Sudden bilateral blindness in Wernicke's encephalopathy: case report and review of the literature.
We report on a patient suffering from bilateral sudden blindness as initial symptom of Wernicke's encephalopathy (WE). A 37-year-old male alcoholic was admitted to a psychiatric clinic because of excessive alcohol consumption (3.4 per thousand). 24 h later he developed acute bilateral blindness with no light perception, downbeat nystagmus, bilateral ocular abduction deficits, cerebellar ataxia as well as a slight psychomotor slowing and mild disorientation. MRI including diffusion-weighted imaging and MR-angiography 3 h after symptom onset did not reveal findings suggestive for ischemic stroke. Immediate iv-application of thiamine led to a nearly complete remission of the neuroophthalmologic symptoms within 12 h. Although we critically discuss other potential etiologies, we conclude that the complex clinical picture with initial sudden blindness is an unusual presentation of WE.
Surges
Rainer
R
Department of Neurology, University of Freiburg, Breisacherstr, 64, 79106 Freiburg, Germany. rainer.surges@uniklinik-freiburg.de
Beck
Sandra
S
Niesen
Wolf-Dirk
WD
Weiller
Cornelius
C
Rijntjes
Michel
M
D000208:Acute Disease; D000328:Adult; D020268:Alcohol-Induced Disorders, Nervous System / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D001766:Blindness / Q000139:chemically induced / Q000473:pathology* / Q000503:physiopathology; D001921:Brain / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D002536:Cerebral Arteries / Q000473:pathology / Q000503:physiopathology; D038524:Diffusion Magnetic Resonance Imaging; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D009413:Nerve Fibers, Myelinated / Q000378:metabolism / Q000473:pathology; D020521:Stroke / Q000175:diagnosis; D013831:Thiamine / Q000627:therapeutic use; D013832:Thiamine Deficiency / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D016896:Treatment Outcome; D014899:Wernicke Encephalopathy / Q000139:chemically induced / Q000473:pathology* / Q000503:physiopathology
D013831:Thiamine