Nonalcoholic Wernicke encephalopathy with petechial hemorrhage in the tectal region.

A 39-year-old woman, after an episode of acute appendicitis, developed necrosis and intestinal obstruction, requiring colectomy and ileostomy. After hospital discharge, she had a high output through the ileostomy and low food intake. A few months later, she developed bilateral nystagmus, ataxic syndrome and difficulty concentrating. Susceptibility weighted imaging (SWI) sequence of the brain magnetic resonance imaging (MRI) showed hypointensities in the mammillary bodies and inferior colliculi, which might represent microbleeds ([Figure 1]).