[Paralysis of vertical gaze as a sequela of Wernicke's encephalopathy]

In the acute phase of Wernicke's encephalopathy the treatment with thiamine results quickly in a normal ocular motor function. In a patient with severe and long-time alcoholism, and poor nutrition, an acute Wernicke's disease is reported in which a complete gaze palsy was associated with cerebellar symptoms, desorientation and anterograde amnesia. The treatment by thiamine, pyridoxine and folic acid resulted in the disappearance, in 1 week, of the extra-ocular symptoms. Lateral gaze palsy disappeared in 3 weeks, but vertical gaze palsy was unchanged after 8 months. Eye movement disorders rarely persist more than 1 week in well-treated patients. In this case, clinical signs and course, computed tomography have excluded another disease of the midbrain (i.e.: tumor, infarct, centro-pontine myelinolysis.) Hypotheses are considered to account for this fact: first, subclinical lesions persisting after a similar episode three years before; second, an abnormality of the transcetolase enzyme system: third, the association of the thiamine deficiency with a possible toxicity of very odd fooding habits. This patient, since several months, ate nothing but spoiled food with an admixture of strong alcoholic beverages.