A patient with past history of bariatric surgery presenting with blurred vision, oscillopsia and decreased hearing of few days. Her exam was remarkable for up-beating nystagmus in all gazes. Vision was 20/20 in each eye, pupils equal and reaction. She had full ocular motility and normal anterior segment exam as well as fundus exam. MRI of brain was significant for a 3 mm focus of questionable enhancement within the right porus acusticus visualized on the postcontrast MRI of the brain. Patient was also complaining of problems in short term memory and gait not explained by the MRI findings. Further blood work up was done and came back positive for low thiamine levels. She was diagnosed with Wernicke encephalopathy post bariatric surgery and was admitted to the hospital for management with intravenous thiamine infusion to be followed by oral supplementation. After 4 weeks of therapy, symptoms had improved including nystagmus which resolved in primary position and persisted only in extremes of gaze.
Presentation Date: 03/10/2022
Issue Date: 03/18/2022