Wernicke's encephalopathy (WE) is a neurological disorder induced by a dietary vitamin B1 (thiamine) deficiency. It is characterized by encephalopathy, gait ataxia, and some variant of oculomotor dysfunction which are the classic triad of WE. However, a complicating factor of WE identification may not be associated with the classical clinical triad in up to 90% of patients. In recent years, a loss of the horizontal vestibulo-ocular reflex (VOR) is being reported as the major underdiagnosed symptoms in WE. In this retrospective single center study, we describe four cases of WE presented mainly impaired horizontal VOR in addition to the classical clinical presentations, and imaging and neurotological laboratory findings were described.