When Wernicke encephalopathy (WE) is associated with gastric surgery, it usually develops weeks or months after the procedure. Its development more than 20 years after surgery is extremely rare and, to our knowledge, all the reported cases pertain to Japanese patients.1,2 Moreover, magnetic resonance images were remarkable in a single patient.2 We describe the first white patient who developed WE 28 years after gastric surgery and had reversible lesions shown on magnetic resonance images in all the typical locations where the pathologic abnormalities of WE are known to occur.