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