PMC4039400_01
Goldmann perimetry of both eyes.. Notes: (A) On initial presentation, there were large centrocecal scotomas in both eyes. (B) Two days after thiamine replacement, the visual fields in both eyes had expanded significantly.
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Visual acuity was 2/200 in the right eye and 4/200 in the left eye, with bilateral centrocecal scotomas on Goldmann visual field testing (Figure 1A). After 2 days, her visual acuity improved to 20/25 (right eye) and 20/50 (left eye), and her visual field expanded significantly in both eyes (Figure 1B).
Fundus photographs of both eyes.. Notes: (A) On initial presentation, both optic nerves had pale blurring of the disc margins superiorly and inferiorly, with peripapillary hemorrhage in the left eye. (B) One month later, the swelling had resolved, with only mild prominence of the retinal nerve fiber layer remaining bilaterally.
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The optic nerves had edema with pallor superiorly and inferiorly, along with peripapillary hemorrhages at 2:00 in the left eye (Figure 2A). The optic disc swelling improved over the next month (Figure 2B), but the ataxia and lower extremity dysesthesia persisted.
MRI scans of the patient's brain on initial presentation.. Notes: On MRI, the medial thalami showed increased T2-signal bilaterally as shown on both (A) FLAIR sequences (blue arrows) and (B) diffusion-weighted (white arrows) sequences. (C) The mammillary bodies showed increased T2-signal bilaterally (red arrows).. Abbreviations: FLAIR, fluid-attenuated inversion recovery; MRI, magnetic resonance imaging.
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T2-signal in the medial thalami and mammillary bodies (Figure 3). The diagnosis of Wernicke encephalopathy was made based on her clinical presentation and radiological findings.