Dados do Trabalho

Título

Reviewing and recalling the key role of neuroimaging in Wernicke encephalopathy

RESUMO

Case presentation: AMC, 21 years old, 8 weeks pregnant, previously healthy. Admitted to the gynecological emergency care due to repeated vomiting, being diagnosed with hyperemesis gravidarum. On the third day of hospitalization, the neurology team was called due to mental status change. The neurological examination revealed the presence of confusion, multidirectional ophthalmoparesis and ataxia with significant gait alteration. It was decided to measure serum vitamin B1 (thiamine) and request magnetic resonance imaging (MRI) and analysis of the cerebrospinal fluid. The diagnosis of Wernicke encephalopathy was confirmed due to the finding of vitamin B1 deficiency and, mainly, the presence of hypersignal of the mammillary bodies and lesions of the medial thalamus and of the walls of the third ventricle on MRI. The patient showed significant clinical improvement after thiamine replacement. Discussion: Wernicke encephalopathy can occur as a rare complication of hyperemesis gravidarum. MRI plays an important role in elucidating the diagnosis as it presents classic alterations, with the mammillary bodies, medial thalamus and periventricular region of the third ventricle being the typically affected regions. Because it is an acute neurological disease that results from thiamine deficiency, the prognosis of patients depends on the time from the onset of symptoms and the start of supplementation of this vitamin. When the diagnosis and treatment are delayed, Korsakoff psychosis or death may occur. Final comments: Neuroimaging plays a central role in the early diagnosis of this prevalent pathology, which can be reported in up to 36% of patients with acute mental confusion and lead to significant neurological morbidity if not properly managed.