J Korean Ophthalmol Soc.  2015 Jan;56(1):148-153. 10.3341/jkos.2015.56.1.148.

A Case of Acute Incomitant Esotropia Associated with Wernike's Encephalopathy

• Hwang MW
• Moon SH

• KMID: 2216170
• DOI: http://doi.org/10.3341/jkos.2015.56.1.148

Abstract

PURPOSE
We report a case of an acute incomitant esotropia with Wernike's encephalopathy.
CASE SUMMARY
A 64-year-old male visited our hospital because of diplopia lasting a week. He was a chronic alcoholic drinking two bottles of makgeolli daily and eating little for a month. He showed -2 underaction of bilateral lateral rectus muscles and 45 prism diopters of esotropia at the primary position at the first visit. He had ataxia and mild cognitive impairment. There were high signal intensities in the periaqueductal area and mammillary bodies in the brain fluid attenuated inversion recovery magnetic resonance image. He was diagnosed with Wernike's encephalopathy clinically and was immediately treated with intravenous thiamine. He showed -0.5 underaction of bilateral lateral muscles and 8 prism diopters of esotropia at the primary position 3 days after thiamine treatment.
CONCLUSIONS
Wernicke's encephalopathy is a medical emergency. If diagnosis and treatment are delayed, patients may have neurological sequelae that can lead to death. Esotropia and diplopia can be the presenting manifestations in Wernike's syndrome without other symptoms. In taking patient histories, physicians should ask about alcohol consumption and low food intake because of the possibility of acute incomitant esotropia associated with Wernicke's encephalopathy.

Keyword

Incomitant esotropia; Thiamine (vitamin B1); Wernicke's encephalopathy

MeSH Terms

Alcohol Drinking
Alcoholics
Ataxia
Brain
Diagnosis
Diplopia
Drinking
Eating
Emergencies
Esotropia*
Humans
Male
Mamillary Bodies
Middle Aged
Mild Cognitive Impairment
Muscles
Thiamine
Wernicke Encephalopathy
Thiamine

Figure

• 

  Figure 1. Nine cardinal gaze photographs at the first visit showing -2 underaction of bilateral lateral rectus muscles and 45-prism diopter esotropia at primary position.

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  Figure 2. Brain fluid attenuated inversion recovery magnetic resonance image. There are high signal intensities in the periaqueductal area (arrow, A) and mammillary body (arrow heads, B).

• 

  Figure 3. Nine cardinal gaze photographs at the third day after thiamine treatment showing -0.5 underaction of bilateral lateral rectus muscles and 8 prism diopters of esotropia at the primary position.

• 

  Figure 4. Brain fluid attenuated inversion recovery magnetic resonance image. There are normal signal intensities in periaqueductal area (arrow, A) and mammillary body (arrow heads, B). Previous high signal intensities disappeared.

Reference

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