Wernicke’s Encephalopathy from Hyperemesis Gravidarum. A Case Report

Abstract

Introduction: Wernicke's encephalopathy (WE) is a potentially reversible, yet serious neurological emergency due to vitamin B1 (thiamine) deficiency. It is a rare but known complication of hyperemesis gravidarum. Prolonged vomiting in pregnancy results in thiamine depletion. Most frequently Wernicke's encephalopathy is found among persons suffering from chronic alcoholism. It can also occur in any medical condition producing malnourishment and causing thiamine deficiency including gastric bypass, a variety of gastrointestinal disorders, malignant diseases, anorexia nervosa, hyperthyroidism and prolonged intravenous feeding. Magnetic resonance imaging (MRI) is sensitive and specific for diagnosis and follow up evaluation. Most patients present with the triad of ocular signs, ataxia, and confusion. It can be associated with life-threatening complication like central pontine myelinolysis. Although early recognition and treatment with thiamine can reverse the symptoms, the mortality rate remains 10-20% due to underdiagnosis. It is frequently not identified until autopsy. Here we stress upon the importance of early diagnosis and prompt treatment of WE. The aim of this report is to present case of Wernicke's encephalopathy induced by hyperemesis gravidarum. The course of the disease, clinical signs, diagnostic tools, treatment and its results are presented.