Abstract
Wernicke's encephalopathy (WE) is a potentially reversible yet severe neurological manifestation caused by thiamine (vitamin B1) deficiency. It is commonly associated with heavy alcohol consumption. Other rare causes include severe and prolonged vomiting, starvation, and prolonged intravenous feeding. WE patients usually present with the triad of ocular signs, ataxia, and confusion. In non-alcoholic patients, the full classic triad develops in 10-16% of cases. Characteristic MRI findings and clinical response to thiamine confirm the diagnosis. In this report, we present a case of WE in the setting of transient gestational hyperthyroidism and hyperemesis gravidarum (HG).
Highlights
Wernicke's encephalopathy (WE) is a serious neurological disorder secondary to severe thiamine deficiency [1]
We present a case of WE in the setting of transient gestational hyperthyroidism and hyperemesis gravidarum (HG)
We present a case of severe WE in a female non-alcoholic inpatient that was precipitated by inadequate nutritional intake due to HG and development of thyrotoxicosis
Summary
Wernicke's encephalopathy (WE) is a serious neurological disorder secondary to severe thiamine deficiency [1] It is mostly prevalent among alcoholics (12.5%), and is difficult to recognize in non-alcohol-related conditions, including prolonged starvation and post-bariatric surgery. A 32-year-old female, who was 12 weeks pregnant, presented with a history of confusion and abnormal behavior for one day She had experienced recurrent vomiting for the past one month. She had been on a liquid diet for the past month due to severe vomiting She had received intravenous dextrose infusion from her primary care physician. The patient received thiamine 500 mg intravenously three times a day for three days, followed by 250 mg orally for 14 days She had a complete clinical recovery and was discharged home safely. She went on to have an unremarkable pregnancy and a normal vaginal delivery with an unremarkable post-natal course
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