Wernicke's encephalopathy due to hyperemesis gravidarum: an under‐recognised condition

Abstract

We present a case of a 25-year-old woman with drowsiness, nystagmus, severe ataxia and areflexia, which developed six weeks after admission to an obstetric clinic for hyperemesis gravidarum. She had been treated with intravenous dextrose and electrolyte solutions and antiemetics. Magnetic resonance imaging (MRI) performed on the fifth day of her neurologic symptoms showed increased intensity in both thalami, periaqueductal grey matter, the floor of the fourth ventricle and superior cerebellar vermis in T2 weighted and FLAIR images. Clinical signs and MRI findings were consistent with the diagnosis of Wernicke's encephalopathy. On the third day of thiamine replacement, neurologic signs improved dramatically In addition to our case, we review 29 previously reported cases of Wernicke's encephalopathy associated with hyperemesis gravidarum, and emphasize the importance of thiamine supplementation to women with prolonged vomiting in pregnancy especially if they are given intravenous or parenteral nutrition.

Wernicke's Encephalopathy following Hyperemesis Gravidarum

“…Deep tendon reflexes may recover a month after treatment 8 . Mild ataxia, dysmetria and nystagmus may persist, as seen in our patients 2,3,7 . The outcome of pregnancy in patients with WE, on the other hand, is not very good.…”

“…Vestibular dysfunction is a common finding. Most adults also have associated features of peripheral neuropathy such as absent deep tendon reflexes, hypotonia and weakness of the lower limbs 7 . A large number of patients have associated antegrade and retrograde amnesia, so-called Korsakoff's psychosis.…”

“…More than 50% of patients with hyperemesis gravidarum and WE show liver function abnormalities, probably due to a nutritional cause. In addition, hyperemesis gravidarum with liver dysfunction has an increased risk of WE 7 . Two of our three patients had biochemical evidence of liver dysfunction, and all had excessive vomiting for more than a month before admission.…”

Wernicke?s Encephalopathy Secondary to Prolonged Total Parenteral Nutrition: Case Report

“…[26][27][28] Sunulan olgu, uzun süre hastane yatışı ve parenteral beslenme sonucu riskli gruplar arasındadır. Olgu kliniğimize danışıldığında, enfeksiyöz öyküsü göz önünde bulundurulup ilk önce ensefalit tanısı dış-lanmış, sonrasında tipik görüntüleme sonuçlarıyla WE tanısı alıp tedavi edilmeye başlanmıştır.…”

Wernicke’s encephalopathy: a case report and mri findings

“…WE can also be precipitated by parenteral nutrition or infusion of glucosecontaining solutions without prior administration of thiamine (4,5).…”