Wernicke Encephalopathy as a Complication of Hyperemesis Gravidarum: Case Report

Abstract

Wernicke encephalopathy (WE) is an acute neurological disorder resulting from vitamin B1 deficiency, which is common in chronic alcoholism. We report a rare case of WE due to hyperemesis gravidarum in a 25-year-old pregnant patient at 13 weeks and 5 days of gestation. Initially, the disease manifested as weakness, mental confusion, anterograde amnesia, and visual and auditory hallucinations. The diagnosis was established after the detection of suggestive findings of WE in the thalamus by magnetic resonance imaging (MRI) and a rapid improvement in the patient's clinical status subsequent to treatment with thiamine. Hyperemesis is a rare cause of WE, which makes the reported case important in the literature and reinforces the need for attention in clinical practice to rare but important complications of this common condition (hyperemesis gravidarum).

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

“…We are sensitive to this reality with three cases of HG‐related hallucinations, or ASG, from our institution 65 . In this study, hallucinations, altered mental status, and/or delirium were presenting symptoms in at least five (18.5%) women 21,23,24,26,36 …”

“…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…”

“…65 In this study, hallucinations, altered mental status, and/or delirium were presenting symptoms in at least five (18.5%) women. 21,23,24,26,36 Many women with NVP are told it is a first-trimester issue and is normal, which it is. Extremely ill women ask how vomiting and weight loss can be healthy for their pregnancy and are reassured that having NVP leads to a lower risk of miscarriage, which is true but only in a cohort of women experiencing "morning sickness."…”

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.…”