Before and after the administration of thiamine (vitamin B(1)), MRI and proton magnetic resonance spectroscopy ((1)H-MRS) were serially performed in a patient with Wernicke's encephalopathy demonstrating remarkable cerebellar lesions on MRI. Before thiamine administration, high signal intensities were observed in the thalamus around the third ventricle and in the superior portion of the cerebellar vermis and hemisphere on fluid-attenuated inversion recovery (FLAIR) and T2-weighted MR images. After thiamine administration, the high signal intensity in the former region disappeared immediately, while that in the latter regions persisted. The low level of N-acetylaspartate (NAA)/creatine (Cr) in the thalamus before thiamine administration improved to some degree on the (1)[H]-MRS images taken after thiamine administration. In the cerebellum, a lactate peak was observed before thiamine administration, and the NAA/Cr level did not improve after thiamine administration, suggesting that irreversible necrosis occurred. It is suggested that serial MRI/(1)H-MRS observation may be helpful in determining the neuronal viability of Wernicke's encephalopathy and the prognostic implications of sequelae such as Korsakoff's syndrome and cerebellar ataxia.