A rare cause of ophtalmoplegia: about a case

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AbstractPurposeWernicke's encephalopathy (WE) is an acute neurological disorder induced by a thiamine (vitamin b1) deficiency, secondary to undernutrition or malabsorption. It is a rare but serious complication requiring urgent treatment. Characterized by: mental confusion, ophthalmoplegia and ataxia. In the absence of treatment, the progression is towards Korsakov syndrome where the lesions become irreversible. The objective of our work is to alert clinicians to the seriousness of this pathology, which in our case, the revelation was ophthalmological.MethodsWe report the case of a patient who consults in ophthalmological emergencies for bilateral ophthalmoplegia sudden installation and whose etiological diagnosis was in favor of Wernicke encephalitisResultsFifty‐year‐old patient who presented to the ophthalmic emergency department for reduced visual acuity with eye pain. The general examination finds a patient confused, disoriented in time and space with an unbalanced gait.The ophthalmological examination finds: ODG total ophthalmoplegia Lazy direct and consensual photomotor reflex. Bilateral stage I papillary edema.The rest of the ophthalmological examination is unremarkable. An MRI was requested which objectified a hyper signal of the thalamus in flair and T2 sequence. In front of this clinical and radiological picture, the diagnosis of gayet Wernicke's encephalitis was evoked and confirmed by the dosage of vitamin B1 which was lowered. She benefited from an injectable vitamin B1 treatment at a dose of 400 mg/day as soon as the diagnosis was suspected, followed by an oral relay (250 mg, twice a day). The evolution was favorable with improvement of consciousness after the 5th day, regression of visual disturbances and resumption of walking. The 6‐month follow‐up showed a normal fundus and a normal brain MRI.ConclusionsGayet Wernicke's encephalitis is a rare condition, which remains under diagnosed to this day. It is a diagnostic emergency requiring early treatment to prevent complications.