Wernicke’s Encephalopathy with Generalized Weakness In a Woman with Hyperemesis Gravidarum and Gestational Thyrotoxicosis: A Case Report of a Rare Co-Occurrence with Literature Review

Abstract

Wernicke’s encephalopathy(WE) is an uncommon, yet, treatable and acute neuropsychiatric manifestation of thiamine deficiency which may often go undiagnosed .We report this case of a previously healthy 30 year old, non drinker, pregnant woman with hyperemesis gravidarum (HG) and gestational thyrotoxicosis(GT) who presented with a combination of WE, polyneuropathy and dysautonomia. This case is unique in many respects. (WE) is a rare but serious known complication of hyperemesis gravidarum. More so, WE occurring in association with hyperemesis gravidarum and gestational thyrotoxicosis, which are both hypermetabolic states and may predispose to WE, has been rarely reported in literature. Association of polyneuropathy causing generalized weakness and autonomic dysfunction in the same patient as part of the thiamine deficient state, with a good treatment outcome further adds to the complex yet interesting clinical presentation of this case.