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Visual loss and optic nerve head swelling in thiamine deficiency without prolonged dietary deficiency

Authors Gratton S, Lam BL

Received 17 March 2014

Accepted for publication 1 April 2014

Published 22 May 2014 Volume 2014:8 Pages 1021—1024

DOI https://doi.org/10.2147/OPTH.S64228

Checked for plagiarism Yes

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Sean M Gratton, Byron L Lam

Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL, USA

Abstract: Visual loss due to optic neuropathy is a rare manifestation of thiamine deficiency. We report a case of a 39-year-old woman with a body mass index (BMI) of 29 kg/m2 who developed visual loss and bilateral optic nerve head swelling after a short, self-limited gastrointestinal illness. She was disoriented and inattentive and had absent ankle jerk reflexes, diminished sensation in both legs below the knees, and marked truncal ataxia. Magnetic resonance imaging (MRI) showed increased T2-signal in the medial thalami and mammillary bodies. The serum thiamine level was 8 nmol/L (normal 8–30). The diagnosis of thiamine deficiency was made, and the patient’s vision and neurologic symptoms improved significantly with intramuscular thiamine treatment. Thiamine deficiency can occur in the absence of an obvious predisposing factor such as alcoholism or low body weight. The clinician must be aware of the factors that govern vitamin availability and maintain a high index of suspicion to make the diagnosis in such cases.

Keywords: optic neuropathy, nutritional deficiency

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