TWO TYPES OF BRAIN LESIONS IN WERNICKE'S ENCEPHALOPATHY

Abstract

Analysis of 46 cases of Wernicke''s encephalopathy showed that the pathological processes in the thalamus and inferior olives were clearly different from those in the mammillary bodies and the subependymal structures along the 3rd and 4th ventricles and the aqueduct. The latter regions showed a progressive destruction of the neuropil with severe endothelial swelling and a definite sparing of the neurons. In the thalamus and inferior olives, by contrast, the reverse was found with neuronal disintegration, sparing of the neuropil, and a mild endothelial swelling. The distintegrating neurons in the thalamus and olives resembled those seen in anoxic necrosis. Careful comparisons indicated a gradual drop out of the neurons in Wernicke''s encephalopathy in contrast to the sudden and simultaneous affection of the neurons in anoxia and the nuclear structure of the affected neurons were better and longer preserved in the Wernicke lesions. The disintegrating neurones in Wernicke''s disease were removed by neuronophagia and, in severe cases, the process led to a widespread neuronal loss in the thalamus and olives. The 2 types of histological processes largely paralleled each other in time and severity and it is suggested that they had the same aetiology.