Atypical neurological manifestations in Wernicke’s encephalopathy due to hyperemesis gravidarum

ABSTRACT

Objectives: Hyperemesis gravidarum is known to induce nutritional, water and electrolyte deficiencies which can be fatal if not treated urgently. Thiamine deficiency may lead to a constellation of neurological symptoms that include Wernicke encephalopathy. Moreover, Wernicke encephalopathy is typically manifested as ocular paresis, ataxia and confusion. Methods: Retrospective review of 6 women who developed neurological abnormalities following hyperemesis gravidarum and were treated with varying dosage of parenteral thiamine. Results: Five women developed atypical neurological symptoms, namely, slurred speech, visual loss, seizure and aggressive behaviour while one woman developed typical clinical triad of Wernicke encephalopathy after hyperemesis gravidarum. Magnetic Resonance Imaging (MRI) scans revealed abnormalities suggestive of Wernicke encephalopathy in three women only. All women improved after parenteral thiamine administration during hospital stay and had a complete neurological recovery during 2 months follow up. Discussion: Wernicke encephalopathy may not be necessarily associated with the typical neurological triad and may not have noticeable hyperintensity signal in dorsomedial thalami, mammillary bodies, hippocampus and periaqueductal region during magnetic resonance imaging. Atypical neurological signs and symptoms following hyperemesis gravidarum would invariably respond immediately to appropriate dosage of parenteral thiamine. A lower loading dosage of thiamine (100 mg thrice daily) appeared adequate for management in women with normal MRI scans.

KEYWORDS:

• Wernicke’s encephalopathy
• hyperemesis
• pregnancy
• ataxia
• nystagmus
• thiamine
• magnetic resonance imaging‌
• outcome‌

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes on Contributions

MB Divya helped in conceptualization, extraction of data, interpretation of findings and preparation and approval of the final draft of manuscript.

NS Kuber, N Jha, AK Jha and MM Thabah helped in conceptualization, extraction of data, interpretation, and preparation and approval of the final draft of manuscript.

Data availability statement

The authors confirm that the data supporting the findings of this study are available within the article.