Visual loss and optic neuropathy associated with Wernicke's encephalopathy in hyperemesis gravidarum

Abstract

Wernicke's encephalopathy (WE) is a potentially fatal neuropsychiatric syndrome precipitated by thiamine deficiency due to a variety of causes such as chronic severe alcoholism, starvation, and prolonged intravenous feeding. WE has also been observed rarely in the clinical setting of hyperemesis gravidarum. Here, we report the case of a 34-year-old pregnant woman who presented with reduced vision, gaze-evoked nystagmus, and postural imbalance preceded by 2 weeks of hyperemesis. Fundus examination showed features consistent with papillitis. Magnetic resonance imaging (MRI) showed T2WI, FLAIR, and diffusion-weighted imaging MR images showing hyperintensity in dorsomedial thalami and periaqueductal grey matter with diffusion restriction. She was diagnosed with WE based on history, clinical examination findings, and MRI findings and was treated with injectable thiamine. She showed marked improvement in vision and nystagmus within 3 days. Our case is a rare presentation of WE in a pregnant woman with hyperemesis gravidarum.

Wernicke Syndrome: Case Report and Literature Review of Contributing Factors—Can Malpractice Dynamics Be Identified?

“…The authors of said review article evaluated patient characteristics (the mean age, the mean duration of excessive vomiting at diagnosis, and the mean gestational age before onset of WE), the incidence rates of WE prodromal symptoms and classic triad, the percentage of radiologic findings, the rate of suboptimal treatment with thiamine, and fetal and maternal mortality. Moreover, 20 studies centered around 25 cases from June 2018 to February 2023 [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47] were also accounted for, and we evaluated the overall data of the Oudman review [23] and further subsequent studies for a total of 202 cases. The weighted average age of the patients was 27.…”

<p>Neuro-ophthalmic Manifestations of Wernicke Encephalopathy</p>

“…1 Nevertheless, optic disc edema is an uncommon finding. [32][33][34][35][36][37][38] It was found in only 2 of 52 (4%) WE patients reported by De Wardener et al 21 Retinal hemorrhages are also unusual and were seen in only 1 of 52 (2%) WE patients described by De Wardener et al and 6 of 245 (2%) WE patients in a case series by Victor et al 39 One could reasonably speculate that the frequency of fundus abnormalities is underestimated since they could be easily missed in patients evaluated by a physician not skilled in ophthalmoscopy.…”

“…68 With timely treatment, the disc edema resolves and visual function is often preserved. 16,38,40,69 However, if there is necrosis of ganglion cells or myelinated nerve fibers, 69 there will be permanent vision impairment. The retinal hemorrhages have a predilection for the peripapillary area, and have similar pathologic characteristics to the hemorrhages found in the mammillary bodies in patients with WE.…”