Wernicke’s Encephalopathy: A Rare Complication of Hyperemesis Gravidarum

Abstract

Aim: A case of Wernicke’s encephalopathy (WE) due to hyperemesis gravidarum is presented for its rarity and favorable outcome of pregnancy due to timely diagnosis and management. Background: Wernicke’s encephalopathy is a rare reversible neurological complication of hyperemesis gravidarum due to vitamin B1 (thiamine) deficiency. Hyperemesis gravidarum (HG) is associated with prolonged starvation and electrolyte imbalance leading to Wernicke’s encephalopathy, which is a triad of ocular signs, ataxia, and confused mental state. It also leads to a serious complications like central pontine myelinolysis (CPM). During pregnancy, Wernicke’s encephalopathy has poor outcomes in mother and baby. A fifth gravida presented at 14 weeks of gestation with Wernicke’s encephalopathy was treated with thiamine, recovered after 34 days, and delivered by cesarean section at 36.5 weeks, a live healthy baby. Conclusion: A favorable outcome of pregnancy can be there with a high index of suspicion, timely diagnosis, and management with thiamine. Clinical significance: Immediate supplementation of thiamine in antenatal women with prolonged vomiting in pregnancy, especially before starting intravenous glucose can prevent this reversible neurological condition.