ABSTRACT
Wernicke's encephalopathy is a neuropsychiatric condition generally caused by acute thiamine deficiency. Although it is common in the severe alcoholics, several other causes also have been identified, such as total parenteral nutrition (TPN) use, persistent vomiting, hyperemesis gravidarum, anorexia nervosa and malnutrition. The classic triad of Wernicke's encephalopathy are ataxia, altered mentation and ophthalmoplegia. A 19-year-old boy had been treated with high dose Ara-C and mitoxantrone for acute myelogenous leukemia and intravenous hyperalimentation due to persistent vomiting. He suddenly complained of diplopia, gait disturbance and generalized weakness at 36th day after chemotherapy. Physical examinations showed disorientated mentality, oculomotor palsy and horizental nystagmus. The diagnosis of Wernicke's encephalopathy was made with classical brain MRI and decreased thiamine level. The patient was successfully treated with vitamin B1. We presented a case of acute Wernicke's encephalopathy developed after high dose Ara-C chemotherapy followed by intravenous hyperalimentation in a patient with acute myelogenous leukemia.
Subject(s)
Female , Humans , Male , Pregnancy , Young Adult , Alcoholics , Anorexia Nervosa , Ataxia , Brain , Cytarabine , Diagnosis , Diplopia , Drug Therapy , Gait , Hyperemesis Gravidarum , Leukemia, Myeloid, Acute , Magnetic Resonance Imaging , Malnutrition , Mitoxantrone , Ophthalmoplegia , Paralysis , Parenteral Nutrition , Parenteral Nutrition, Total , Physical Examination , Thiamine , Thiamine Deficiency , Vomiting , Wernicke EncephalopathyABSTRACT
In accidental or suicidal methanol ingestion, bilateral necrosis of the putamen and hemispheric white matter lesions are the most common findings on CT and MRI. There are a few reports that have demonstrated abnormal CT findings in methanol intoxication, however, to our knowledge, contrast enhancement of these lesions have not been reported in Korea. We report the case of a 36-year-old male who had a brain MRI performed 3 weeks after accidental methanol intoxication. T2 weighted MRI showed bilateral symmetrical high signal lesions in the frontal lobe and basal ganglia with hemorrhaegic necrosis. A postcontrast MRI demonstrated multifocal enhancing lesions in both frontal lobes, right temporal lobe, both basal ganglias and both cerebellar hemispheres. We suggest that the characteristic brain MRI finding and careful history taking are helpful in diagnosis of methanol intoxication.