Wernicke’s encephalopathy as a complication of hyperemesis gravidarum

Background: Wernicke’s encephalopathy (WE) is an acute neuropsychiatric disorder, best known as a complication of chronic alcoholism, but it can also occur in pregnant women with excessive vomiting due to thiamine deficiency. This condition requires urgent intervention to prevent irreversible neurological damage and fatal outcomes. WE is characterized by the classic triad of symptoms: oculomotor disturbances, cerebellar dysfunction, and altered mental status. Despite the good understanding of WE due to alcoholism, this condition is often undiagnosed in pregnant women since it has nonspecific clinical presentation and it may be similar to other pregnancy complications.

The article provides a review of the pathogenesis, diagnosis, and treatment of WE in pregnant women, as well as a clinical observation of a patient with WE in the first trimester.

Case report: A pregnant woman in her first trimester presented with complaints of persistent vomiting, confusion, and ataxia. Severe hyperemesis gravidarum, metabolic disorders, and neurological pathology were considered during the differential diagnosis. Laboratory tests revealed thiamine deficiency, and MRI scans confirmed the diagnosis of Wernicke’s encephalopathy. The patient was immediately treated with high doses of intravenous thiamine, which led to her recovery. This observation demonstrates the difficulties in diagnosing WE during pregnancy, especially in differentiating it from other causes of neurological symptoms. Timely recognition and thiamine replacement therapy played a significant role in preventing irreversible consequences.

Conclusion: Although rare, Wernicke’s encephalopathy is a life-threatening complication of hyperemesis gravidarum that requires immediate thiamine administration. Clinicians should remain highly alert to this condition in pregnant women who experience prolonged vomiting and neurological symptoms, as delayed diagnosis can lead to irreversible cognitive and motor impairments. The presented case emphasizes the significance of early administration of thiamine for patients at risk, and the need to increase awareness of this condition among obstetricians, gynecologists, and neurologists. It is necessary to carry out further research to develop standardized protocols for the diagnosis and treatment of WE during pregnancy.