[Gayet-Wernicke encephalopathy: clinical features and radiological anomalies]

Abstract

Gayet Wernicke encephalopathy (EGW) is a neurological emergency secondary to thiamine deficiency (vitamin B1). This is more often secondary to chronic alcoholism. The purpose of this study is to remind clinicians of some clinical signs different from ethylism, suggesting EGW as well as to report four cases characterized by different types of anomalies shown by MRI. The average age of patients was 40 years (2 females 2 males). The neurological picture was characterized by disorders of vigilance in all patients, oculomotor disorders in 2 cases, and cerebellar ataxia in one patient. Chronic vomiting was reported in two cases, prolonged fasting in the first case and alcoholism in the second case. MRI of the brain showed anomalies suggesting EGW in all patients with contrast enhancement in one case. Thiamin deficiency was confirmed in two patients. In our context EGW seems to be more frequent in pathological circumstances other than chronic alcoholism (chronic vomiting, severe malnutrition, severe starvation, and chemotherapy...). The clinical signs can suggest other pathologies such as cerebral venous thrombosis, stroke, or other metabolic disorders but MRI excluded them and allowed the diagnosis of EGW. MRI of the brain has an essential role in the diagnosis of EGW. Absence or delay in treatment may influence the prognosis.

Keywords: Gayet Wernicke encephalopathy; MRI anomalies; clinical; context.

Figure 1

IRM cérébrale axiale FLAIR (A), diffusion (B) montrant des lésions en hypersignal bilatérales et symétriques de la région paramédiane des thalami, periacqueducale et des tubercules mamillaires. L’angio-MR veineuse (C) est normale

Figure 2

IRM cérébrale en coupe axiale T2 (A) et coronale FLAIR (B) et Diffusion (C) montrant un hypersignal mésencephalique périacqueducal et autour du 3^e ventricule avec restriction de la diffusion

Figure 3

IRM cérébrale montrant un hypersignal T2 (A) et FLAIR (B) bilatéral symétriques des 2 thalamis, des régions périventriculaires, des parois du 3^e ventricule et des tubercules mamillaires avec discrète prise de contraste de la région périaqueducale

Figure 4

IRM cérébrale en coupe axiale FLAIR (A) et coronale T2 (B) montrant un hypersignal cortical frontal bilatéral symétrique, périaqueducal, des thalami. Il y a une restriction de la diffusion (C) des lésions thalami et discrète rehaussement périaqueducal (D)