Wernicke's encephalopathy

Acute neurologic disorder with the triad of opthalmolegia, ataxia, and confusion, due to thiamine (B1) deficiency. Its probably more common than recognized. Neuroopthalmologic findings are usually horizontal and/or vertical gaze palsy with bilateral abduction deficits, and often, upbeat nystagmus. Mental status changes may be mild. MRI abnormalities may be seen in up to half of patients imaged within two weeks of symptom onset. It may be confirmed by lab testing of erythrocyte ketolase activity. Treatment is 100 mg of thiamine given iv or im with resolution of the symptoms promptly, prevention of Korsakoff's amnesia. MRI deficits may take several days to improve