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Published on: August 4, 2023
Neurological complications in hyperemesis gravidarum
Gabriella Zara1, Valentina Codemo, Arianna Palmieri
1Department of Neurosciences, University of Padova, via Giustiniani, 5, 35128 Padua, Italy. gabriella.zara@sanita.padova.it
Summary
This case study highlights severe neurological complications in a pregnant woman with hyperemesis gravidarum, including Wernicke encephalopathy and polyneuropathy, emphasizing the critical role of thiamine. Prompt treatment improved consciousness but led to Korsakoff syndrome and central pontine myelinolysis.
Area of Science:
- Neurology
- Obstetrics
- Nutritional Neuroscience
Background:
- Hyperemesis gravidarum (HG) can lead to thiamine deficiency and electrolyte imbalances.
- Neurological complications in HG, such as Wernicke encephalopathy (WE), are rare but serious.
- This study examines a unique case of HG with severe neurological sequelae.
Observation:
- A 29-year-old pregnant woman with HG presented with undernutrition and neurological deficits.
- Clinical findings included weakness, hyporeflexia, ophthalmoparesis, nystagmus, optic disk swelling, and coma.
- Brain MRI revealed changes consistent with Wernicke encephalopathy.
Findings:
- The patient developed Wernicke encephalopathy and axonal sensory-motor polyneuropathy.
- Treatment with thiamine and electrolytes improved consciousness but resulted in Korsakoff syndrome.
- Follow-up MRI showed resolution of WE lesions and new lesions in the pons, suggestive of central pontine myelinolysis.
Implications:
- This case underscores the importance of early recognition and aggressive management of thiamine deficiency in HG.
- It highlights the potential for severe, diverse neurological complications, including WE and central pontine myelinolysis.
- Optimal nutritional support and timely thiamine supplementation are crucial for preventing irreversible neurological damage in pregnant women with HG.
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