A postoperative patient with alcoholism presents with blurred vision, nystagmus, amnesia, and ataxia. Which diagnosis is most likely?

• A. Wernicke's encephalopathy
• B. Korsakoff syndrome
• C. Vitamin B12 deficiency
• D. Central pontine myelinolysis

Answer: (A)

Thiamine deficiency from chronic alcohol use leading to Wernicke's encephalopathy is the key idea. This condition presents as an acute neurologic emergency with eye movement abnormalities (such as nystagmus or ophthalmoplegia), gait ataxia, and confusion or amnesia. The combination seen here—blurred vision with nystagmus, amnesia, and ataxia in a patient with alcoholism who recently had surgery—fits this pattern perfectly. The underlying issue is impaired thiamine-dependent energy metabolism in the brain, affecting regions like the mammillary bodies and thalamus, which explains the ocular signs, balance problems, and memory disturbance.

Because it’s a medical emergency, treatment should start with high-dose thiamine given intravenously before dextrose to avoid worsening neuronal injury from glucose fueling already stressed brain tissue. If not treated promptly, the condition can evolve into Korsakoff syndrome, characterized by persistent severe memory deficits and confabulation, but the acute presentation here is most consistent with Wernicke's.

Korsakoff syndrome itself primarily involves chronic memory impairment with confabulation and lacks the acute ocular findings and ataxia seen in this patient. Vitamin B12 deficiency can cause cognitive changes and neuropathy but does not typically produce the acute oculomotor disturbances described. Central pontine myelinolysis presents with different features, such as acute motor deficits and altered consciousness after rapid electrolyte correction, not the eye movement abnormalities and ataxia here.