Hyperemesis Gravidarum Induced Wernickes Encephalopathy
Introduction: Wernicke’s encephalopathy (WE) is a condition caused by the depletion of Vitamin B1 levels. It causes neuropsychiatric symptoms. The triad includes Nystagmus and Ophthalmoplegia, mental status changes and Ataxia. Case description: 29 year old female, Gravida2 Para1 Live1, with 5 months of amenorrhea brought to the hospital with reduced responsiveness for 2 days. Patient had 8-10 episodes of vomiting per day. The vomitus was non-bilious and non-projectile for last 2 months. Patient had opthalmoplegia with restricted extraocular movements. All four limbs had reduced tone. MR imaging showed bilateral thalamus hyperintensities. Serum thiamine level was 2 nmol/L. Patient was treated with 350 mg of intravenous thiamine three times a day. Patient improved clinically. Conclusion: Hyperemesis Gravidarum is one of the rare causes of Wernicke’s encephalopathy. This diagnosis should be brought to consideration when the neurological triad exist in women with hyperemesis gravidarum. Pregnant women who develop hyperemesis should be given thiamine supplementation, before intravenous or parenteral nutrition.
Sriharsha Kulkarni, Suman GR, Jithin George