Petechial Hemorrhage in Wernicke Encephalopathy

Excerpt

Wernicke encephalopathy (WE) is a severe neurological disorder due to vitamin B1 deficiency, i.e. thiamine [1]. If untreated WE may turn over to an anamnestic syndrome or Korsakoff psychosis, which represents the irreversible part of the Wernicke-Korsakoff syndrome and causes lifelong severe disability [2]. Therefore, the earliest possible diagnosis and appropriate treatment is essential for prognosis. The typical clinical presentation of WE is the classical triad of oculomotor abnormalities, cerebellar dysfunction with prominent ataxia and an altered mental state up to a global state of confusion [2]; however, retrospective analysis of neurological symptoms and autopsy studies disclosed that only 20% of patients with WE showed the classical clinical triad and 30% had only cognitive impairment [3‐5]. Thus, especially in cases with incomplete or atypical neurological presentations magnetic resonance imaging (MRI) has an important role to establish the diagnosis [6‐9]. MRI often shows bilateral symmetrical lesions in the medial thalami, the hypothalamus, midbrain tectum and tectal plate, the periaqueductal gray and in the mammillary bodies [6‐12]. Infrequently cortical lesions are also reported [13, 14]. Although petechial hemorrhages are a prominent neuropathological feature of the disease and accordingly the first description was as “polioencephalitis hemorrhagica superior” by Wernicke in 1881 [15], a review of the literature yielded only 2 cases with detection of such petechial hemorrhages in vivo [16, 17]. …