Dynamic progression of Wernicke encephalopathy in a gastric cancer patient: Multimodal MRI insights with arterial spin labeling perfusion imaging

ASL may identify perfusion alterations prior to DWI-detectable cytotoxic edema, suggesting a role in WE's early diagnostic algorithm. Rapid lesion progression in high-risk patients necessitates urgent thiamin repletion even without classic symptoms. Neuroimaging findings in WE may exhibit dynamic spatial-temporal evolution, requiring multimodal imaging interpretation. Serum thiamin levels remain critical for diagnostic confirmation in radiologically ambiguous cases.