Which ocular abnormalities are characteristic of Wernicke-Korsakoff syndrome (WKS) on physical exam?

Updated: May 16, 2018
  • Author: Glen L Xiong, MD; Chief Editor: David Bienenfeld, MD  more...
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The classical triad of confusion, ataxia, and nystagmus is only present in about 16-38% of patients. [34]

Ocular abnormalities

The diagnosis of Wernicke encephalopathy is made most reliably on the basis of the following ocular abnormalities, which can occur singly or in combination:

  • Nystagmus, vertical and horizontal

  • Weakness or paralysis of lateral rectus muscles - Occurs bilaterally but can be asymmetrical and is accompanied by diplopia and internal strabismus

  • Weakness or paralysis of conjugate gaze

  • Nonreacting miotic pupils and complete loss of ocular movements (in advanced cases)

  • Ptosis, small retinal hemorrhages, involvement of near-far focusing mechanism, and optic neuropathy (occasionally)

  • Papilledema (very rare)

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