Esiste impregnazione contrastografica nell'encefalopatia di Wernicke in fase acuta? Descrizione di 3 casi e revisione della letteratura

Abstract

MR imaging enabled diagnosis of Wernicke's encephalopathy by showing symmetric areas of increased signal intensity on proton density and T2 weighted images in the periaqueductal gray matter, mammillary bodies, medial thalami and pericentral and interhemispheric cerebral cortex in three non-alcoholic patients who were examined within 3 days of admission for acute confusional state associated with ophthalmoparesis and ataxia. In two patients the initial examination was completed with intravenous contrast administration and no lesion enhancement was seen. In the third patient computed tomography 10 days after the initial MR imaging study showed marked contrast enhancement of the lesions. Our data and a review of the literature indicate that lesion contrast enhancement presumably reflecting disruption of the blood brain barrier may be lacking in the early phases of Wernicke's encephalopathy. Acquisition and careful evaluation of long TR images is crucial to the diagnosis of Wernickes encephalopathy with MR imaging in the acute phase.