Encéphalopathie de Wernicke: complication rare de l’hyperemesis gravidarum

Abstract

L’encéphalopathie de Wernicke est une pathologie carentielle causée par un déficit profond en thiamine (vitamine B1). Elle survient le plus souvent sur un terrain alcoolique, mais parfois elle est de diagnostic difficile et dont l’évolution en l’absence de traitement conduit à des séquelles cognitives sévères. L’imagerie par résonance magnétique est l’examen de référence permettant de confirmer le diagnostic par la présence d’hyper signaux T2 au niveau périaqueducal, des thalami, et des corps mamillaires. Nous rapportons l’observation d’une femme de 30 ans ayant des vomissements abondants lors du premier trimestre de la grossesse (hyperemesis gravidarum), à l’origine d’une encéphalopathie de Wernicke symptomatique.

Seizures in the third trimester of pregnancy- A rare case of Wernicke's encephalopathy mimicking Eclampsia

“…A thiamine (vitamin B1) deficit causes Wernicke's encephalopathy, a neurological emergency that involves the hippocampal-mammillary-thalamic network [2] . It is an uncommon but dangerous central nervous system illness [1] that has a 30% or higher death rate [2] .…”

“…A thiamine (vitamin B1) deficit causes Wernicke's encephalopathy, a neurological emergency that involves the hippocampal-mammillary-thalamic network [2] . It is an uncommon but dangerous central nervous system illness [1] that has a 30% or higher death rate [2] . The syndrome was first described by Wernicke in 1881, presenting the classical triad of ataxia, ophthalmoplegia, and confusion [2] .…”

“…It is an uncommon but dangerous central nervous system illness [1] that has a 30% or higher death rate [2] . The syndrome was first described by Wernicke in 1881, presenting the classical triad of ataxia, ophthalmoplegia, and confusion [2] . It usually happens following a gastrectomy, in the setting of extreme malnourishment, or in the context of chronic alcoholism [1] .…”

“…It is often underdiagnosed, with a clinical prevalence of 0.04% to 0.13%, compared to 0.8% and 2.8% in pathology [1] . The symptoms may suggest other conditions such as cerebral venous thrombosis, stroke, or another metabolic disorder [2] , but MRI is essential for diagnosis [2] . Brain MRI is of paramount importance in WE diagnosis [3] .…”

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.…”