[Unusual cortical compromise in a case of Wernicke's encephalopathy].
BACKGROUND
Wernicke's encephalopathy (WE) is a metabolic disease due to thiamine deficiency; only 10% of cases are diagnosed pre-mortem. Symptoms of WE include ophthalmoplegia, nistagmus, ataxia and mental confusion; post-mortem examination shows characteristic symmetrical lesions in the mamillary bodies (MB), hypothalamus, thalamus, brain stem and cerebellum with spongiosis, demyelination, vascular proliferation and relative preservation of neurons.


METHODS
50 years-old male with alcoholic hepatopathy and orthotopic hepatic transplant who suffered a second surgical intervention 10 days after due to problems in the biliar anastomosis. After this second surgery he showed an altered mental status, with fluctuating global confusion, disorientation and agitation. He died 52 days after the hepatic transplantation. Autopsy study showed bilateral broncopneumonia, brown discoloration of the MB and bilateral linear lesions in the cortex of both motor gyri, which histologically showed identical to the MB lesions with demyelination, capillary and glial proliferation and preservation of neurons. Alzheimer type II astrocytes were also found in basal nuclei and cortex.


CONCLUSIONS
Typical WE lesions affect MB, hypothalamus, thalamus, brain stem and cerebellum; cortical lesions, when found, are due to hepatocerebral degeneration with Alzheimer type II astrocytes or to the citopathic effects of ethanol. In our case, cortical lesions were identical to the lesions found in MB, an extraordinary finding which we have not found reported in the literature.
Blanco-Múñez
O
O
Sección de Neuropatología, Departamento de Anatomía Patológica, Hospital Universitario 12 de Octubre, Ctra. Andalucia km. 5,4, E-28045 Madrid, Spain.
Suárez-Gauthier
A
A
Martín-García
H
H
Díaz-Konrad
V
V
San Antonio-Román
V
V
Cabello
A
A
D000437:Alcoholism / Q000150:complications; D002540:Cerebral Cortex / Q000473:pathology*; D017809:Fatal Outcome; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008326:Mammillary Bodies / Q000473:pathology; D008875:Middle Aged; D014899:Wernicke Encephalopathy / Q000139:chemically induced / Q000473:pathology* / Q000503:physiopathology* / Q000601:surgery