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December 1965

The Hemorrhagic Component of Wernicke's Encephalopathy

Author Affiliations

From the Department of Pathology, New York University School of Medicine and Bellevue Hospital, New York.

Arch Neurol. 1965;13(6):627-632. doi:10.1001/archneur.1965.00470060063006

Wernicke in 1881 reported four cases which he labeled "acute hemorrhagic polioencephalitis superior."1 The pathological lesions in these patients were bilateral and involved the periaqueductal gray matter, the cranial nerve nuclei, and portions of the thalamus and hypothalamus. These lesions described by Wernicke1 consisted of petechial hemorrhages no larger than pinhead size, congested capillaries, and, occasionally, proliferation of capillary endothelium. Macrophages were seen in the vicinity of the hemorrhages. Subsequently, this entity became known simply as Wernicke's disease or Wernicke's encephalopathy, and its principal pathological feature was the presence of bilateral lesions in any or all of the above mentioned sites, most frequently in the mamillary bodies.2-5 Although Wernicke emphasized the presence of minute hemorrhages in his description of the disease and in the name he gave it, later studies disclosed that hemorrhages were often absent and that the lesions also included myelin loss and gliosis in

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