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KMID : 1036520220120020044
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Clinical Neuro-Ophthalmology
2022 Volume.12 No. 2 p.44 ~ p.46
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Acute Visual Loss as Initial Manifestation of Wernicke Encephalopathy
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Song Min-Jun
Kim Han-Beet
Nam Gi-Won
Cho Soo-Jin
Kim Joo-Yong
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Abstract
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We present a case of Wernicke encephalopathy with initial manifestation of acute visual loss. 59-year-old male was referred to a neurologist because of acute bilateral visual loss. He has been in the intensive care unit for 45 days d/t oral abscess, pneumonia and sepsis. He had a history of subtotal gastrectomy d/t gastric ulcer perforation 7 years ago. Neurological examination revealed no light perception in both eyes, mild anisocoria, and abnormal light reflex. Diffusion and FLAIR MRI image showed high signal in bilateral medial thalamus and nodulus of cerebellum, suggesting Wernicke encephalopathy. His blindness was dramatically restored by high-dose thiamine supplementation. With improvement of his vision, diplopia and gaze-evoked nystagmus occurred but gradually disappeared after 2-3 weeks. Acute visual loss in Wernicke encephalopathy is very rare. Possible pathogenesis of visual loss is thiamine deficiency-induced mitochondrial dysfunction, which leads to optic disc edema and retinal hemorrhage. Early diagnosis and thiamine supplementation can prevent irreversible damage to the optic nerve and visual function.
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KEYWORD
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Wernicke encephalopathy, Vision disorders, Thiamine deficiency
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