Neuromyelitis Optica Spectrum Disorders Resembling Wernicke's Encephalopathy: A Case Report and Review of Literature

Abstract

Both neuromyelitis optica spectrum disorder (NMOSD) and Wernicke's encephalopathy (WE) involve brain lesions. However, their treatments are quite different. In this report, we describe the case of a 29-year-old woman with NMOSD, who presented with clinical and imaging findings similar to those of WE. She was admitted to our hospital with a headache, vomiting, and loss of appetite for two weeks and diplopia for nine days. Magnetic resonance imaging revealed lesions in the area postrema, periaqueductal gray matter, thalamus, and right frontal lobe. Vitamin B1 supplementation was ineffective. The patient was diagnosed with NMOSD because serum aquaporin-4 antibody was detected after admission. Her symptoms improved with immunotherapy. The possibility of NMOSD should be considered in patients with suspected WE.

Keywords: brain diseases; encephalopathy; immunotherapy; neuromyelitis optica; radiology; wernicke encephalopathy.

Figure 1. Magnetic resonance imaging findings

Fluid-attenuated inversion recovery images show high-signal lesions in the bilateral area postrema (arrowhead in A), bilateral periaqueductal gray matter (arrowheads in B), bilateral medial thalamus (arrowheads in C), and medial part of the right frontal lobe (arrowhead in D). Diffusion-weighted imaging shows high-signal lesions in the bilateral medial thalamus (arrowheads in E), although no contrast enhancement (arrowhead in F).