Korean J Crit Care Med.  2015 May;30(2):128-131. 10.4266/kjccm.2015.30.2.128.

A Critical Case of Wernicke's Encephalopathy Induced by Hyperemesis Gravidarum

• Kang BJ
• Kim MG
• Kim JH
• Lee M
• Jeon SB
• Kim HI
• Huh JW

• KMID: 2227683
• DOI: http://doi.org/10.4266/kjccm.2015.30.2.128

Abstract

Wernicke's encephalopathy is a reversible but potentially critical disease caused by thiamine deficiency. Most patients complain of symptoms such as ophthalmoplegia, ataxia and confusion. Heavy alcohol drinking is commonly associated with the disease, but other clinical conditions also can provoke it. In pregnant women, hyperemesis gravidarum can lead to the depletion of body thiamine due to poor oral intake and a high metabolic demand. We report a case of Wernicke's encephalopathy following hyperemesis gravidarum in a 36-year-old female at 20 weeks of pregnancy, who visited our hospital because of shock with vaginal bleeding. This case suggests that although the initial presentation may include atypical symptoms (e.g., shock or bleeding), Wernicke's encephalopathy should be considered, and thiamine replacement should be performed in pregnant women with neurologic symptoms and poor oral intake.

Keyword

acute kidney injury; hyperemesis gravidarum; Wernicke encephalopathy

MeSH Terms

Acute Kidney Injury
Adult
Alcohol Drinking
Ataxia
Female
Humans
Hyperemesis Gravidarum*
Neurologic Manifestations
Ophthalmoplegia
Pregnancy
Pregnant Women
Shock
Thiamine
Thiamine Deficiency
Uterine Hemorrhage
Wernicke Encephalopathy*
Thiamine

Figure

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  Fig. 1. Initial brain magnetic resonance imaging findings: T2-weighted imaging and diffusion-weighted imaging showed bilateral symmetric edematous high-signal changes in medio-posterior thalami (arrow) and fornices (large arrowhead) (A, B). Fluid-attenuated inversion recovery imaging showed high-signal-intensity lesions in medio-posterior thalami (arrow), fornices (large arrowhead) and mammillary bodies (small arrowhead) (C, D). (A) T2-weighted imaging of both medio-posterior thalami and fornices. (B) Diffusion-weighted imaging of both medio-posterior thalami and fornices. (C) Fluid-attenuated inversion recovery imaging of both medio-posterior thalami and fornices. (D) Fluid-attenuated inversion recovery imaging of both mammillary bodies.

Reference

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