title: The Spectrum of Vestibular and Ocular Motor Abnormalities in Thiamine Deficiency.
abstract: OBJECTIVE
  The first aim of this review is to summarize recent ocular motor signs in pre-encephalopathy patients with nutritional deficiency at risk of thiamine deficiency. Timely recognition of thiamine depletion in these patients, who may have a normal brain MRI, could lead to appropriate management and prevention of Wernicke's encephalopathy (WE) with full recovery. The second aim is to incorporate recent diagnostic testing on the revised WE diagnostic criteria and the identification of patients who may show slow, partial, or no response to treatment.
  
  
  RESULTS
  Selective vulnerability of periventricular gray neurons in thiamine deficiency is well known. Involvement of the vestibular and abducens nuclei may precede encephalopathy. Studies have shown mild ophthalmoparesis and bilateral symmetric vestibular loss in thiamine deficiency. Moreover, quantitative data has shown decreased horizontal vestibulo-ocular reflex (VOR) gain and nystagmus, with a favorable response to timely treatment. Ophthalmoparesis, horizontal nystagmus, and decreased gain of the horizontal VOR, sparing the vertical VOR, may be present in the early pre-encephalopathy stage of thiamine deficiency. Rapid response to a loading dose of parenteral thiamine might be seen in some cases and normalization, albeit slower in others. In contrast, analogous to the Korsakoff's syndrome, ocular motor and vestibular abnormalities may show only partial improvement. Future studies in larger populations at risk are needed to confirm the results of these preliminary observations.
authors.affiliation: Illinois Neurologic Institute, University of Illinois College of Medicine, Peoria, IL, USA. kattahj@uicomp.uic.edu.
authors.forename: Jorge C
authors.initials: JC
authors.lastname: Kattah
mesh_terms: D006801:Humans; D015835:Ocular Motility Disorders / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology*; D013832:Thiamine Deficiency / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D015837:Vestibular Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology*
keywords: Nystagmus; Thiamine deficiency; Vestibular paresis; Vestibulo-ocular reflex (VOR); Video head impulse test (vHIT)