Abstract
Wernicke's encephalopathy (WE) is an acute neuropsychiatric syndrome resulting from thiamine deficiency. Traditionally, diagnosis of WE rests on a clinical symptom triad consisting of ocular signs, altered consciousness, and ataxia. However, the complete triad is only present in a fraction of cases, which means that WE tends to be under-diagnosed, especially in nonalcoholic patients. Brain MRI of WE patients usually shows symmetrical signal intensity alterations in the thalami, mammillary bodies, and periaqueductal area, because of cytotoxic edema in the same region. These typical findings are useful diagnostic leads in WE patients with atypical symptoms. However, atypical findings can occasionally be seen in the vermis of cerebellum and cerebellar nuclei. Notably, alterations of signal intensity in the cerebellar dentate nuclei, which is a typical finding of metronidazole-induced encephalopathy (MIE), need to be distinguished according to medication history and response to thiamine.
담낭암 환자에서 갑작스럽게 발생한 구음장애와 보행실조에 대한 평가를 위해 시행한 뇌자기공명영상에서 치상핵에 국한된 신호강도 변화를 보여 metronidazole 유발성 뇌병증과의 감별이 어려웠으나 thiamine 선제 치료 후 증상과 영상학적 호전을 보여 비정형성 베르니케 뇌병증으로 진단할 수 있었던 증례를 문헌고찰과 함께 보고한다.