Title : Wernicke encephalopathy in pregnancy: The silent threat of thiamine deficiency
Abstract:
Background. Wernicke encephalopathy (WE) is a severe, potentially fatal neurological disorder caused by thiamine deficiency. While traditionally linked to alcoholism, non-alcoholic cases have emerged due to prolonged vomiting, malnutrition, and systemic diseases. This report presents a case of WE because of hyperemesis gravidarum (HG), emphasizing the need for early recognition, timely thiamine supplementation, and nutritional screening to prevent severe neurological complications as well as the importance of adherence to medicine and follow-up.
Case presentation. A 21-year-old pregnant woman (G2P0, 14 weeks gestation) presented with persistent nausea, severe vomiting more than 10 times/day, dehydration, malnutrition, and weight loss on March 6, 2023. Her medical history included a previous miscarriage at 5 weeks gestation in 2022, with no known systemic diseases, prior surgeries, allergies. She presented as fatigued but hemodynamically stable. Laboratory findings showed anemia, transient hyperglycemia, and starvation ketonuria. Despite antiemetic and supportive therapy, her condition worsened. She developed confusion, gait ataxia, and ophthalmoplegia, hallmark signs of WE. MRI confirmed bilateral hyperintensities in the thalamus and mammillary bodies. Due to worsening health and suspected partial molar pregnancy, medical termination was performed on March 25, 2023. High-dose IV thiamine (500 mg TID) was initiated, leading to some neurological improvement. However, the patient was discharged prematurely and did not follow up, ultimately dying from complications of untreated WE.
Discussion. WE results from impaired cerebral metabolism due to thiamine deficiency, leading to selective vulnerability of key brain structures. Early diagnosis is challenging in pregnancy due to overlapping symptoms, but MRI aids confirmation. Immediate thiamine supplementation is critical, as delayed treatment can lead to irreversible neurologic complications and death.
Conclusion. Healthcare providers, particularly obstetricians and neurologists must recognize WE in HG early and initiate thiamine without delay. Strict adherence to treatment regimens and follow-up visits is crucial to avoid complications and prevent fatal outcomes.
