A nice article in AJNR 2009; 30: 171 shows that the brain lesions, mostly seen on FLAIR images, are different between patients with Wernicke’s induced by alcohol than that due to dietary restrictions. The abnormalities tend to be more severe in the latter. I recently saw a case that also showed involvement of the cranial nerve nuclei in the midbrain and high signal in the amygdalae. Although the article that I am mentioning here did show brainstem lesions, no lesions in the mesial temporal lobes were seen in any patients. I wonder if perhaps, hypoglycemia is also present in these starved patients and could account for the hippocampal/amygdalar lesions.
Diet-Induced Wernicke’s
We recently saw a case that looked like a Wernicke’s plus — an alcoholic found down with complete arrest, rescuscited in the field. Tox screens negative, got parenteral thiamine 4 hours after arrest. Follow-up scans with lesions in bilateral symmetric globi pallidi (ok, anoxia) but also banks of third vent, periaqueductal grey, bilateral peduncles, and amygdalae…we wondered if D50 given during rescicitation, plus lactic acidosis, all wrapped up in anoxia caused this curious pattern. Has anybody else seen this combination?