HYPOXIA-ISCHEMIA AND THIAMINE-DEFICIENCY

In order to test the hypothesis that Wernicke's encephalopathy is of t opographic rather than of pathogenetic specifity we examined the brain s of 49 patients without any evidence of chronic alcoholism. They had died at least four days after an event of severe hypoxia-ischemia. The y all showed extensive lesions in the cortex, in the thalamus and in o ther regions. In 19 of them there was additional necrosis in the mamil lary bodies which apparently was of the same age as the associated cor tical and thalamic lesions and which could not be distinguished from W ernicke's encephalopathy. In three of the 19 cases there was a total n ecrosis within the mamillary bodies. By re-examining the mamillary bod ies of 12 known alcoholics without any evidence for an ischemic impact we could affirm that total necrosis may fit into the spectrum of Wern icke's encephalopathy. Our findings demonstrate that the morphological changes in the mamillary bodies due to thiamine deficiency and those due to hypoxia-ischemia may be identical.