Jin Tao¹, Vibhav Bansal²*, Dorothy Bennett¹, Ayaz Gen¹, Samridh Gupta³, Samantha Aguilar³, Roy El Koussa¹, Sarah Linder², Vijayta Geeta Bansal-Kapuria¹ and Drew Rust¹

¹Internal Medicine, MercyHealth, Rockford, IL, USA
²Neurology, MercyHealth, Rockford, IL, USA
³University of Chicago College of Medicine, Rockford, IL, USA

*Corresponding Author: Vibhav Bansal, Neurology, MercyHealth, Rockford, IL, USA.

Received: July 26,2022; Published: August 08, 2022

Abstract

Wernicke’ encephalopathy is a rare but potentially reversible neurological disorder characterized by ophthalmoplegia, ataxia and confusion. Wernicke’s encephalopathy occurs as result of severe vitamin B1 (i.e., thiamine) deficiency. The most common etiology of Wernicke’s encephalopathy is malnutrition among alcoholics. Here, we report an unusual case of hyperemesis gravidarum induced Wernicke’s encephalopathy. A 25-year-old female, G2P1, with recent miscarriage at 20 weeks gestation and hyperemesis gravidarum presented with 1-month history of confusion, blurred vision, and progressive bilateral lower extremity weakness. The magnetic resonance imaging of brain revealed bilateral symmetrical hyperintensities in the thalami, mammillary bodies, and surrounding aqueduct of the midbrain suggesting Wernicke’s encephalopathy. Patient was subsequently managed with aggressive thiamine replacement therapy. Her symptoms gradually improved, and she was eventually discharged to an inpatient rehabilitation facility for long term physical therapy. Wernicke’s encephalopathy is a rare complication of hyperemesis gravidarum. This case highlights the importance of recognizing neurological changes due to thiamine deficiency during pregnancy. We would like to emphasize the importance of thiamine supplementation and monitoring in pregnant women with severe and prolonged vomiting history.

Keywords: Hyperemesis Gravidarum; Wernicke’s Encephalopathy; Thiamine Deficiency; Ataxia; Confusion; Ophthalmoplegia

References

1. Kotha VK and A De Souza. “Wernicke's encephalopathy following Hyperemesis gravidarum. A report of three cases”. The Neuroradiology Journal1 (2013): 35-40.
2. Netravathi M., et al. “Hyperemesis-gravidarum-induced Wernicke's encephalopathy: serial clinical, electrophysiological and MR imaging observations”. Journal of the Neurological Sciences1-2 (2009): 214-216.
3. Oudman Erik., et al. “Wernicke's encephalopathy in hyperemesis gravidarum: A systematic review”. European Journal of Obstetrics, Gynecology, and Reproductive Biology 236 (2019): 84-93.
4. Galvin R., et al. “EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy”. European Journal of Neurology12 (2010): 1408-1418.
5. Gárdián G., et al. “Wernicke's encephalopathy induced by hyperemesis gravidarum”. Acta Neurologica Scandinavica3 (1999): 196-198.
6. Chataway J and E Hardman. “Thiamine in Wernicke's syndrome--how much and how long?” Postgraduate Medical Journal834 (1995): 249.
7. National Research Council (US) Subcommittee on the Tenth Edition of the Recommended Dietary Allowances. Recommended Dietary Allowances: 10^th Edition. National Academies Press (US) (1989).
8. Toth C and C Voll. “Wernicke's encephalopathy following gastroplasty for morbid obesity”. The Canadian Journal of Neurological Sciences. Le Journal Canadien des Sciences Neurologiques1 (2001): 89-92.
9. Harper CG., et al. “Clinical signs in the Wernicke-Korsakoff complex: a retrospective analysis of 131 cases diagnosed at necropsy”. Journal of Neurology, Neurosurgery, and Psychiatry4 (1986): 341-345.
10. Togay-Işikay C., et al. “Wernicke's encephalopathy due to hyperemesis gravidarum: an under-recognised condition”. The Australian and New Zealand Journal of Obstetrics and Gynaecology4 (2001): 453-456.
11. Antunez E., et al. “Usefulness of CT and MR imaging in the diagnosis of acute Wernicke's encephalopathy”. American Journal of Roentgenology 171.4 (1998): 1131-1137.
12. Zuccoli G., et al. “Wernicke encephalopathy: MR findings at clinical presentation in twenty-six alcoholic and nonalcoholic patients”. American Journal of Neuroradiology 28.7 (2007): 1328-1331.
13. Manzanares, William, and Gil Hardy. “Thiamine supplementation in the critically ill”. Current Opinion in Clinical Nutrition and Metabolic Care6 (2011): 610-617.
14. Indraccolo Ugo., et al. “Thiamine deficiency and beriberi features in a patient with hyperemesis gravidarum”. Nutrition (Burbank, Los Angeles County, Calif.)9 (2005): 967-968.
15. Michel ME., et al. “Wernicke encephalopathy complicating hyperemesis gravidarum: a case report”. European Journal of Obstetrics, Gynecology, and Reproductive Biology1 (2010): 118-119.

Citation

Citation: Vibhav Bansal., et al. “Hyperemesis Gravidarum Induced Wernicke’s Encephalopathy". Acta Scientific Neurology 5.9 (2022): 11-14.

Copyright

Copyright: © 2022 Vibhav Bansal., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.