Alcohol related encephalopathy

Alcohol related encephalopathy

Wernicke encephalopathy
Clinical features:
- Disorientation
- Gaze paralysis, Nystagmus, Ophthalmoplegia
- Ataxia, Thiamine deficiency

MRI:
- Increased T2/FLAIR: Medial thalami, periaqueductal grey matter, mamillary bodies, tectal plate
- Contrast enhanced: All above EXCEPT Mamillary bodies
- +/- Haemorrhage, Necrosis, Oedema (in acute stage)
- +/- Atrophy of all above Especially Mamillary bodies
(DDx: Leigh disease - Mamillary bodies are not involved in this entity)


Marchifava-Bignami disease
Rare complication of chronic alcoholism
Demyelination + Necrosis of corpus callosum +/- other white matter tracts


Central pontine myelinolysis

Occurs in rapid correction of hyponatremia => Destruction of myelin sheath

Some recover completely, but 6mo survival rate is ~5-10% only

Affects central pons, spare the peripheral rim of pons tissue

Affects basal ganglia, cerebellar white matter, thalami

MRI:

- T1 hypointense, T2 focal  hyperintense

- Restricted diffusion in central pons

- No contrast enhancement