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Age: 66

Sex: Female

Indication: Encephalopathy

Save ("V")

Case #14


Findings

  • T2/FLAIR signal hyperintensity in the bilateral periaqueductal gray matter, medial thalami, hypothalamus, and possibly mamillary bodies
  • Scattered T2/FLAIR hyperintensities in the periventricular and subcortical white matter
  • Incidental right cerebellar developmental venous anomaly
  • Extraaxial lesion along the lateral aspect of the right temporal lobe with low signal on all sequences


Diagnosis

  • Wernicke encephalopathy

Sample Report

T2/FLAIR signal hyperintensity in the bilateral periaqueductal gray matter, medial thalami, hypothalamus, and possibly mamillary bodies. Though nonspecific, this distribution of signal abnormality raises particular concern for Wernicke encephalopathy. No evidence of acute ischemia.

Scattered T2/FLAIR hyperintensities in the periventricular and subcortical white matter, which though nonspecific are commonly attributable to chronic small vessel disease.

Extraaxial lesion along the lateral aspect of the right temporal lobe with low signal on all sequences, likely representing bulky dystrophic calcification. Consider postcontrast imaging to assess for associated enhancing mass.


Discussion

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Images

Wernicke encephalopathy: abnormal FLAIR signal hyperintensity in the periaqueductal gray matter of the midbrain (red arrow), involving the hypothalamus (yellow arrows), and involving the bilateral medial thalami (blue arrows).



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