A 27-YEAR-OLD MAN with chronic alcohol dependency had a history of sudden-onsetdiplopia and difficulty walking. Examination revealed a 25-diopter esotropiawith an associated failure of abduction in both eyes. Vertical eye movementswere full (Figure 1). Neurologicalexamination revealed a broad-based gait, cerebellar ataxia, and a profoundshort-term memory deficit. A slow infusion of 250 mg of intravenous thiamine,500 mg of ascorbic acid, 50 mg of pyridoxine hydrochloride, and 4 mg of riboflavinwas administered, and within hours, the external ophthalmoplegia (Figure 2) and ataxia had completely resolved.
Squirrell D, Shipman T, Rennie I. Wernicke Encephalopathy. Arch Ophthalmol. 2004;122(3):418-419. doi:10.1001/archopht.122.3.418