Subscribe to RSS
Download PDF
DOI: 10.1055/s-0045-1810626
Cauda Equina Enhancement in Wernicke Encephalopathy: An Atypical Radiologic Manifestation
Funding None.
Abstract
A 13-year-old female with restrictive eating and associated weight loss presented with progressive neurological decline, including bilateral ptosis, gait disturbance, dysphonia, and hyporeflexia. Brain magnetic resonance imaging revealed T2 and FLAIR (fluid-attenuated inversion recovery) hyperintensities in the medial thalami, periaqueductal gray matter, and mild diffuse cerebral and cerebellar volume loss characteristic of Wernicke encephalopathy (WE). Additionally, smooth enhancement of the cauda equina nerve roots was observed, a finding not usually seen in thiamine (vitamin B1) deficiency. Infectious, metabolic, and autoimmune causes were ruled out, and low serum thiamine levels established WE. This case highlights an atypical radiologic feature of WE—cauda equina enhancement, suggesting broader neurological involvement. Early diagnosis and thiamine repletion therapy are required immediately to prevent long-term neurological damage.
Declaration of GenAI use
During the preparation of this manuscript, AI tool Grammarly was used for grammar correction, language refinement, and editing support. No AI tool was used for the generation of scientific content or interpretation of clinical data. All clinical findings, analysis, and conclusions were authored by the listed authors.
Ethical Approval
Institutional ethics committee approval was obtained for this case report.
Patient's Consent
Informed consent was obtained from the patient's guardian for publication of this case and accompanying images.
Publication History
Article published online:
18 August 2025
© 2025. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
-
References
- 1 Sechi G, Serra A. Wernicke's encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol 2007; 6 (05) 442-455
- 2 Isenberg-Grzeda E, Kutner HE, Nicolson SE. Wernicke-Korsakoff-syndrome: under-recognized and under-treated. Psychosomatics 2012; 53 (06) 507-516
- 3 O'Keeffe ST. Thiamine deficiency in elderly people. Age Ageing 2000; 29 (02) 99-101
- 4 Zuccoli G, Pipitone N. Neuroimaging findings in acute Wernicke's encephalopathy: review of the literature. AJR Am J Roentgenol 2009; 192 (02) 501-508
- 5 Lineback C, Brahmbhatt N, Abbott S. A case of non-alcoholic Wernicke's encephalopathy and dry beri-beri with GI involvement following a period of prolonged gastrointestinal illness (1266). Neurology 2020; 94 (15, Suppl): 1266
- 6 Galvin R, Bråthen G, Ivashynka A, Hillbom M, Tanasescu R, Leone MA. EFNS. EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy. Eur J Neurol 2010; 17 (12) 1408-1418
- 7 Ishikawa S, Ando K, Katakami T, Kawamoto M. Cervical cord lesions in Wernicke's encephalopathy. Radiol Case Rep 2022; 17 (07) 2424-2427
- 8 Ota Y, Capizzano AA, Moritani T, Naganawa S, Kurokawa R, Srinivasan A. Comprehensive review of Wernicke encephalopathy: pathophysiology, clinical symptoms and imaging findings. Jpn J Radiol 2020; 38 (09) 809-820
- 9 Divya MB, Kubera NS, Jha N, Jha AK, Thabah MM. Atypical neurological manifestations in Wernicke's encephalopathy due to hyperemesis gravidarum. Nutr Neurosci 2022; 25 (10) 2051-2056
- 10 Vasconcelos MM, Silva KP, Vidal G, Silva AF, Domingues RC, Berditchevsky CR. Early diagnosis of pediatric Wernicke's encephalopathy. Pediatr Neurol 1999; 20 (04) 289-294