A patient with chronic alcoholism presents with nystagmus, ophthalmoplegia, confusion, and ataxia. This presentation is most consistent with deficiency of which vitamin?

• A. Cerebrovascular accident
• B. Hypoxemia
• C. Uremia
• D. Vitamin B1 deficiency

Answer: (D)

This presentation reflects thiamine (vitamin B1) deficiency causing Wernicke’s encephalopathy. In chronic alcoholism, poor intake and impaired absorption lead to insufficient thiamine, a crucial cofactor for carbohydrate metabolism. When thiamine is lacking, brain energy production falters, especially in areas like the mammillary bodies, leading to the classic triad of ocular findings (nystagmus and ophthalmoplegia), ataxia, and confusion. This combination is highly characteristic of vitamin B1 deficiency, making it the best fit for the scenario.

Other conditions don’t produce this exact cluster in an alcoholic patient: a cerebrovascular accident causes focal deficits; hypoxemia leads to generalized symptoms without this specific ocular-ataxia-confusion pattern; uremia has different encephalopathic features. In practice, recognize the urgency and treat promptly with thiamine (ideally before giving glucose) to prevent progression.