What is the role of imaging studies in the evaluation of Wernicke-Korsakoff syndrome (WKS)?

Updated: May 16, 2018
  • Author: Glen L Xiong, MD; Chief Editor: David Bienenfeld, MD  more...
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Computed tomography (CT) scanning can help in the rapid assessment for hemorrhage, mass effect, edema, and large, subacute stroke.

MRI of the brain with contrast

MRI can be a useful confirmatory in cases in which there is a clinical suspicion or a diagnostic procedure in patients presenting with a suggestive history and stupor or coma, in whom ataxia and ophthalmoplegia are not detectable. The possible diagnosis of Wernicke-Korsakoff syndrome should be communicated to the radiologists prior to ordering the scan to confirm that protocols suitable for the highest-yield imaging of the mammillary bodies, hippocampus, medial thalami, periaqueductal region, and the tectum of the midbrain are used. While specificity of MRI findings is high, the sensitivity is not; one study reported 53%. [42] Nevertheless, early diagnosis of WKS using MRI (T2 and FLAIR hyperintensities) in typical locations (thalami, mammillary bodies, tectal plate, and peraqueductal area) and atypical locations (cerebellum, cranial nerve nuclei, and cerebral cortex) has been proposed. [43]

As opposed to structural lesions and necrosis of the mammillary bodies, another study compared 9 patients with chronic Wernicke encephalopathy to 7 patients with Alzheimer disease and 37 controls. They found that 78% (7) of the chronic Wernicke patients had smaller mammillary bodies than 36 of 37 controls and 7 of 7 Alzheimer patients. The decrease was not related to age or ventricular size and is consistent with previous reports of autopsy findings. [44]

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