A number of clinical findings may be present in a patient with thiamine deficiency prior to the onset of encephalopathy. Prompt thiamine therapy may avoid disease progression and is associated with a good recovery.
Patient selection: at risk for malnutrition (alcoholism, liquid-only diet, HIV, starvation)
Clinical features may include:
(1) horizontal gaze-evoked nystagmus
(2) abnormal horizontal head impulse vestibulo-ocular reflex (VOR) response
(3) variable unsteady gait or mild ataxia
The head MRI is typically normal.
There is prompt correction of abnormal findings after high-dose, intravenous therapy with thiamine.
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