Wernicke encephalopathy is an acute encephalopathy, characterized by the triad of mental confusion, ophthalmoplegia, and gait ataxia. It may develop due to many reasons that may be associated with insufficient intake or malabsorption of thiamine. Here, we report a rare case of Wernicke's encephalopathy presenting with papilledema as the initial finding. In the patient who developed tetraparesis and ophthalmoplegia after gastric by-pass surgery, there was also a change in consciousness at follow-up. Wernicke's encephalopathy was considered as diagnosis. Her clinic improved progressively under high dose intravenous thiamine treatment. The diagnosis was delayed because the characteristic findings were obscure at the initial stage, the patient was obese, and had papilledema. This case was thought to be important as it would increase awareness of the uncommon findings of Wernicke's encephalopathy.
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