Wernicke's encephalopathy, which in its classic form consists of the triad of oculomotor abnormalities, ataxia, and a confusional state, must also be considered in an alcoholic with altered mental status. Although the presence of ocular signs was once considered pathognomonic, it is now recognized that the syndrome may present with encephalopathy alone. Many patients with Wernicke's encephalopathy (as many as 80 %) will develop Korsakoffs syndrome. The point at which Wernicke's encephalopathy ends and Korsakoff's syndrome begins is difficult to ascertain. Differentiating between Wernicke's encephalopathy and other causes of delirium, including alcohol withdrawal delirium, can be difficult. Although the case described herein appears to involve a protracted alcohol withdrawal delirium, the validity of that diagnosis may be questioned. That is, can a delirium that persists beyond 4 weeks (totally 3 months) following the cessation of heavy drinking still be considered an alcohol withdrawal delirium? The most common outcome of delirium is full recovery. Sometimes the patient may experience recurrent episodes of it over a period of months or even years. This is most likely to happen in someone suffering from a progressive brain disease, such as a space-occupying lesion, or from a metabolic disease punctuated by recurrent exacerbation's and concomitant cerebral dysfunction. Chronic renal, hepatic, cardiovascular and pulmonary diseases offer relevant examples.