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The Spectrum of Vestibular and Ocular Motor Abnormalities in Thiamine Deficiency

  • Neuro-Ophthalmology (A Kawasaki, Section Editor)
  • Published:
Current Neurology and Neuroscience Reports Aims and scope Submit manuscript

Abstract

Purpose

The first aim of this review is to summarize recent ocular motor signs in pre-encephalopathy patients with nutritional deficiency at risk of thiamine deficiency. Timely recognition of thiamine depletion in these patients, who may have a normal brain MRI, could lead to appropriate management and prevention of Wernicke’s encephalopathy (WE) with full recovery. The second aim is to incorporate recent diagnostic testing on the revised WE diagnostic criteria and the identification of patients who may show slow, partial, or no response to treatment.

Recent Findings

Selective vulnerability of periventricular gray neurons in thiamine deficiency is well known. Involvement of the vestibular and abducens nuclei may precede encephalopathy. Studies have shown mild ophthalmoparesis and bilateral symmetric vestibular loss in thiamine deficiency. Moreover, quantitative data has shown decreased horizontal vestibulo-ocular reflex (VOR) gain and nystagmus, with a favorable response to timely treatment.

Summary

Ophthalmoparesis, horizontal nystagmus, and decreased gain of the horizontal VOR, sparing the vertical VOR, may be present in the early pre-encephalopathy stage of thiamine deficiency. Rapid response to a loading dose of parenteral thiamine might be seen in some cases and normalization, albeit slower in others. In contrast, analogous to the Korsakoff’s syndrome, ocular motor and vestibular abnormalities may show only partial improvement. Future studies in larger populations at risk are needed to confirm the results of these preliminary observations.

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Authors and Affiliations

  1. Illinois Neurologic Institute, University of Illinois College of Medicine, Peoria, IL, USA

    Jorge C. Kattah

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  1. Jorge C. Kattah
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Correspondence to Jorge C. Kattah.

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Conflict of Interest

GN Otometrics based in Schaumburg, Illinois, loaned Jorge C. Kattah equipment to perform the video head impulse test.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Kattah, J.C. The Spectrum of Vestibular and Ocular Motor Abnormalities in Thiamine Deficiency. Curr Neurol Neurosci Rep 17, 40 (2017). https://doi.org/10.1007/s11910-017-0747-9

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  • DOI: https://doi.org/10.1007/s11910-017-0747-9

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