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Severe global amnesia presenting as Wernicke–Korsakoff syndrome but resulting from atypical lesions

Published online by Cambridge University Press:  09 July 2009

L. W. Welch ,
A. Nimmerrichter ,
R. Kessler ,
D. King ,
R. Hoehn ,
R. Margolin  and
P. R. Martin
L. W. Welch*
Affiliation:
Departments of Psychiatry and Radiology, Vanderbilt University Medical Center, Nashville, TN, USA
A. Nimmerrichter
Affiliation:
Departments of Psychiatry and Radiology, Vanderbilt University Medical Center, Nashville, TN, USA
R. Kessler
Affiliation:
Departments of Psychiatry and Radiology, Vanderbilt University Medical Center, Nashville, TN, USA
D. King
Affiliation:
Departments of Psychiatry and Radiology, Vanderbilt University Medical Center, Nashville, TN, USA
R. Hoehn
Affiliation:
Departments of Psychiatry and Radiology, Vanderbilt University Medical Center, Nashville, TN, USA
R. Margolin
Affiliation:
Departments of Psychiatry and Radiology, Vanderbilt University Medical Center, Nashville, TN, USA
P. R. Martin
Affiliation:
Departments of Psychiatry and Radiology, Vanderbilt University Medical Center, Nashville, TN, USA
*
1Address for correspondence: Dr Larry W. Welch, Vanderbilt University Medical Center. 1161 21st Avenue South. A2215 MCN, Nashville. TN 37232–2647. USA.
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Synopsis

A female alcoholic presented with Wernicke's encephalopathy subsequent to administration of diazepam and glucose (without thiamine) for treatment of withdrawal seizures. Nystagmus and cerebellar ataxia quickly resolved when administered thiamine, although severe global amnesia consistent with Korsakoffs syndrome persisted. Magnetic resonance imaging (MRI) revealed infarction of the right temporal lobe with hippocampal atrophy, but no lesions of thalamus or atrophy of mammillary bodies. Positron emission tomography (PET) confirmed decreased cerebral metabolic rates for glucose (CMRglu) in the right temporal lobe corresponding to MRI findings, but also significant metabolic asymmetry of dorsal thalamus, i.e reduced CMRglu in left versus right. This patient is unique in that neuroradiological findings revealed intact mammillary bodies and suggest asymmetrical dysfunctions (structural right temporal and functional left diencephalic) to produce her profound amnesia.

Type
Case Report
Information
Psychological Medicine , Volume 26 , Issue 2 , March 1996 , pp. 421 - 425
Copyright
Copyright © Cambridge University Press 1996

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