Atypical Cerebellar Vermis Signal Abnormality in Wernicke Encephalopathy

Wernicke encephalopathy is classically associated with signal changes involving the mamillary bodies, medial thalami, and periaqueductal gray matter on MRI. We present a case of a 57-year-old woman with progressive Wernicke encephalopathy with imaging abnormalities in the cerebellar vermis and bilateral cerebellar hemispheres. This case highlights atypical imaging features that can be seen in Wernicke encephalopathy and emphasizes the importance of early clinical recognition to prevent progression.