Bilateral Horizontal Gaze Paresis as an Initial Manifestation of Wernicke Encephalopathy

Abstract

A 62-year-old man with hypertension, diabetes mellitus and alcoholic chronic pancreatitis developed bilateral horizontal gaze paresis (BHGP) with convergence paralysis. He declared that alcohol intake was given up for 4 years. Cranial magnetic resonance imaging (MRI) findings were normal. Tiny pontine infarction was suspected. However, 5 days later, confusional status and bilateral total external ophthalmoplegia appeared. MRI demonstrated typical findings of Wernicke encephalopathy (WE). Decreased blood thiamine level was confirmed. Neurological symptoms and MRI findings rapidly normalized under intravenous thiamine therapy. He confessed his alcohol abuse. This is a first reported case of BHGP as an initial manifestation of WE.