Wernicke's encephalopathy secondary to hyperemesis gravidarum in pregnancy.
Siraj Sundaran, C R Biju, Shanmugam Sabesh et al.
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Case in brief
A 28-year-old woman at 17 weeks’ gestation presented with severe hyperemesis gravidarum and cerebellar dysfunction. She met three of the four European Federation of Neurological Societies diagnostic requirements for Wernicke’s encephalopathy. Brain MRI showed symmetrical medial thalamic hyperintensities consistent with the diagnosis. Thyroid tests also showed gestational thyrotoxicosis, which contributed to the severity of hyperemesis but did not account for the neurological findings or MRI pattern. The case was interpreted as coexisting hyperemesis-related thyrotoxicosis and thiamine-deficiency Wernicke’s encephalopathy.
What made this case unusual
Gestational thyrotoxicosis offered a concurrent explanation for severe hyperemesis, but not for the cerebellar dysfunction or characteristic MRI changes, pointing to superimposed Wernicke’s encephalopathy.
Diagnostic / clinical pearl
In prolonged hyperemesis gravidarum during pregnancy, consider thiamine-deficiency Wernicke’s encephalopathy when neurological signs emerge; thyrotoxicosis does not exclude a concurrent diagnosis.
Why it matters
The report emphasizes prompt parenteral thiamine to help prevent irreversible neurological injury.