Discussion:
Wernicke’s encephalopathy is a serious nutritional disorder with
potentially life- threatening consequences, if unrecognized. Although,
the triad of opthalmoparesis, changes in higher mental functions and
ataxia are easily recognized, there may be confounding clinical features
such as blurring of vision, which is rarely seen, thus delaying the
diagnosis. Among the ocular findings, nystagmus is most common, followed
by bilateral 6th nerve paresis, conjugate gaze palsy,
scotomata, pupillary abnormalities, retinal haemorrhages, ptosis, and
disc edema. 5
Disc edema is a rare finding in Wernicke’s encephalopathy.6 Retinal haemorrhages are seen more frequently, sans
disc edema. These manifestations have been described with bariatric
surgery too. In the patients described, disc edema with retinal
hemorrhages accompanied the vision loss, along with other characteristic
manifestations. The patients showed a good response to intravenous
thiamine. 7,8
Mumford described a similar case of disc edema with retinal hemorrhages
in a case of hyperemesis gravidarum, with other features of Wernicke’s
encephalopathy, who responded well to parenteral thiamine
administration.1
The mechanisms underlying the visual manifestations are not clear. It is
likely that an optic neuropathy associated with Wernicke’s
encephalopathy, due to nutritional deficiency of thiamine could result
in the disc edema. This is consistent with quick resolution of
fundoscopic findings with thiamine administration. Another plausible
explanation is the possible necrosis of nerve cells with edema, which
underlies neuropathology of Wernicke’s.1