Acute Wernicke's Encephalopathy Associated with Hyperemesis Gravidarum: Magnetic Resonance Imaging Findings

Abstract

A 25-year-old woman with hyperemesis gravidarum developed acute Wernicke's encephalopathy during prolonged intravenous fluid therapy without vitamin supplements. Delay in diagnosis led to a persistent severe neurological deficit, including coma. Gadolinium-diethylenetriaminepentaacetic acid-enhanced magnetic resonance imaging revealed symmetrical lesions around the aqueduct and fourth ventricle, which resolved after treatment with thiamine. She did not regain consciousness. This report demonstrates the diagnostic value of enhanced magnetic resonance imaging in acute Wernicke's encephalopathy.

Magnetic resonance imaging in a case of Wernicke's encephalopathy

“…The same findings are found in 12.5 % of autopsies made in alcoholic patients [6], although WE is clinically diagnosed only in 20 % of these subjects [2,7]. Although it was initially considered a consequence of the alcohol-related malnutrition, WE can occur in all conditions associated with a reduced thiamine intake and/or absorption, including prolonged starvation [8], hyperemesis gravidarum [9], anorexia nervosa, Wipple's disease, malignancies [10] and extensive inflammatory disorder of the gastrointestinal tract [11,12].…”

Wernicke encephalopathy: MR findings in two patients

“…Magnetic resonance imaging can detect minor changes in the brain far more sensitively than CT [3,4,22]. To our knowledge, the reported cases of acute Wernicke encephalopathy investigated with MR are sparse [3,4,5,6,7,8,9,10,11,12,13]. As in our two cases, T2-weighted sequences often show hyperintense symmetric lesions most typically in the paraventricular regions of the third and/or fourth ventricle and/or around the cerebral aqueduct.…”

“…The typical locations of Wernicke encephalopathy (paraventricularly in the thalamus and hypothalamus, in the mamillary bodies, the periaqueductal region of the midbrain, the floor of the fourth ventricle and the anterior parts of the cerebellum, mainly the vermis) were extensively studied on post-mortem examinations [2]. Reports with MR examination in the acute phase of Wernicke encephalopathy, however, are sparse [3,4,5,6,7,8,9,10,11,12,13]. In the literature the characteristic symmetric paraventricular lesions of Wernicke encephalopathy are hyperintense on SE T2-weighted sequences and enhance on T1-weighted spin-echo (SE) sequences after intravenous gadolinium administration in the acute phase.…”

Die Vitamine B1, B6 und B12

“…1 [6] und Demenzen ebenso für einen akuten Thiaminmangel wie Hyperemesis gravidarum [7] und Neoplasien [5]. In Analogie zu anderen wasserlöslichen Molekü-len sind die Organspeicher für Vitamin B1 in Herz, Leber, Niere und Gehirn nur für wenige Tage bis maximal 2 bis 4 Wochen ausreichend und somit von einer regelmäßigen Aufnahme abhängig, damit es nicht zu Mangelerscheinungen kommt.…”