Bilateral sixth nerve palsy as a manifestation of Wernicke’s encephalopathy in a patient with refractory vomiting

Domenico Porfido¹, Silvana Guerriero¹, Giovanni Giancipoli¹, Michele Vetrugno¹, Velia Lefons², Franca Dicuonzo<sup>2

1</sup>Department of Ophthalmology, ²Department of Neuroradiology, University of Bari, Italy

Purpose: To report a case of Wernicke’s encephalopathy in a nonalcoholic woman with secondary hypoadrenalism.

Methods: A 58-year-old Italian woman developed Wernicke’s syndrome secondary to recurrent vomiting due to secondary hypoadrenalism.

Results: Recurrent vomiting and resulting malnutrition caused a depletion of the patient’s body stores of thiamine and the development of mental confusion and an oculomotor deficit. On the diagnostic suspicion of encephalitis in this patient with immunosuppression due to prolonged cortisone-based therapy, she underwent magnetic resonance imaging (MRI), which showed typical bilateral abnormal lesions pathognomonic of Wernicke’s encephalopathy. The patient improved after parenteral administration of vitamin B1.

Conclusions: Wernicke’s encephalopathy must be regarded as a medical emergency that should be suspected in all cases presenting with a sudden deficit or lack of coordination of the ocular movements associated with ataxia and general degeneration of the mental faculties, in patients who have suffered recurrent vomiting or malnutrition for different reasons.

Keywords: hypoadrenalism, oculomotor abnormalities, Wernicke’s syndrome