A rare case of Hyperemesis gravidarum presenting as Werncike 's encephalopathy

INTRODUCTION: Wernicke’s encephalopathy presents as a triad of ataxia, global confusion and ophthalmoplegia. It can have multiple causes; Hyperemesis gravidarum is one of the causative factors. It results in severe vomiting in pregnancy resulting in dehydration. This can lead to acute deficiency of thiamine, which can manifest as Wernicke’s encephalopathy. Poor nutritional intake, depletion of stores and and increased demands of pregnancy can also result in Wernicke’s.MRI Brain is both specific and sensitive for diagnosis. CASE SUMMARY –: A 25 year old married, primi-gravida hailing from urban background belonging to middle socio-economic status, presented at 16 weeks of gestation with complaints of 6 weeks history of severe vomiting, talking irrelevantly, disturbed sleep and weakness of all four limbs. Symptoms progressed over a week with total inability to ambulate and confusion. Clinically she had signs of minimal power and loss of tone, ataxic gait and disorientation. However no ophthalmoplegia was noted. Routine blood investigations were within normal limits. MRI Brain revealed hyperintensities in thalamus and mammillary bodies. A diagnosis of Wernicke’s encephalopathy was made and treatment was instituted with high dose parental thiamine. She reported significant improvement in symptoms over the next 2 weeks. DISCUSSION AND CONCLUSION-: Hyperemesis gravidarum is one of the treatable causes of Wernicke’s encephalopathy. It requires a high degree of clinical suspicion. Neurologic outcomes are usually good, however pregnancy outcomes vary.