Dizziness in elderly patients is heterogeneous and nonspecific, leading to frequent misdiagnosis. Wernicke encephalopathy (WE) is a severe but reversible nutritional disorder responsive to timely thiamine supplementation; it often lacks typical MRI changes and may mimic neurodegenerative diseases such as multiple system atrophy (MSA)....
Audiologists and vestibular specialists performing videonystagmography should be alert to periodic alternating nystagmus as a potential red-flag sign warranting urgent medical referral, even when neuroimaging is negative.
This case highlights how a rare but recognizable nystagmus pattern can prevent diagnostic delay in a life-threatening and treatable neurological condition that can mimic complex vestibular disorders.
- 01Case report: elderly patient with MRI-negative Wernicke encephalopathy presenting as complex dizziness.
- 02Periodic alternating nystagmus (eye movements that rhythmically reverse direction) was the key diagnostic clue.
- 03Standard brain MRI was negative, underscoring the risk of false reassurance from normal imaging.
- 04Wernicke encephalopathy mimicked multiple system atrophy, illustrating diagnostic pitfalls.
- 05Early recognition of this nystagmus pattern can prompt timely, life-saving treatment.
Periodic alternating nystagmus can be a diagnostic clue for Wernicke encephalopathy even when MRI is negative.
studypartially supportedWernicke encephalopathy can mimic multiple system atrophy in elderly patients with complex dizziness.
studypartially supported- PMID
- 42246039
- DOI
- 10.3389/fneur.2026.1837183.
- Journal
- Frontiers in Neurology
- Publication type
- case_report
- Evidence level
- 4
- Sample size
- 1
- Population
- Single elderly patient with complex heterogeneous dizziness and MRI-negative Wernicke encephalopathy
- Intervention
- Clinical and neuro-oculomotor evaluation including nystagmus characterization
Primary outcomes
Identification of periodic alternating nystagmus as a diagnostic marker for MRI-negative Wernicke encephalopathy