George Black Report of a Case of Wernicke's Syndrome Complicating Pregnancy and Associated with Ocular Complications*

*WERNICKE first published an account of the condition in 1881. He based his account upon three cases and described the condition as one of acute superior haemorrhagic polioencephalitis. Two of his cases were due to chronic alcoholism and the third to sulphuric acid poisoning. All the cases showed minute haemorrhagic foci situated in the walls of the third ventricle, the grey matter around the aqueduct and the floor of the fourth ventricle. Quite early, the association oi polyneuritis and Korsakoff's syndrome with the special cerebral signs were noted. Wernicke considered that the condition was an acute inflammatory process. In recent years, however, the views regarding the aetiology and the pathology of the condition have changed. Neuberger emphasised the occurrence of the condition as a complication of a variety of primary diseases. Furthermore, the condition is no longer regarded as an encephalitis, but rather as an encephalopathy or encephalosis. Campbell and Biggart published an excellent survey in the past few years of twelve cases which came to post-morten. Of these twelve cases, only one occurred in chronic alcoholism. There were three cases of gastric carcinoma and two of hyperemesis gravidarum. Other cases occurred in pernicious anaemia, chronic gastritis, bronchiectasis and pyosalpynx. They found focal lesions consisting of small petechial haemorrhages with vascular proliferation. There was an absence of inflammatory infiltration and only slight evidence of injury to nerve cells. The lesions had a selective distribution, the corpora mammillaria being the most characteristic site. In fact, histological examination of these bodies they regarded as essential to diagnosis. The lesions are almost always symmetrical involving the grey matter surrounding the third ventricle, the peri-aqueductal grey matter, hence involving the ocular nuclei, and the floor of the fourth ventricle. The lesions suggest a toxic agent, producing a loss of vascular tone and stasis. The main clinical features of this disease are drowsiness, leading to coma, associated with eye signs: retinal haemorrhages of the type which I will describe later, nystagmus, ophthalmoplegia and