Isolated abnormalities in the mamillary bodies on MRI in a patient with Wernicke’s encephalopathy

Excerpt

A 48-year-old woman with a history of alcohol abuse presented at the emergency department (ED) with confusion, progressive gait disturbance, nausea, and vomiting since 2 weeks. She had history of alcohol-related diarrhea since 3 months. Neurological examination revealed apathy, impaired recent memory, dysarthria, bilateral dysmetria, and truncal ataxia. Mild proximal muscle weakness (grade 4/5) was noted. Deep tendon reflexes were hypoactive. There was no dysmetria or dysdiadochokinesia. Brain magnetic resonance imaging (MRI) revealed mild hyperintensity of the mammillary bodies with higher prominence on the right side on T2-weighted and fluid-attenuated inversion recovery (FLAIR) images. In addition, marked contrast enhancement was seen in the right mammillary body. Increased signal intensity of the right mammillary body was present on diffusion-weighted images (DWI) (Fig. 1). There was no reduced apparent diffusion coefficient (ADC) value compatible with restricted diffusion, however. Patient’s history, clinical signs, and MRI findings were consistent with the diagnosis of Wernicke’s encephalopathy (WE). Intravenous thiamine (200 mg, drip 3 times a day) was immediately administered. Her clinical features dramatically improved.

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