The vestibulo-ocular reflexes during head impulse in Wernicke's encephalopathy

Abstract

A 63-year-old woman had undergone Whipple’s operation because of carcinoma of the ampulla of Vater 1 month previously and had received total parenteral nutrition (TPN). Two weeks after initiation of TPN, she began to suffer from anorexia, vomiting and vertigo which progressed to psychomotor slowing, apathy, forgetfulness and ataxia. On examination, she was awake but not attentive. She was fluent, but comprehension was impaired. The pupils were normal. Horizontal saccades were slowed and limited, and the limited ocular motor range did not improve with oculocephalic stimulation of the VOR. Other findings included horizontal GEN, limb dysmetria and severe truncal ataxia. T2 weighted …