Introduction:
“Polioencephalitis hemorrhagica superioris” was the original term coined by Carl Wernicke in 1881 to describe the classical syndrome, with a triad of ophthalmoparesis, ataxia and mental status changes. Typically, it is encountered in clinical situations involving poor nutrition such as alcoholics, post gastrointestinal surgery, hyperemesis gravidarum, malignancy and other such states.1Operational criteria proposed for Wernicke’s encephalopathy need any two of the following: Dietary inadequacies, eye movement abnormalities, ataxia and either an altered mental state or memory disturbances.2 Thiamine is the mainstay of treatment. Although in the initial series of Adams, 100 mg per day was recommended, many subsequent studies recommend 500 mg, initially, parenterally.3,4
Visual loss is an unusual and rare manifestation of Wernicke’s encephalopathy. In the original series of Adams et al, only 3 of 232 patients had retinal haemorrhages with visual loss. 4Papilloedema with Wernicke’s encephalopathy has been described only rarely in a few case reports. We describe a patient of Wernicke’s, who presented with predominantly visual loss.