Wernicke's Encephalopathy Complicating Hyperemesis during Pregnancy

Area of Science:

• Neurology
• Obstetrics & Gynecology
• Nutritional Science

Background:

• Wernicke's encephalopathy (WE) is a serious neurological condition resulting from severe thiamine deficiency, commonly associated with alcoholism.
• Hyperemesis gravidarum (HG), characterized by severe nausea and vomiting during pregnancy, can lead to nutritional deficiencies.
• WE is a rare but critical complication of HG, posing significant risks to both mother and fetus.

Purpose of the Study:

• To report a case of Wernicke's encephalopathy in a pregnant patient with hyperemesis gravidarum.
• To highlight the importance of early diagnosis and prompt thiamine treatment in preventing severe neurological sequelae.
• To emphasize the need for thiamine supplementation in pregnant women experiencing prolonged vomiting.

Main Methods:

• Case report of a 28-year-old woman at 17 weeks gestation presenting with symptoms of WE.
• Clinical evaluation including neurological examination and MRI brain.
• Biochemical confirmation of low serum thiamine levels.
• Management with high-dose intravenous thiamine therapy.

Main Results:

• The patient presented with altered consciousness, nystagmus, ophthalmoplegia, and ataxia.
• MRI revealed characteristic symmetrical hyperintensities in the thalamus and periaqueductal areas.
• Diagnosis was confirmed by low serum thiamine levels.
• Treatment with high-dose thiamine led to partial recovery, with residual mild ataxia and nystagmus.

Conclusions:

• Wernicke's encephalopathy is an uncommon but potentially devastating complication of hyperemesis gravidarum.
• Prompt recognition and aggressive thiamine administration are vital for improving outcomes and preventing irreversible neurological damage.
• Prophylactic thiamine supplementation should be considered in pregnant women with persistent vomiting, particularly before initiating dextrose infusions.