Cenk ERASLAN, Ayşe GÜLER, Erman KURT, Cem ÇALLI, Ömer KİTİŞ

Non-alkolik nedenlere bağlı gelişen Wernicke ensefalopatisinde manyetik rezonans görüntüleme bulguları

Amaç: Wernicke ensefalopatisi (WE) tiamin (vitamin B1) eksikliğine bağlı olarak gelişen nöropsikiyatrik bir hastalıktır. Sıklıkla kronik alkolizme bağlı olarak görülmekle birlikte tiamin alım veya emilim eksikliğine neden olan her türlü durumda ortaya çıkabilir. Bu çalışmanın amacı tedavi edilmediği takdirde ölüme kadar giden ciddi sonuçlar doğurabilen bu hastalığın tanı ve izleminde manyetik rezonans görüntülemenin (MRG) önemini vurgulamaktır. Gereç ve Yöntem: Çalışmamıza kurumumuzda hospitalize edilen ve non-alkolik nedenlerle WE tanısı alan 10 hasta dahil edildi. Hastaların MRG tetkiklerinde tutulum yerlerinin lokalizasyonuna göre tipik ve atipik bulguların varlığı değerlendirildi. Ayrıca eşlik eden difüzyon kısıtlılığı varlığı araştırıldı. Bulgular: Kraniyal MRG’de tipik tutulum alanları 10 hastada bilateral talamus mediali, 8 hastada bilateral mamiller cisim, 7 hastada periakuaduktal alan/tektal plak olarak tespit edildi. Atipik tutulum alanları ise 5 hastada forniks, 4 hastada serebral korteks, 2 hastada putamen, 1 hastada ise serebellum tutulumu şeklinde idi. 8 hastada bu bulgulara difüzyon kısıtlılığı eşlik etmekteydi. Sonuç: Sunulan çalışmanın sonuçlarına göre, non-alkolik WE tanılı olgularda MRG’de, alkolik WE tanılı olgularla benzer bulgular gözlenmektedir. Bu hastaların tanı ve tedavilerinin gecikmemesi amacıyla MR görüntülemenin kullanımının önemli rol oynadığı sonucuna varılmıştır.

Magnetic resonance imaging findings of Wernicke’s encephalopathy in non-alcoholic patients

Aim: Wernicke encephalopathy (WE) is a neuropsychiatric disease that develops due to the deficiency of thiamine (vitamin B1). It is often observed due to chronic alcoholism; however it can arise in any condition that causes deficiency in the intake or absorption of thiamine. The aim of this study is to emphasize the importance of magnetic resonance imaging (MRI) in the diagnosis and follow-up of this disease which can even lead to death when it is not treated. Materials and Methods: Ten patients, who had been hospitalized in our institution and diagnosed as WE due to non-alcoholic reasons, were included in our study. In the MRI examinations of the patients, typical and atypical findings were evaluated according to the localization of involvement areas. The existence of accompanying diffusion restriction was evaluated. Results: Typical involvement areas in cranial MRI were determined as bilateral medial thalamus in 10 patients, bilateral mammillary bodies in 8 patients, periaqueductal area/tectal plate in 7 patients. Atypical involvement areas were determined as fornix in 5 patients, cerebral cortex in 4 patients, putamen in 2 patients and cerebellum involvement in 1 patient. These findings were accompanied by diffusion restriction in 8 patients. Conclusion: According to the results of the presented study, cranial MRI has similar findings in alcoholic and nonalcoholic WE patients. We conclude that, the utilization of cranial MRI in these patients has an important role to prevent the latency of the diagnosis and treatment.

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