The Spectrum of Vestibular and Ocular Motor Abnormalities in Thiamine Deficiency
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NEURO-OPHTHALMOLOGY (A KAWASAKI, SECTION EDITOR)
The Spectrum of Vestibular and Ocular Motor Abnormalities in Thiamine Deficiency Jorge C. Kattah 1
Published online: 1 April 2017 # Springer Science+Business Media New York 2017
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
This article is part of the Topical Collection on Neuro-Ophthalmology Electronic supplementary material The online version of this article (doi:10.1007/s11910-017-0747-9) contains supplementary material, which is available to authorized users. * Jorge C. Kattah [email protected] 1
Illinois Neurologic Institute, University of Illinois College of Medicine, Peoria, IL, USA
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. Keywords Thiamine deficiency . Vestibulo-ocular reflex (VOR) . Video head impulse test (vHIT) . Nystagmus . Vestibular paresis
Introduction Historically, progress in technology results in parallel progress in clinical medicine. This is particularly true regarding the ocular motor and vestibular manifestations of thiamine deficiency, which is the subject of this review. The seminal contribution from Victor, Adams, and Collins in 1978 identified consistent characteristics of eye movement manifestations of acute thiamine deficiency that made ophthalmoplegia and nystagmus one of the most consistent diagnostic signs [1]. More specifically, abducens paresis and gaze-evoked nystagmus emerged in their series as the most frequent and consistent ocular manifestations. Reversibility with timely vitamin B1 replacement, alcohol discontinuation, when present, and resumption of a
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