External Ophthalmoplegia and Nystagmus in a 64-Year-Old Man

Abstract

A 64-year-old man with chronic alcoholism presented with disorientation. He was disoriented and displaying oculomotor dysfunction, including external ophthalmoplegia and nystagmus. Magnetic resonance imaging revealed high-intensity areas surrounding the aqueduct and third ventricle and within the medial thalamus and mammillary bodies on fluid-attenuated inversion recovery–weighted images, consistent with Wernicke encephalopathy. After treatment with 500 mg of thiamine thrice daily for 2 days, his ophthalmoplegia improved, although his nystagmus persisted. After continuation of 250 mg per day of thiamine for 5 days, he was discharged on day 8 without disorientation or ocular motor deficits.