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Wernicke encephalopathy presenting with severe optic neuropathy and oculomotor dysfunction
Pooja Patel1, Shelly Rishty1, Michael Trottini2
1Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
BMJ Case Reports
|May 19, 2026
Summary
This case study highlights a rare nutritional optic neuropathy caused by thiamine and folate deficiencies. Prompt vitamin supplementation rapidly improved vision and neurological symptoms in a patient with severe vomiting and diarrhea.
Area of Science:
- Neurology
- Ophthalmology
- Nutritional Science
Background:
- A female patient presented with acute binocular diplopia and blurry vision.
- Symptoms followed two months of severe vomiting, diarrhea, and poor oral intake.
- Ophthalmological examination revealed bilateral abduction palsies and optic disc edema.
Purpose of the Study:
- To investigate the cause of acute vision loss and neurological deficits.
- To identify potential nutritional deficiencies contributing to the patient's condition.
- To demonstrate the efficacy of vitamin supplementation in treating nutritional optic neuropathy.
Main Methods:
- Clinical examination including fundoscopy.
- Magnetic Resonance Imaging (MRI) of the brain and orbits.
- Serum level testing for thiamine and folic acid.
Main Results:
- MRI showed T2-FLAIR hyperintensities in the periaqueductal grey matter and left optic nerve.
- Confirmed severe thiamine and folic acid deficiencies.
- Patient showed significant improvement in mentation, oculomotor function, vision, and gait after supplementation.
Conclusions:
- This case illustrates a multifactorial nutritional optic neuropathy.
- Thiamine and possible folate deficiency can cause severe visual and neurological impairment.
- Early consideration of nutritional deficiencies is crucial for patients with similar presentations.
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