Wernicke's encephalopathy: is diffusion-weighted MRI useful?

We present the clinical and magnetic resonance imaging (MRI) findings of five patients with acute Wernicke's encephalopathy. T2-weighted and fluid-attenuated inversion recovery (FLAIR) images demonstrated symmetrical hyperintense lesions within the dorsomedial thalami, periaqueductal white matter, and the tectum of the midbrain. None of the lesions enhanced with gadolinium. In addition to conventional MRI sequences, we performed diffusion-weighted imaging (DWI). In all patients, DWI showed symmetrical pathologic thalamic and midbrain signal hyperintensities more distinctly than did conventional T2-weighted or FLAIR sequences. The apparent diffusion coefficient (ADC) map images showed slight signal reductions in four patients, suggesting restricted diffusion within these regions. In one patient, the signal intensity within the affected thalami was isointense with the ipsilateral basal ganglia on ADC map images. For enhanced detection of pathology, we conclude that DWI should be included in the imaging protocols of patients suspected to suffer from Wernicke's encephalopathy.