title: Non-alcoholic acute Wernicke's encephalopathy: role of MRI in non typical cases.
abstract: OBJECTIVE
  Acute Wernicke's encephalopathy (WE) is a severe neurological disorder caused by thiamine deficiency, most commonly found in chronic alcoholics. It is not so easy to suspect acute WE when the clinical picture does not include all the typical symptoms and alcohol abuse is not reported. Three rare cases of Wernicke's encephalopathy (WE) in non-alcoholic patients are reported.
  
  
  METHODS
  Two patients developed the disease following prolonged intravenous feeding, the third was carrying a gastric lymphoma. None of them presented with the classic clinical triad of WE (ophtalmoplegia/nystagmus, ataxia and consciousness disturbance), showing just one or two of the typical symptoms. Brain Magnetic Resonance Imaging (MRI) represented the key tool to suspect and define WE diagnosis, showing a picture characterized by bilaterally altered signal of the thalamic pulvinar, mesencephalic cup, mammillary bodies, periaqueductal grey matter and floor of fourth ventricle. All patients dramatically improved within 48 h after administration of thiamine.
  
  
  CONCLUSIONS
  We emphasize that WE should be suspected in all patients showing typical MRI features presenting with at least one of the clinical triad of WE.
authors.affiliation: Department of Neuroradiology, University of Naples "Federico II", Naples, Italy. aelefant@unina.it
authors.forename: Andrea
authors.initials: A
authors.lastname: Elefante
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Puoti
authors.forename: Rossana
authors.initials: R
authors.lastname: Senese
authors.forename: Cinzia
authors.initials: C
authors.lastname: Coppola
authors.forename: Carmela
authors.initials: C
authors.lastname: Russo
authors.forename: Fabio
authors.initials: F
authors.lastname: Tortora
authors.forename: Oreste
authors.initials: O
authors.lastname: de Divitiis
authors.forename: Arturo
authors.initials: A
authors.lastname: Brunetti
mesh_terms: D000208:Acute Disease; D000368:Aged; 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 / Q000473:pathology*