QUIZ: No. 29, 04/10/2025

MRI

MRI

MRI

ANS – Wernicke encephalopathy

Wernicke encephalopathy is the acute form, which classically presents with a triad of acute confusion, ataxia, and ophthalmoplegia. 

Symmetric T2/FLAIR hyperintensity in:

Medial thalami (most common)

Mammillary bodies

Periaqueductal gray matter

Tectal plate

Around the third ventricle

These areas are around the ventricular system and have high thiamine requirement, explaining the selective vulnerability.

Treatment of acute Wernicke encephalopathy is with intravenous thiamine hydrochloride, along with other vitamins/minerals, and treatment of the underlying cause 

Take home points

Always suspect WE in an altered sensorium with alcoholism or malnutrition.

MRI shows symmetric periventricular grey matter involvement.

Early imaging + clinical correlation prevents chronic sequelae.