Pregnancy vomiting obscuring other disease: a clinical case of Wernicke encephalopathy

The article presents a clinical case of Wernicke encephalopathy occurring as complication of excessive pregnancy-related vomiting (hyperemesis gravidarum). This disorder has developed due to thiamine (vitamin B1) deficiency. The correct diagnosis is challenging due to the similarity of clinical manifestations with several other disorders. Timely diagnosis and early treatment reduce the risk of severe course and irreversible complications that can lead to the potentially adverse outcome. This case is remarkable due to the appearance of the disease in a 32-year-old pregnant woman with excessive vomiting. The patient demonstrated the classic symptom triad found in only 16% of patients with Wernicke encephalopathy. Primarily ataxia and nystagmus appeared, and later memory impairment with confabulations was recorded. Magnetic resonance imaging of the brain revealed bilateral symmetrical areas with increased MR signal intensity in T2 (SE and FLAIR) sequences in the mediodorsal nucleus (MD) of thalamus, subependymal microglia of the III ventricle, and periaqueductal gray. The treatment of Wernicke encephalopathy was immediately initiated with the use of intravenous thiamine 200 mg 3 times daily. The beneficial treatment effect was reported. Further pregnancy proceeded unremarkably and resulted in the birth of a live term girl. During the postpartum period, the patient reported persisting instability when walking, which increased with closed eyes, and non-systemic dizziness.