AN INTERESTING CASE OF WERNICKE’S ENCEPHALOPATHY SECONDARY TO HYPEREMESIS GRAVIDARUM

Abstract

Background

Wernicke's encephalopathy (WE) is a rare but serious neurological disorder caused by thiamine deficiency. It is often underdiagnosed in pregnant women due to vague and overlapping symptoms. Delayed recognition can lead to severe neurological impairment and progression to Korsakoff’s syndrome.

Case Presentation

A 26-year-old primigravida at four months of gestation presented with a two-day history of progressively worsening altered sensorium. She had persistent vomiting throughout the first trimester, which worsened in the second trimester (5–7 episodes per day for one week) and low-grade fever for two days. Additionally, she had small maculopapular lesions with vesicles on her back and anterior chest wall for two months. On examination, she was hemodynamically stable with a Glasgow Coma Scale (GCS) score of E2 V2 M4. Fundus examination showed bilateral papilledema with peri-papillary haemorrhages, which led to the suspicion of a space-occupying brain lesion. Meningitis was also considered as a provisional diagnosis.

Laboratory investigations, including complete blood count, renal function, and arterial blood gas analysis, were normal, but liver function tests showed elevated liver enzymes. Viral markers were negative. MRI brain revealed bilateral T2 and DWI hyperintensities in the dorsomedial and pulvinar nuclei of the thalami. Cerebrospinal fluid analysis was unremarkable. A clinical diagnosis of Wernicke’s encephalopathy was made, and the patient received intravenous thiamine, leading to significant improvement in GCS within two days, confirming the diagnosis.

Discussion

Hyperemesis gravidarum affects 0.5–2% of pregnancies and can cause severe thiamine deficiency. The classic WE triad—confusion, ataxia, and ophthalmoplegia—may be absent, making diagnosis difficult. A high index of suspicion and early thiamine replacement are crucial to prevent permanent neurological damage.

Conclusion

Early recognition of WE in hyperemesis gravidarum is vital. Prompt intravenous thiamine administration leads to significant recovery, preventing irreversible complications.