All are associated with Wernicke's encephalopathy except

Wernicke's encephalopathy This is an acute reaction to a severe deficiency of thiamine, the commonest cause being chronic alcohol use. Characteristically, the onset occurs after a period of persistent vomiting. The impoant clinical signs are: i. Ocular signs: Coarse nystagmus and ophthalmoplegia, with bilateral external rectus paralysis occurring early. In addition, pupillary irregularities, retinal haemorrhages and papilloedema can occur, causing an impairment of vision. ii. Higher mental function disturbance: Disorientation, confusion, recent memory disturbances, poor attention span and distractibility are quite common. Other early symptoms are apathy and ataxia. Peripheral neuropathy and serious malnutrition are often co-existent. Neuropathologically, neuronal degeneration and haemorrhage are seen in the thalamus, hypothalamus, mammillary bodies and midbrain. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no.38