Purpose or Case Report: Wernicke’s encephalopathy, traditionally a clinical diagnosis, may present a diagnostic conundrum, particularly those cases that do not present with the clinical triad of ataxia, ocular abnormalities, and mental status changes. MR imaging is often employed in the work-up of patients with altered mental status, and although the imaging findings of Wernicke’s encephalopathy are non-specific, suggestion of the diagnosis on imaging in conjunction with clinical findings can enable treatment of a potentially reversible encephalopathy, which may otherwise result in significant morbidity and mortality if the diagnosis is delayed or missed. A case is presented with MR images characteristic of Wernicke's encephalopathy, in which the patient had clinical resolution of her symptoms following thiamine administration. The patient in this case had short gut syndrome complicated by sepsis, which likely contributed to her thiamine deficiency. Given the underdiagnosis of Wernicke's encephalopathy in the pediatric population and the general safety of intravenous thiamine, being able to suggest the diagnosis based on MR imaging can potentially significantly influence patient outcomes.
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