We report a case of a 29-year-old overweight female with PMH of gastric sleeve surgery two months prior, presenting with a one-week history of worsening double vision and decreased visual acuity with transient visual obscurations. About three weeks after undergoing gastric sleeve surgery she developed nausea and vomiting, and was unable to keep food down. Exam was pertinent for confusion, bilateral CN VI palsies; vertical and horizontal nystagmus on primary gaze and with upward gaze. Funduscopic exam revealed bilateral grade IV papilledema with hemorrhages. She had no history of prior headaches. MRI brain and orbits showed prominence and tortuosity of the of the sheath complex with flattening of the posterior globe/pituitary gland. MRV was unremarkable. Initial working diagnosis was IIH based on the papilledema and the MRI findings. Patient underwent lumbar drain placement, and opening pressure was 21 cmH20, making the diagnosis of IIH less likely. Patient was treated with IV thiamine 500 mg TID and symptoms improved considerably. Given the clinical presentation with nystagmus, ophthalmoplegia, optic neuropathy with papillitis and improvement with IV thiamine even in the absence of typical MRI findings, patient was diagnosed with WE. Although neuroimaging studies can be helpful, WE is primarily a clinical diagnosis.