Wernicke encephalopathy—a rare complication of hyperemesis gravidarum

Žigrai, Miroslav; Smetanová, Viera; Gmitterová, Karin; Klepancová, Petra; Vyskočil, Milan

doi:10.1038/s41430-020-0592-9

Cited by 9 publications

(7 citation statements)

References 9 publications

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“…Administering thiamin in insufficient doses, <500 mg of intravenous thiamin three times per day until acute symptoms resolve is considered suboptimal treatment, which continues in current times 38 . In our series of 27 women with HG‐WE, 8 (29.8%) were undertreated with thiamin (24,25,27,28,32: cases 2,3,6; 37). We highlight the role of minerals in thiamin metabolism as critical, and whereas magnesium was assessed in many of these 18 reports, phosphorus was not.…”

Section: Discussionmentioning

confidence: 91%

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Gestational malnutrition, hyperemesis gravidarum, and Wernicke's encephalopathy: What is missing?

Erick

2022

Nut in Clin Prac

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Hyperemesis gravidarum (HG), or the severe nausea and vomiting of pregnancy, is one of the most dreaded complications of gestation, affecting between 1.5% and 3.0% of pregnant women. From the late 1800s to the mid-1980s, the etiology was frequently cited to have psychological and/or-laterperhaps hormonal origins, which have numbered at least 10. Current research has unearthed a genetic basis for HG that implicates growth differentiation factor 15, insulin-like growth factor binding protein 7, and hormone receptors (namely, glial cell line-derived neurogenic factor family receptor alpha-like and the progesterone receptor). Whatever the origins of this disease, it has caused immeasurable physiological and psychological damage to women, their fetuses, and their families. The psychological trauma includes a high rate of suicidal ideation as well as posttraumatic stress disorder. Whereas the healthcare costs are substantial for the mother with HG, the lifetime costs to the neonate include that which accompanies reduced employment earnings related to cognitive compromise. Another devastating outcome of severe HG can be Wernicke's encephalopathy (WE), which has a high fetal and maternal mortality rate. Our study explored 18 current reports of HG and WE. We highlighted additional presenting features we believe also accompany, and sometimes replace, the classically taught triad components of WE: ataxia, confabulation, and nystagmus. We agree with the conclusion made by Sheehan and Ironside in 1939 that thiamin alone may not reverse WE, and we offer possible explanations. Lastly, we offer suggestions for remediation.

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Section: Discussionmentioning

confidence: 91%

“…We present our findings, representing 27 women, in Table 1. [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] T A B L E 1 Description of pregnant women with HG deteriorating into WE…”

Section: Resultsmentioning

confidence: 99%

Gestational malnutrition, hyperemesis gravidarum, and Wernicke's encephalopathy: What is missing?

Erick

2022

Nut in Clin Prac

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“…In conclusion, WE secondary to HG is being diagnosed and reported with increasing frequency although relatively uncommon. [ 15 16 ] The presented case is peculiar for presentation in a very advanced stage with seizures and radiologically proven cortical involvement. Despite poor prognostic indicators, we could save the life of mother and baby due to prompt diagnosis, appropriate intervention, and vigilance.…”

Section: Discussionmentioning

confidence: 96%

Seizure as a presenting manifestation of Wernicke's encephalopathy induced by hyperemesis gravidarum

Ghosh

Mandal

Roy

et al. 2021

Journal of Family Medicine and Primary Care

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Wernicke's encephalopathy (WE) is an acute neurological condition characterized by the triad of ophthalmoparesis with nystagmus, ataxia, and global confusion. WE is a life-threatening illness caused by thiamine deficiency, primarily affecting the peripheral and central nervous systems. Thiamine deficiency is predominantly associated with chronic alcoholism, but various other causes have also been reported, including severe malnutrition, prolonged parenteral nutrition, malignancies, immunodeficiency syndromes, liver disease, hyperthyroidism and severe anorexia nervosa, and hyperemesis gravidarum. We, hereby, report a unique case of WE induced by hyperemesis gravidarum that presented in mid-trimester of pregnancy in a rather extremely unusual way with focal seizures and secondary generalization but fortunately ended up with a good feto-maternal outcome.

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“…Subsequent treatment with thiamine led to rapid improvement. 22 A 57-year-old male patient with gastric carcinoma who underwent a radical distal gastrectomy type II + Braun and who developed refractory arterial hypotension is found at necropsy to have WE. 23 WE is also observed in two non-alcoholic homosexual patients with acquired immunodeficiency syndrome patients.…”

Section: Clinical Aspectsmentioning

confidence: 99%

The Wernicke-Korsakoff encephalopathy: An updated review

Reuck¹

2022

JNSK

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Wernicke's encephalopathy is responsible for an acute neuropsychiatric syndrome that is associated with significant morbidity and mortality. It is most frequently due to alcoholism but can also be the result of chronic diseases, mainly systemic tumours, leading to thiamine deficiency. In the non-thiamine treated patients Korsakoff’s syndrome is the residual complication of the encephalopathy. The clinical diagnosis of Wernicke encephalopathy in alcoholics requires two of the following four signs: dietary deficiencies, eye signs, cerebellar dysfunction, and either disturbed mental state or mild memory impairment. These symptoms are less specific in the non-alcoholic patients. Korsakoff's syndrome is the residual condition in none thiamine treated patients. It is predominantly characterized by global amnesia, and in the more severe cases also by cognitive and behavioral dysfunction. Magnetic resonance imaging of the brain can detect the specific lesions and be helpful for the diagnosis. Treatment with 2500 mg thiamine intravenously is recommended as soon as possible.

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Wernicke encephalopathy—a rare complication of hyperemesis gravidarum

Cited by 9 publications

References 9 publications

Gestational malnutrition, hyperemesis gravidarum, and Wernicke's encephalopathy: What is missing?

Gestational malnutrition, hyperemesis gravidarum, and Wernicke's encephalopathy: What is missing?

Seizure as a presenting manifestation of Wernicke's encephalopathy induced by hyperemesis gravidarum

The Wernicke-Korsakoff encephalopathy: An updated review

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