• Often the initial presenting signs of Wernicke’s encephalopathy include abducens palsy,
  • horizontal diplopia, nystagmus, and strabismus; and ataxia may cause ambulation difficulties. These neuromuscular signs often antecede mental changes. The disorder is caused by deficiency of thiamine (vitamin B1); administration of which can quickly reverse ocular symptoms but often has little effect on mental changes once they have occurred (such as anterograde and retrograde amnesia, apathy, drowsiness, confusion.) Glucose infusion into a thiamine-depleted individual (generally alcoholics) can precipitate Wernicke’s syndrome and all alcoholics receiving glucose infusions should have concomitant thiamine administration (50-100 mg immediately and then daily.)Wernicke