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CC BY 4.0 · Arq Neuropsiquiatr 2023; 81(08): 776
DOI: 10.1055/s-0043-1770347
Images in Neurology

Nonalcoholic Wernicke encephalopathy with petechial hemorrhage in the tectal region

Encefalopatia de Wernicke não alcoólica com hemorragia petequial na região tectal
Gabriel de Deus Vieira 
1   Universidade de Campinas, Departamento de Neurologia, Campinas SP, Brazil.
,
Augusto Celso Scarparo Amato Filho 
2   Universidade de Campinas, Departamento de Neuroradiologia, Campinas SP, Brazil.
,
Alfredo Damasceno 
1   Universidade de Campinas, Departamento de Neurologia, Campinas SP, Brazil.
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A 39-year-old woman, after an episode of acute appendicitis, developed necrosis and intestinal obstruction, requiring colectomy and ileostomy. After hospital discharge, she had a high output through the ileostomy and low food intake. A few months later, she developed bilateral nystagmus, ataxic syndrome and difficulty concentrating. Susceptibility weighted imaging (SWI) sequence of the brain magnetic resonance imaging (MRI) showed hypointensities in the mammillary bodies and inferior colliculi, which might represent microbleeds ([Figure 1]).

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Figure 1 SWI sequence: focal hypointensities in the mammillary bodies (straight arrow) and mesencephalic quadrigeminal plate, notably in the inferior colliculi (sharp arrows).

Wernicke encephalopathy (WE) usually affects the mamillary bodies, thalami, and periaqueductal region. Rare hemorrhagic manifestations are reported in the literature, most in the mamillary bodies. The breakdown of the blood-brain barrier may contribute to this petechial hemorrhage in WE.[1] [2]

Authors' Contributions

All authors contributed equally to the present work.




Publication History

Received: 05 January 2023

Accepted: 25 February 2023

Article published online:
30 August 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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  • References

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