Thiamine refractory Wernickes encephalopathy reversed with magnesium therapy

A 34-year-old man was presented to our emergency department in alcohol withdrawal. Despite initial treatment with high-dose intravenous thiamine therapy he went on to develop nystagmus (video 1), ataxia, pass pointing, intention tremor and worsening confusion. He was diagnosed with Wernickes encephalopathy, an acute neuropsychiatric syndrome resulting from thiamine deficiency.1 Video 1 Our patient demonstrates bilateral vertically upbeat nystagmus. His serum magnesium levels were found to be …