Arka Publishing Company Canon Journal of Medicine 2676-5446 Articles in Press 2026 01 05 Acute Wernicke’s Encephalopathy in a Chronic Alcohol User: Clinical Presentation, MRI Findings, and Treatment Response 238247 10.30477/cjm.2025.530413.1105 EN Ali Madadi Mahani Student Research Committee, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran 0000-0003-3096-4321 Bizhan Ahmadi Gastroenterology Department, Kerman University of Medical Sciences, Kerman, Iran Ali Hajghani Student Research Committee, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran Mohammadmahdi Ghani Rayeni Student Research Committee, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran Journal Article 2025 06 14 This case report is about a 37-year-old man who came to the emergency room with the chief complaint of a decrease in level of consciousness. According to the history given by his family, he had a heavy alcohol consumption (about one liter per day) for the past four years. In Neurological exams, he showed signs of ataxia (loss of coordination), strabismus because of sixth cranial nerve damage. Based on clinical signs and MRI findings (showing signal changes in the periaqueductal region and mammillary bodies), the diagnosis of Wernicke’s Encephalopathy (WE) was confirmed, with no evidence of progression to Korsakoff Syndrome (WKS). The patient was being treated with sodium valproate because of a seizure disorder. The treatment protocol was high-dose thiamine, B-complex vitamin injection, and changing sodium valproate to levetiracetam due to liver involvement. Although there were relative improvements after the treatment, sixth nerve damage was still present in the patient and needed much longer follow-ups.