Not All Who Stagger Are Drunk: Ocular and Gait Abnormalities in a Young Adult

A 31-year-old woman presented to the emergency department for the third time in 4 weeks with vomiting, unstable gait, and odd behavior. She had a history of chronic nausea and vomiting. She denied any history of alcohol use. Physical examination showed vertical nystagmus (Video), hyperreflexia, ataxia, and an odd affect. Computed tomography and magnetic resonance imaging of the brain were normal. Laboratory results were normal except for a vitamin B1 (thiamine) level of 30 nmol/L (reference range 78-185 nmol/L).