Non-alcoholic Wernicke's encephalopathy with atypical brain MRI in setting of severe subacute malnutrition

Abstract

Wernicke encephalopathy (WE) classically presents as encephalopathy, oculomotor dysfunction, and gait ataxia. WE usually occurs in the setting of chronic alcohol use and thiamine insufficiency. MRI imaging generally demonstrates edema of the periaqueductal region of the midbrain, mammillary bodies, and thalamus. Basal ganglia (BG) involvement, more commonly seen in pediatric WE, is classically thought to differentiate pediatric versus adult WE. However, we report a case of adult non-alcoholic WE with both thalamic and BG involvement.