Complex ophthalmoplaegia denoting Wernicke encephalopathy in a non-alcoholic individual

A 62-year-old man presented with subacute horizontal binocular diplopia and slight gait imbalance, preceded by frequent episodes of vomiting. The patient had undergone two gastric surgeries for gastric ulcer in the past (in 1988 and 2002). Bilateral internuclear ophthalmoplaegia, conjugate vertical gaze palsy and mild tandem gait abnormalities were observed (video 1, part 1; figure 1). Upper gastrointestinal endoscopy and gastric emptying scintigraphy suggested a delay in gastric emptying. Brain MRI demonstrated hyperintense symmetric areas in the thalami, midbrain tegmentum, quadrigeminal plate and floor of the fourth ventricle, suggesting Wernicke encephalopathy (figure …