Wernicke's encephalopathy presenting with confusion and hearing loss.

We present a case of a male in his early 50s assessed in the emergency department with a seemingly clear alcohol history but with classic symptoms of Wernicke's encephalopathy (WE): disorientation, gait ataxia and vertical nystagmus. He also had significant bilateral hearing loss and profound anterograde amnesia. Neuroimaging revealed hallmark signs of WE, including symmetrical T2/fluid-attenuated inversion recovery hyperintensity in the medial thalami. Here, we consider important differentials beyond WE, discuss the importance of revisiting the patient's history and explore the significance of his imaging findings. Although the patient's cognitive function and ocular symptoms improved on standard treatment, his condition progressed to Korsakoff's syndrome accompanied by residual anterograde amnesia and ongoing confabulation that required cognitive rehabilitation.