WERNICKE’S ENCEPHALOPATHY SECONDARY TO HYPEREMESIS GRAVIDARUM PRESENTING WITH INTERNUCLEAR OPHTHALMOPLEGIA AND PONTINE DEMYELINATING LESION IN EARLY PREGNANCY: A CASE REPORT

Abstract

Wernicke’s encephalopathy is a rare but serious neurological emergency caused by thiamine deficiency. It is most commonly associated with chronic alcoholism but can also occur in hyperemesis gravidarum [1]. In pregnancy, hyperemesis gravidarum can lead to profound nutritional depletion, and Wernicke’s encephalopathy should be suspected when neurological symptoms develop [2]. We report a case of a 24-year-old primigravida at 6 weeks and 3 days of gestation who presented with persistent vomiting, weight loss, diplopia, and gait ataxia. Clinical examination revealed right eye adduction palsy with nystagmus consistent with internuclear ophthalmoplegia, multiple cranial nerve palsies involving the third, ninth, tenth and eleventh nerves, and gait ataxia. Magnetic resonance imaging of the brain demonstrated a possible demyelinating lesion in the right paramedian posterior pons [3]. Lumbar puncture and autoimmune markers were negative. High-dose intravenous thiamine at 200 mg twice daily for five days was initiated promptly along with antiemetics, fluid resuscitation and nutritional support [4]. The patient showed rapid improvement in ocular movements and resolution of nystagmus. This case highlights that Wernicke’s encephalopathy can present without the classic triad of ophthalmoplegia, ataxia and confusion and with atypical magnetic resonance imaging findings such as pontine demyelinating lesions [5]. A high index of suspicion is essential in pregnant women with hyperemesis gravidarum to prevent irreversible neurological damage [6].