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Background: We report an unusual case of Wernicke’s encephalopathy presenting with transient upbeat nystagmus that changed to a persistent downbeat nystagmus . Case: A 27-year-old man presented with upbeat nystagmus. Three months earlie r, he had been diagnosed with Wernicke’s encephalopathy after fasting for a mon th. Observations: This diagnosis was supported by his symptoms (ataxia, a confus ed state). Clinical recovery followed thiamine therapy. His upbeat nystagmus had linear slow phases with average amplitude and frequency (±SD) during fixation straight ahead of 2.8±0.7°and 4.6±2.2Hz. respectively. Two months later, the primary position upbeat nystagmus had diminished and down beat nystagmus (0.9 + 0.5°and 3.2±0.7 Hz on average) for a 20°downward gaze had developed. Then, 8 months later, he showed only downbeat nystagmus, which obeyed Alexander’s law. His primary position downbeat nystagmus was completely suppressed by clonazepam, a γ-aminobutyric acid (GABA) agonist. Conclusions: Owing to an underlying cen tral vestibular imbalance, even after the recovery of acute neurological symptom s, Wernicke’s encephalopathy can be complicated by persistent downbeat nystagmu s, which can be treated by a GABA agonist.
Background: We report an unusual case of Wernicke’s encephalopathy presenting with transient upbeat nystagmus that changed to a persistent downbeat nystagmus. Case: A 27-year-old man presented with upbeat nystagmus. Three months earlie r, had had been diagnosed with Wernicke’s encephalopathy after fasting for a month. Observations: This diagnosis was supported by his symptoms (ataxia, a confus ed state). Clinical up followed thiamine therapy. His upbeat nystagmus had linear slow phases with average amplitude and frequency (± SD) during fixation straight ahead of 2.8 ± 0.7 ° and 4.6 ± 2.2 Hz. respectively. Two months later, the primary position upbeat nystagmus had diminished and down beat nystagmus (0.9 + 0.5 ° and 3.2 ± 0.7 Hz on average) for a 20 ° downward gaze had developed. His primary position downbeat nystagmus was completely suppressed by clonazepam, a γ-aminobutyric acid (GABA) agonist. Con clusions: Owing to an underlying cen tral vestibular imbalance, even after the recovery of acute neurological symptom s, Wernicke’s encephalopathy can be complicated by persistent downbeat nystagmu s, which can be treated by a GABA agonist.