# Nystagmus and Abducens Nerve Palsy as an Early Presentation of Non-alcoholic Wernicke Encephalopathy

## TL;DR

A rare brain condition called Wernicke encephalopathy presented with eye movement issues in a non-alcoholic patient, highlighting the need for early diagnosis.

## Contribution

This case report highlights non-alcoholic Wernicke encephalopathy presenting with nystagmus, emphasizing clinical diagnosis without MRI confirmation.

## Key findings

- Nystagmus was the earliest and prominent sign in a non-alcoholic Wernicke encephalopathy case.
- The patient showed clinical improvement after intravenous thiamine treatment.
- MRI findings were normal, indicating clinical suspicion is crucial for diagnosis.

## Abstract

Wernicke encephalopathy (WE) is a rare but life-threatening syndrome that is commonly associated with chronic alcoholism. It has also been found to be associated with malnutrition, prolonged parenteral nutrition, hemodialysis, hyperemesis gravidarum, gastroplasty, and AIDS. It usually presents as a clinical triad of confusion, ophthalmoplegia, and gait ataxia. Nystagmus is usually the most common and earliest ophthalmologic sign. We report a case of non-alcoholic WE in a patient who had prior bariatric surgery and was treated for malnutrition and sepsis, with nystagmus being the initial presentation. The MRI of the brain was normal. The diagnosis of WE was made clinically and was supported by the patient's symptomatic and clinical recovery following intravenous thiamine treatment. It is essential to highlight that a high level of suspicion is needed to diagnose non-alcoholic WE to allow the commencement of appropriate treatment and reduce morbidity and mortality rates related to this condition.