384. Wernicke’s encephalopathy: An uncommon complication from Hyperemesis Gravidarum

Abstract

Hyperemesis Gravidarum (HG) is a complication of pregnancy associated with severe nausea and vomiting that can lead to fluid-electrolyte imbalances and nutritional deficiencies. HG is distinguished from the benign nausea and vomiting of pregnancy by the presence of ketonuria and weight loss. Wernicke’s Encephalopathy is a neurologic manifestation of acute thiamine (Vitamin B1) deficiency. We describe a case of Hyperemesis Gravidarum presenting with gait ataxia and nystagmus which led to Wernicke’s encephalopathy. An 18-year-old Prima Gravida at 18 weeks gestation with a history of HG presented to our hospital with a 5-day history of vertigo. She was diagnosed with dehydration secondary to HG and was admitted for further workup of her vertigo. On neurologic examination, bilateral horizontal and vertical nystagmus were present. A magnetic resonance imaging (MRI) of the brain demonstrated an area of restricted diffusion in the medial thalamic nuclei. This abnormality paired with the patient’s history of malnutrition secondary to HG supported a diagnosis of Wernicke’s Encephalopathy. The patient was administered IV thiamine 200 mg and then subsequently transitioned to oral thiamine 100 mg daily. The patient was discharged home on hospital day 5 with out-patient follow up. Hyperemesis Gravidarum is defined as persistent vomiting with a weight loss exceeding 5% of pre-pregnancy weight, in addition to ketonuria unexplained by other causes. Wernicke’s Encephalopathy presents with a classic triad of gait ataxia, ophthalmoplegia, and confusion. Wernicke’s Encephalopathy is most commonly caused by chronic alcoholism, but it can also occur rarely as a complication of HG. In conclusion, vertigo during pregnancy should be carefully evaluated and physicians should maintain a broad differential diagnosis, including Wernicke’s Encephalopathy. When treating Hyperemesis Gravidarum, clinicians should have a high level of suspicion for Wernicke’s encephalopathy if neurologic complaints occur, as failure to provide timely treatment could lead to fatal maternal and fetal consequences.