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Case Reports
. 2022 May 7;17(7):2424-2427.
doi: 10.1016/j.radcr.2022.04.004. eCollection 2022 Jul.

Cervical cord lesions in Wernicke's encephalopathy

Sho Ishikawa  1 , Kumiko Ando  1 , Takashi Katakami  2 , Michi Kawamoto  2
Affiliations
Case Reports

Cervical cord lesions in Wernicke's encephalopathy

Sho Ishikawa et al. Radiol Case Rep. .

Abstract

A 30-year-old woman suffering from an eating disorder and alcoholism presented with a progressively worsening gait disturbance lasting 2 weeks. Her neurological findings included impaired ocular motility and trunk ataxia. Fluid-attenuated inversion recovery imaging of the brain showed hyperintensity in the dorsal brainstem, aqueduct, thalamus, and cerebral cortex. A long hyperintense segment on T2-weighted imaging was visible in the central gray matter of the cervical spinal cord. No restricted diffusion was observed; thus, T2 elongation in the spine was suggested to be due to vasogenic edema. We diagnosed the patient with Wernicke's encephalopathy and initiated vitamin supplementation. Thereafter, her symptoms rapidly improved; magnetic resonance imaging on the 11th day of hospitalization showed normalization of the signals in her brain and spinal cord. As our case demonstrates, Wernicke's encephalopathy can induce vasogenic edema of the spinal cord, which can rapidly improve with early therapeutic intervention.

Keywords: FLAIR; MRI; Spinal lesion; Vasogenic edema; Wernicke's encephalopathy.

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Figures

Fig. 1
Fig. 1
Brain magnetic resonance imaging (MRI) before treatment. Axial fluid-attenuated inversion recovery (FLAIR) imaging (TR: 8000 msec, TE: 116 msec, TI: 2500 msec, FA: 170, slice thickness: 5.0 mm) of the brain showed hyperintensities in the dorsal medulla oblongata (A) (arrow), periventricular gray matter surrounding third ventricle (B) (arrow), thalamus (C) (arrow), and cerebral cortex (D) (arrows). These lesions showed no water diffusion restriction (not shown).
Fig. 2
Fig. 2
Cervical spine magnetic resonance imaging (MRI) before treatment. Sagittal (TR: 4000 msec, TE: 91 msec, slice thickness: 4.0 mm) and axial (TR: 3610 msec, TE: 82 msec, slice thickness: 4.0 mm) T2-weighted imaging of MRI of the cervical spine (A, D) showed longitudinal hyperintensity in the central gray matter of the spinal cord (arrows). The lesion showed hyperintensity on sagittal diffusion-weighted imaging (TR: 3100 msec, TE: 78 msec, slice thickness: 4.0 mm, b = 600 s/mm2) with a high apparent diffusion coefficient (B, C).
Fig. 3
Fig. 3
Cervical magnetic resonance imaging (MRI) 11 days after treatment. Sagittal and axial T2-weighted imaging of cervical spine showed regression of hyperintensities in the cervical spine (A, B).
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