Wernicke encephalopathy revealing occult gastric adenocarcinoma: Radiological and clinical insights

Q4 Medicine

Radiology Case Reports Pub Date : 2025-09-24 DOI:10.1016/j.radcr.2025.08.078

Hind Qajia MD , Chaimaa Jabbari MD , Salma El Kadiri MD , Saleck Choumad MD , Yassine Eddahoumi MD , Omar El Aoufir PHD , Laila Jroundi PHD

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引用次数: 0

Abstract

Wernicke’s encephalopathy (WE) is an acute neuropsychiatric disorder caused by thiamine deficiency, often underdiagnosed in non-alcoholic patients. We report a rare case of Wernicke encephalopathy in a 60-year-old male presenting with diplopia, dizziness, and gait instability secondary to prolonged vomiting and malnutrition.

Contrast-enhanced thoracoabdominal CT revealed irregular wall thickening of the antropyloric region of the stomach with heterogeneous soft-tissue density and multiple hepatic hypodense lesions showing peripheral enhancement, consistent with metastatic spread. Brain MRI demonstrated symmetric FLAIR hyperintensities involving the medial thalami, mammillary bodies, and periaqueductal gray matter, without diffusion restriction, consistent with Wernicke encephalopathy. Lesions measured 3mm in the mammillary bodies. Prompt administration of thiamine led to rapid clinical improvement.

This case is notable as occult gastric cancer presented primarily through neurological symptoms of WE, highlighting the importance of considering neoplastic causes in non-alcoholic presentations.

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揭示隐蔽性胃腺癌的韦尼克脑病：放射学和临床见解

韦尼克脑病（WE）是一种由硫胺素缺乏引起的急性神经精神疾病，通常在非酒精患者中未被诊断出来。我们报告一例罕见的韦尼克脑病病例，患者为60岁男性，表现为复视、头晕、步态不稳，继发于长期呕吐和营养不良。胸腹CT增强显示胃幽门区不规则壁增厚，软组织密度不均，多发肝低密度病灶外周强化，与转移扩散一致。脑MRI显示对称的FLAIR高信号累及内侧丘脑、乳状体和导尿管周围灰质，无扩散限制，符合韦尼克脑病。乳腺内病变约3mm。及时给予硫胺素导致临床迅速改善。本病例的隐蔽性胃癌主要表现为WE的神经系统症状，强调了在非酒精性表现中考虑肿瘤原因的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Radiology Case Reports Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

1.10

自引率

0.00%

发文量

1074

审稿时长

30 days

期刊介绍： The content of this journal is exclusively case reports that feature diagnostic imaging. Categories in which case reports can be placed include the musculoskeletal system, spine, central nervous system, head and neck, cardiovascular, chest, gastrointestinal, genitourinary, multisystem, pediatric, emergency, women''s imaging, oncologic, normal variants, medical devices, foreign bodies, interventional radiology, nuclear medicine, molecular imaging, ultrasonography, imaging artifacts, forensic, anthropological, and medical-legal. Articles must be well-documented and include a review of the appropriate literature.