Reversible MRI abnormalities in an unusual paediatric presentation of Wernicke's encephalopathy

Background. We report an unusual paediatric presentation of acute Wernicke' s encephalopathy in a 12-year-old boy affected by chronic gastrointestinal disease. MRI demonstrated, in addition to the typical diencephalic and mese ncephalic signal abnormalities on T2-weighted images, enhancement of the ma mmillary bodies and the floor of the hypothalamus. Materials and methods. Following parenteral administration of thiamine for 4 days, the patient recovered from his neurological deficits and on follow- up enhanced MRI 1 month later, no signal abnormalities were found nor was t here diencephalic or mesencephalic atrophy, as is usual in the chronic phas e of the disease. Results. MRI provides crucial information in the diagnosis of Wernicke's en cephalopathy, either in the acute or chronic phases of the disease. Conclusion. Our report provides an additional clue for recognition of the a cute phase of the disease; enhancement of the floor of the hypothalamus has not previously been described despite its recorded involvement at autopsy.