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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">D.G. Na</span> and <span class="highwire-citation-author" data-delta="1">E. Kim</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">October 2008,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">29 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(9) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">e85; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A1145 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-8311--6523573942" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">D.G. Na </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=D.G.%2BNa%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Na%20D&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AD.G.%2BNa%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">E. Kim </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=E.%2BKim%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Kim%20E&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AE.%2BKim%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article fulltext-view"><span class="highwire-journal-article-marker-start"></span><p id="p-1">We thank Drs. Zuccoli, Pipitone, and Cruz for their interest in our recent article regarding MR imaging features of metronidazole-induced encephalopathy (MIE).<sup><a id="xref-ref-1-1" class="xref-bibr" href="#ref-1">1</a></sup> Although the exact mechanisms of MIE and Wernick encephalopathy (WE) are not elucidated, we agree with the opinion that MIE may be mediated by pathogenic pathways similar to those thought to be operating in WE.</p><p id="p-2">In our article, we reported that the brain lesions of MIE were typically located at the cerebellar dentate nucleus, midbrain, dorsal pons, medulla, and splenium of the corpus callosum. The recently published case reports of WE show lesions in the cerebellar dentate<sup><a id="xref-ref-2-1" class="xref-bibr" href="#ref-2">2</a>,<a id="xref-ref-3-1" class="xref-bibr" href="#ref-3">3</a></sup> and focal tegmental lesions of low pons,<sup><a id="xref-ref-3-2" class="xref-bibr" href="#ref-3">3</a>,<a id="xref-ref-4-1" class="xref-bibr" href="#ref-4">4</a></sup> which we described as characteristic lesion locations of MIE and controversial atypical MR features of WE in the article.<sup><a id="xref-ref-1-2" class="xref-bibr" href="#ref-1">1</a></sup> These recent reports<sup><a id="xref-ref-2-2" class="xref-bibr" href="#ref-2">2</a>–<a id="xref-ref-4-2" class="xref-bibr" href="#ref-4">4</a></sup> suggest that the MR imaging feature of bilateral symmetric involvement of dentate nuclei and cranial nerve nuclei may be found in WE, as well as in MIE. However, in these WE cases,<sup><a id="xref-ref-2-3" class="xref-bibr" href="#ref-2">2</a>–<a id="xref-ref-4-3" class="xref-bibr" href="#ref-4">4</a></sup> there was involvement of at least one of medial thalamus, mammillary body, or pericentral cortices, which were well-documented MR features in WE but were not reported in MIE. Therefore, although 2 diseases of MIE and WE may share the similar pathogenic pathways for metabolic pathology and similar MR features in the cerebellum and brain stem, the analysis of lesion distribution on MR images may still be useful in distinguishing MIE from WE.</p><div class="section ref-list" id="ref-list-1"><h2>References</h2><ol class="cit-list"><li><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1 in text" id="ref-1">↵</a><div class="cit ref-cit ref-other" id="cit-29.9.e85.1" data-doi="10.3174/ajnr.A0655"><div class="cit-metadata"><cite>Kim E, Na DG, Kim EY, et al. <strong>MR imaging of metronidazole-induced encephalopathy: lesion distribution and diffusion-weighted imaging findings.</strong> <span class="cit-source">AJNR Am J Neuroradiol</span> <span class="cit-pub-date">2007</span>;<span class="cit-vol">28</span>:<span class="cit-fpage">1652</span>–58</cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpuciI7czo1OiJyZXNpZCI7czo5OiIyOC85LzE2NTIiO3M6NDoiYXRvbSI7czoxOToiL2FqbnIvMjkvOS9lODUuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-2-1" title="View reference 2 in text" id="ref-2">↵</a><div class="cit ref-cit ref-other" id="cit-29.9.e85.2" data-doi="10.1016/j.clineuro.2005.05.010"><div class="cit-metadata"><cite>Liu YT, Fuh JL, Lirng JF, et al. <strong>Correlation of magnetic resonance images with neuropathology in acute Wernicke's encephalopathy.</strong> <span class="cit-source">Clin Neurol Neurosurg</span> <span class="cit-pub-date">2006</span>;<span class="cit-vol">108</span>:<span class="cit-fpage">682</span>–87</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1016/j.clineuro.2005.05.010&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=15992992&amp;link_type=MED&amp;atom=%2Fajnr%2F29%2F9%2Fe85.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-3-1" title="View reference 3 in text" id="ref-3">↵</a><div class="cit ref-cit ref-other" id="cit-29.9.e85.3"><div class="cit-metadata"><cite>Zuccoli G, Motti L. <strong>Atypical Wernicke's encephalopathy showing lesions in the cranial nerve nuclei and cerebellum.</strong> <span class="cit-source">J Neuroimaging</span> <span class="cit-pub-date">2008</span>;<span class="cit-vol">18</span>:<span class="cit-fpage">194</span>–97</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=18298680&amp;link_type=MED&amp;atom=%2Fajnr%2F29%2F9%2Fe85.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-4-1" title="View reference 4 in text" id="ref-4">↵</a><div class="cit ref-cit ref-other" id="cit-29.9.e85.4" data-doi="10.1111/j.1399-6576.2005.00879.x"><div class="cit-metadata"><cite>Nolli M, Barbieri A, Pinna C, et al. <strong>Wernicke's encephalopathy in a malnourished surgical patient: clinical features and magnetic resonance imaging.</strong> <span class="cit-source">Acta Anaesthesiol Scand</span> <span class="cit-pub-date">2005</span>;<span class="cit-vol">49</span>:<span class="cit-fpage">1566</span>–70</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1111/j.1399-6576.2005.00879.x&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=16223408&amp;link_type=MED&amp;atom=%2Fajnr%2F29%2F9%2Fe85.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li></ol></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">Copyright © American Society of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 29</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 9 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">October 2008 </div></div>
      
      
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