Wernicke-Korsakoff Syndrome in Hyperemesis Gravidarum: A Case Report and Literature Review

Abstract

Background: Wernicke-Korsakoff syndrome (WKS) is a triad of ophthalmoplegia, ataxia and memory deficits due to thiamine insufficiency resulting from under- or untreated Wernicke’s encephalopathy (WE), which may be associated with hyperemesis gravidarum (HEG). Case presentation: We present a case of a 36-year-old Filipino woman in her first trimester with HEG, along with the WKS triad and abnormal hyperintense signals in the bilateral thalami and midbrain, left occipital lobe, periaqueductal gray matter and pontine periventricular areas. Neurologic deficits partially improved but persisted despite intravenous thiamine administration. Evidence review: A review of current treatments for WE, and the prevention and neurocognitive recovery of WKS was done. The beneficial effects of thiamine for acute WKS are supported by several case reports and clinical experience. Evidence from one randomized controlled trial wherein thiamine was given in various doses for treating WE or preventing WKS in an alcohol-dependent population is limited by methodological issues. Rehabilitation and pharmacotherapy for neurocognitive recovery seems promising, but they have inadequate evidentiary support. More robust studies on multi-modal strategies are warranted to facilitate the neurocognitive recovery of patients with WKS.

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

“…Ironside noted uncertainty that death from severe HG with advancing deterioration would be averted by vitamin B 1 therapy 57 . Similar to findings by Sheehan and Ironside in 1939, incomplete recovery from thiamin administration was evident in our series, with prolonged ataxia, which included wheelchair dependence, psychosis/delirium, and loss of short‐term and long‐term memory 26,31,32,34,36,37 . Whereas there were no maternal fatalities in our series, there were four cases of IUFD and one neonatal demise, a pregnancy wastage rate of 18.5%.…”

“…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…”

Wernicke-Korsakoff Syndrome as a Consequence of Hyperemesis Gravidarum: A Case Report

“…Treatment for this syndrome is well established and therefore based on correcting electrolyte imbalance and dehydration and intravenous thiamine administration (200mg/day for two days), in combination with other B vitamins [ 11 ] which can result in symptom resolution in a few hours or days depending on the severity of the disease. However, rigorous studies are lacking to confirm the efficacy of this treatment [ 9 , 12 ].…”