Abstract
A 53-year-old man with an esophageal ulcer, mediastinal emphysema, and diabetic ketoacidosis who was highly malnourished developed Wernicke's encephalopathy. He showed lateral gaze-evoked nystagmus and disturbance of gait. A caloric test showed bilateral canal paresis, but cervical and ocular vestibular-evoked myogenic potentials (c-VEMP, o-VEMP) were present. The brain MRI demonstrated a high intensity signal in the bilateral medial thalamic region on T2 weighted images and diffusion weighted images. These findings suggest involvement of the medial vestibular nucleus and the medial thalamic region. Thiamine was administered, but the nystagmus remained. Persisted diet lacking thiamine possibly made the brain lesion irreversible.
