A patient with laryngeal cancer had difficulty in eating during radio-chemotherapeutic treatment. Transfusion without vitamins had been given for 40 days, then dizziness on walking and nystagmus developed.
Equilibrium function tests showed a saccadic pattern of the ETT, inhibition of the OKP and the reduced caloric responce, but the normal VEMP. Symmetrical high-intensity lesions from the thalamus to the brain stem was observed on MRI-FLAIR.
Since Wernicke encephalopathy was suspected, administration of vitamin B1 was started. Four days later, dizziness improved and appetite was increased. ETT, OKP and MRI findings improved.
Although thiamine deficiency in the blood was not proved, Wernicke encephalopathy was highly suspected. The equilibrium function tests and MRI findings suggested a lesion from the thalamus to the abducens nucleus. Thiamine administration improved the symptoms rapidly. It is necessary for undernourished patients to take a vitamin supplements to prevent Wernicke encephalopathy.
