholics may differ from alcoholics. AJNR Am J Neuororadiol. 2009;30(1):171-6. Manzo G, De Gennaro A, Cozzolino A, Serino A, Fenza G, Manto A. MR imaging findings in alcoholic and nonalcoholic acute Wernicke’s encephalopathy: A review. Biomed Res Int 2014;2014(4):503-96. Zuccoli G, Pipitone N. Neuroimaging findings in acute Wernicke's encephalopathy: Review of the literature. AJR Am J Roentgenol 2009;192(2):501-8. Victor M, Adams RD, Collins GH. The Wernicke-Korsakoff syndrome and related neurological disorders due to alcoholism and malnutrition. 2nd ed. Philadelphia: FA Davis Company; 1989:123-9 Bae SJ, Lee HK, Lee JH, Choi CG, Suh DC. Wernicke’s encephalopathy: Atypical manifestation at MR imaging. AJNR Am J Neuroradiol 2001;22(8):1480-2. Cui HW, Zhang BA, Peng T, Liu Y, Liu YR. Wernicke’s in a patient with acute pancreatitis: Unusual cortical involvement and marvelous prognosis. Neurol Sci 2012;33(3):615-8. Mascalchi M, Simonelli P, Tessa C, et al. Do acute lesions of Wernicke's encephalopathy show contrast enhancement? Report of three cases and review of the literature. Neuroradiology 1999;41(4):249-54. Shogry ME, Curnes JT. Mamillary body enhancement on MR as the only sign of acute Wernicke encephalopathy. AJNR Am J Neuroradiol 1994;15(1):172-4. Ha ND, Weon YC, Jang JC, Kang BS, Choi SH. Spectrum of MR imaging findings in Wernicke encephalopathy: Are atypical areas of involvement only present in nonalcoholic patients? AJNR Am J Neuroradiol 2012;33(7):1398-402. Sugai A, Kikugawa K. Atypical MRI findings of Wernicke encephalopathy in alcoholic patients. AJR Am J Roentgenol 2010;195(5):W372-3. Sechi G, Serra A. Wernicke's encephalopathy: New clinical settings and recent advances in diagnosis and management. Lancet Neurol 2007;6(5):442-55.