Disclosures: Joseph R. Mallory, MD, MPH: No financial relationships or conflicts of interest

Case Description: A 45 year-old woman was admitted to acute care hospital for confusion, weakness, bowel and bladder incontinence, severe ataxia, and bilateral ophthalmoparesis. Past medical history included chronic back pain, depression, hypothyroidism, neurogenic bladder, history of alcohol abuse, and gastric bypass surgery that was performed 8 years prior to the current admission. She was ultimately diagnosed with Wernicke’s encephalopathy and bilateral internuclear ophthalmoplegia. She was initially treated with intravenous thiamine with significant improvement. An attempt to transition to oral supplementation was unsuccessful. Due to overall functional decline she was transferred to the acute rehabilitation facility. Her scores in the Functional Independence Measures demonstrated the largest gains in the domains of self-care, sphincter, mobility and social cognition. She was successfully discharge to home with a peripherally inserted central catheter.

Setting: Acute rehabilitation hospital.

Patient: 45 year-old woman with Wernicke’s encephalopathy and bilateral internuclear ophthalmoplegia. Assessment/

Results: Following a 99-day stay in acute rehabilitation, this patient demonstrated minimal gains in overall FIM scores. Per therapy and nursing evaluations, the largest gains were seen in grooming, bladder continence, bath transfers, wheelchair FIM, and expression. She was discharged to home with her husband; PICC line left in place due to uncertainty of continued IV support.

Discussion: This case illustrates an unusual presentation of bilateral internuclear ophthalmoplegia associated with Wernicke’s encephalopathy. In most cases, internuclear ophthalmoplegia associated with Wernicke’s encephalopathy is unilateral. Most cases of bilateral internuclear ophthalmoplegia are associated with multiple sclerosis. This case also illustrates a patient with chronic thiamine deficiency many years post-gastric bypass requiring long-term supplementation of thiamine via peripherally inserted central catheter.

Conclusion: Bilateral internuclear ophthalmoplegia is more commonly seen in cases of MS. In cases of Wernickes encephalopathy, it is usually presents unilaterally.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/bilateral-internuclear-ophthalmoplegia-in-a-patient-with-wernickes-encephalopathy-a-case-report/