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CC BY 4.0 · Arq Neuropsiquiatr 2023; 81(08): 776
DOI: 10.1055/s-0043-1770347
Images in Neurology

Nonalcoholic Wernicke encephalopathy with petechial hemorrhage in the tectal region

Encefalopatia de Wernicke não alcoólica com hemorragia petequial na região tectal
Gabriel de Deus Vieira 
1   Universidade de Campinas, Departamento de Neurologia, Campinas SP, Brazil.
,
Augusto Celso Scarparo Amato Filho 
2   Universidade de Campinas, Departamento de Neuroradiologia, Campinas SP, Brazil.
,
Alfredo Damasceno 
1   Universidade de Campinas, Departamento de Neurologia, Campinas SP, Brazil.
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A 39-year-old woman, after an episode of acute appendicitis, developed necrosis and intestinal obstruction, requiring colectomy and ileostomy. After hospital discharge, she had a high output through the ileostomy and low food intake. A few months later, she developed bilateral nystagmus, ataxic syndrome and difficulty concentrating. Susceptibility weighted imaging (SWI) sequence of the brain magnetic resonance imaging (MRI) showed hypointensities in the mammillary bodies and inferior colliculi, which might represent microbleeds ([Figure 1]).

Zoom Image
Figure 1 SWI sequence: focal hypointensities in the mammillary bodies (straight arrow) and mesencephalic quadrigeminal plate, notably in the inferior colliculi (sharp arrows).

Wernicke encephalopathy (WE) usually affects the mamillary bodies, thalami, and periaqueductal region. Rare hemorrhagic manifestations are reported in the literature, most in the mamillary bodies. The breakdown of the blood-brain barrier may contribute to this petechial hemorrhage in WE.[1] [2]


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Conflict of Interest

The authors have no conflict of interest to declare.

Authors' Contributions

All authors contributed equally to the present work.


  • References

  • 1 Zuccoli G, Santa Cruz D, Bertolini M. et al. MR imaging findings in 56 patients with Wernicke encephalopathy: nonalcoholics may differ from alcoholics. AJNR Am J Neuroradiol 2009; 30 (01) 171-176
    CrossrefPubMedGoogle Scholar
  • 2 Hattingen E, Beyle A, Müller A, Klockgether T, Kornblum C. Wernicke encephalopathy: SWI detects petechial hemorrhages in mammillary bodies in vivo. Neurology 2016; 87 (18) 1956-1957
    CrossrefPubMedGoogle Scholar

Address for correspondence

Gabriel de Deus Vieira

Publikationsverlauf

Eingereicht: 05. Januar 2023

Angenommen: 25. Februar 2023

Artikel online veröffentlicht:
30. August 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Zuccoli G, Santa Cruz D, Bertolini M. et al. MR imaging findings in 56 patients with Wernicke encephalopathy: nonalcoholics may differ from alcoholics. AJNR Am J Neuroradiol 2009; 30 (01) 171-176
    CrossrefPubMedGoogle Scholar
  • 2 Hattingen E, Beyle A, Müller A, Klockgether T, Kornblum C. Wernicke encephalopathy: SWI detects petechial hemorrhages in mammillary bodies in vivo. Neurology 2016; 87 (18) 1956-1957
    CrossrefPubMedGoogle Scholar

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Zoom Image
Figure 1 SWI sequence: focal hypointensities in the mammillary bodies (straight arrow) and mesencephalic quadrigeminal plate, notably in the inferior colliculi (sharp arrows).