Persistence of disturbed thalamic glucose metabolism in a case of Wernicke-Korsakoff syndrome.
We report the case of a 40-year-old alcoholic male patient, hospitalized with an acute ataxia of stance and gait, ocular muscle weakness with nystagmus and a global apathetic-confusional state. After admission, an amnestic syndrome with confabulation was also observed and diagnosis of Wernicke-Korsakoff syndrome was made. Under treatment with intravenous thiamine, the patient recovered completely from gaze weakness and ataxia, whereas a severe amnestic syndrome persisted. Fluorodeoxyglucose (FDG) positron emission tomography (PET) showed bilateral thalamic and severe bilateral temporal-parietal hypometabolism resembling a pattern typical for Alzheimer's disease. Longitudinal assessment of the alcohol-abstinent and thiamine-substituted patient revealed improvements of clinical state and neuropsychological performance that were paralleled by recovered cerebral glucose metabolism. In contrast to metabolic rates that increased between 7.1% (anterior cingulate, left) and 23.5% (parietal, left) in cortical areas during a 9-month remission period, thalamic glucose metabolism remained severely disturbed over time (change: left +0.2%, right +0.3%).
Fellgiebel
Andreas
A
Department of Psychiatry, University Hospital of Mainz, Untere Zahlbacher Str. 8, Mainz, Germany. fellgiebel@psychiatrie.klinik.uni-mainz.de
Scheurich
Armin
A
Siessmeier
Thomas
T
Schmidt
Lutz G
LG
Bartenstein
Peter
P
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D002540:Cerebral Cortex / Q000000981:diagnostic imaging / Q000187:drug effects; D004292:Dominance, Cerebral / Q000502:physiology; D019788:Fluorodeoxyglucose F18; D006179:Gyrus Cinguli / Q000000981:diagnostic imaging / Q000187:drug effects; D006801:Humans; D007091:Image Processing, Computer-Assisted; D020915:Korsakoff Syndrome / Q000000981:diagnostic imaging* / Q000188:drug therapy; D008297:Male; D009460:Neurologic Examination; D009483:Neuropsychological Tests; D013788:Thalamus / Q000000981:diagnostic imaging* / Q000187:drug effects; D013831:Thiamine / Q000008:administration & dosage; D014055:Tomography, Emission-Computed
D001786:Blood Glucose; D019788:Fluorodeoxyglucose F18; D013831:Thiamine