title: Spectrum of MR imaging findings in Wernicke encephalopathy: are atypical areas of involvement only present in nonalcoholic patients?
abstract: OBJECTIVE
  Although MR imaging is considered the most effective method to confirm a diagnosis of WE, MR imaging studies designed to distinguish WE between NA and AL patients have yielded controversial results. The purpose of this study was to determine potential differences in MR imaging features between AL and NA patients with WE and to compare neurologic symptoms with MR imaging findings.
  
  
  METHODS
  This retrospective study included 24 consecutive patients (male/female, 15:9; mean age, 54 years) diagnosed with WE in a university hospital (AL = 13, NA = 11). Clinical manifestations and MR imaging findings between AL and NA patients were evaluated. Classic WE symptom triad and consciousness level and MR imaging findings were scored and compared with each other. Statistical analyses were performed with χ(2), Fisher exact, and Spearman tests.
  
  
  RESULTS
  No differences were observed regarding the areas of hyperintense signal intensity on FLAIR imaging and enhancement of the mammillary bodies between AL and NA patients (P > .05). Frequent sites of involvement were the medial thalami (86%), dorsal medulla (82%), tectal plate (77%), and the periaqueductal gray matter (75%). A positive association was found between the consciousness levels of the patients and the involvement of atypical sites (P = .01). Only 4 of the 24 patients (17%) had all 3 symptoms of the classic WE symptom triad.
  
  
  CONCLUSIONS
  MR imaging features of WE may not be different between AL and NA patients. The medulla is 1 of the most frequently involved sites, and consciousness level is also associated with atypical site involvement.
authors.affiliation: Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea.
authors.forename: N D
authors.initials: ND
authors.lastname: Ha
authors.forename: Y C
authors.initials: YC
authors.lastname: Weon
authors.forename: J C
authors.initials: JC
authors.lastname: Jang
authors.forename: B S
authors.initials: BS
authors.lastname: Kang
authors.forename: S H
authors.initials: SH
authors.lastname: Choi
mesh_terms: D000437:Alcoholism / Q000150:complications* / Q000473:pathology*; D001921:Brain / Q000473:pathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014899:Wernicke Encephalopathy / Q000150:complications* / Q000473:pathology*