0:01

I am showing you three different cases of thiamine

0:05

deficiency, for which I was consulted as a medical-legal

0:09

expert because the radiologist did not recognize this

0:14

pattern as representative of thiamine deficiency,

0:18

and all three patients went on to permanent

0:21

neurologic damage in Wernicke-Korsakoff psychosis.

0:25

Here's case number one, where you see dramatic

0:28

periaqueductal gray matter high signal

0:30

intensity on FLAIR imaging, as well

0:33

as involvement of the mammillary bodies.

0:38

Here you see bilateral symmetrical medial

0:42

thalamic high signal intensity on T2-weighted

0:45

scan, as well as diffusion-weighted imaging.

0:47

Now, the differential diagnosis in this case is

0:51

artery of Percheron infarction from the basilar artery.

0:55

This is a branch of the basilar artery, which

0:59

will go bilaterally to supply the medial thalamus.

1:02

And that was what was suggested in this case.

1:05

Unfortunately, this was another bariatric

1:08

surgery patient who had thiamine deficiency,

1:10

not an artery of Percheron infarction.

1:13

So the diffusion-weighted scan was positive, but not from

1:18

infarction, but from cytotoxic edema secondary to

1:22

thiamine deficiency.

1:23

And finally, this is the third

1:25

case for which I was consulted.

1:27

It shows bilateral thalamic high signal intensity.

1:30

This was interpreted by the radiologist as being

1:33

a lymphoma. It did not show contrast enhancement.

1:37

There is no mass effect.

1:39

And in point of fact, this

1:40

patient had thiamine deficiency.

1:42

So be wary of this diagnosis.

1:45

It is a diagnosis that radiologists should

1:48

be able to recognize by pattern recognition

1:52

and suggest the diagnosis.

1:55

So thiamine deficiency: bilateral symmetric,

1:58

typically involving the mammillary bodies,

2:00

the periaqueductal gray matter, and the medial thalamus.

2:03

Sometimes the frontal regions. Late cerebellar

2:06

atrophy. Readily reversible before Wernicke-Korsakoff

2:12

psychosis if it's recognized within days to weeks.

Thiamine Deficiency

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