Convergence Spasm in Wernicke Encephalopathy

A 48-year-old man with alcoholism and previous gastric bypass surgery presented with a convulsive episode after heavy alcohol use. He had not adhered to his multivitamins since the procedure, and his caloric source was mainly from alcohol for the preceding few weeks. On examination, he was confused and had convergence spasm (Figure 1) (Online Supplemental Video), which resolved with parenteral doses of thiamine over the course of several days