Serial MRI and H-1-MRS of Wernicke's encephalopathy: report of a case withremarkable cerebellar lesions on MRI

Before and after the administration of thiamine (vitamin B-1), MRI and prot on magnetic resonance spectroscopy OH-MRS) were serially performed in a pat ient with Wernicke's encephalopathy demonstrating remarkable cerebellar les ions on MRI. Before thiamine administration, high signal intensities were o bserved in the thalamus around the third ventricle and in the superior port ion of the cerebellar vermis and hemisphere on fluid-attenuated inversion r ecovery (FLAIR) and T2-weighted MR images. After thiamine administration, t he high signal intensity in the former region disappeared immediately, whil e that in the latter regions persisted. The low level of N-acetylaspartate (NAA)/creatine (Cr) in the thalamus before thiamine administration improved to some degree on the (1)[H]-MRS images taken after thiamine administratio n. In the cerebellum, a lactate peak was observed before thiamine administr ation, and the NAA/Cr level did not improve after thiamine administration, suggesting that irreversible necrosis occurred. It is suggested that serial MRI/H-1-MRS observation may be helpful in determining the neuronal viabili ty of Wernicke's encephalopathy and the prognostic implications of sequelae , such as Korsakoff's syndrome and cerebellar ataxia. (C) 2001 Elsevier Sci ence Ireland Ltd. All rights reserved.