Wernicke's Encephalopathy

Wernicke's encephalopathy (WE) is a neurologic emergency that requires immediate attention to prevent permanent neurological morbidity and mortality. It presents with confusion, ophthalmoplegia and gait ataxia which together comprise its classic triad. Thiamine deficiency related to alcohol abuse remains the primary culprit; non-alcoholic WE, however, can have an atypical clinical presentation and is often missed. Thus, although the diagnosis of WE remains primarily clinical, neuroimaging plays an important role, especially in the diagnosis of nonalcoholic WE. Here, we present a case of non-alcoholic WE with an atypical clinical presentation but typical magnetic resonance imaging (MRI) findings in a woman with a history of non-bariatric gastrointestinal surgery. Thiamine replacement therapy rapidly reversed her neurologic symptoms and MRI findings.