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Fetal demise and Wernicke–Korsakoff syndrome in a patient with hyperemesis gravidarum: a case report

BACKGROUND: Wernicke–Korsakoff syndrome is a neuropsychiatric disorder caused by thiamine deficiency composed of two related disorders accounting for an acute presentation and chronic progression. Hyperemesis gravidarum presents a significant risk factor for Wernicke–Korsakoff syndrome as symptoms m...

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Autores principales: Olmsted, Alisa, DeSimone, Andrea, Lopez-Pastrana, Jahaira, Becker, Madeleine
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9893614/
https://www.ncbi.nlm.nih.gov/pubmed/36726136
http://dx.doi.org/10.1186/s13256-022-03748-2
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author Olmsted, Alisa
DeSimone, Andrea
Lopez-Pastrana, Jahaira
Becker, Madeleine
author_facet Olmsted, Alisa
DeSimone, Andrea
Lopez-Pastrana, Jahaira
Becker, Madeleine
author_sort Olmsted, Alisa
collection PubMed
description BACKGROUND: Wernicke–Korsakoff syndrome is a neuropsychiatric disorder caused by thiamine deficiency composed of two related disorders accounting for an acute presentation and chronic progression. Hyperemesis gravidarum presents a significant risk factor for Wernicke–Korsakoff syndrome as symptoms may rapidly progress in the setting of pregnancy. We present the first-reported case of hyperemesis-gravidarum-associated Wernicke encephalopathy in a patient in the first half of pregnancy in which a missed diagnosis led to septic shock, fetal demise, and eventual profound Korsakoff syndrome. CASE PRESENTATION: We present the case of a 33-year-old primigravid African American woman at 15 weeks gestational age who initially presented at a community emergency department with nausea and vomiting that ultimately progressed to severe hyperemesis-gravidarum-associated Wernicke–Korsakoff syndrome, fetal demise, and septic shock. The patient received a total of 6 weeks of high-dose parenteral thiamine. Magnetic resonance imaging of the head and formal neuropsychological assessment following treatment plateau confirmed the diagnosis of Wernicke–Korsakoff syndrome. CONCLUSIONS: The multisystem complications seen in severe thiamine deficiency can delay timely administration of high-dose thiamine, particularly in pregnancy, in which the classic triad of Wernicke–Korsakoff syndrome may not raise clinical suspicion due to rapid progression of neurological sequelae in this population. We advise a low threshold for parenteral thiamine repletion in pregnant women with persistent vomiting as hyperemesis gravidarum-induced severe thiamine deficiency can result in Wernicke–Korsakoff syndrome, sepsis, and fetal demise.
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spelling pubmed-98936142023-02-03 Fetal demise and Wernicke–Korsakoff syndrome in a patient with hyperemesis gravidarum: a case report Olmsted, Alisa DeSimone, Andrea Lopez-Pastrana, Jahaira Becker, Madeleine J Med Case Rep Case Report BACKGROUND: Wernicke–Korsakoff syndrome is a neuropsychiatric disorder caused by thiamine deficiency composed of two related disorders accounting for an acute presentation and chronic progression. Hyperemesis gravidarum presents a significant risk factor for Wernicke–Korsakoff syndrome as symptoms may rapidly progress in the setting of pregnancy. We present the first-reported case of hyperemesis-gravidarum-associated Wernicke encephalopathy in a patient in the first half of pregnancy in which a missed diagnosis led to septic shock, fetal demise, and eventual profound Korsakoff syndrome. CASE PRESENTATION: We present the case of a 33-year-old primigravid African American woman at 15 weeks gestational age who initially presented at a community emergency department with nausea and vomiting that ultimately progressed to severe hyperemesis-gravidarum-associated Wernicke–Korsakoff syndrome, fetal demise, and septic shock. The patient received a total of 6 weeks of high-dose parenteral thiamine. Magnetic resonance imaging of the head and formal neuropsychological assessment following treatment plateau confirmed the diagnosis of Wernicke–Korsakoff syndrome. CONCLUSIONS: The multisystem complications seen in severe thiamine deficiency can delay timely administration of high-dose thiamine, particularly in pregnancy, in which the classic triad of Wernicke–Korsakoff syndrome may not raise clinical suspicion due to rapid progression of neurological sequelae in this population. We advise a low threshold for parenteral thiamine repletion in pregnant women with persistent vomiting as hyperemesis gravidarum-induced severe thiamine deficiency can result in Wernicke–Korsakoff syndrome, sepsis, and fetal demise. BioMed Central 2023-02-02 /pmc/articles/PMC9893614/ /pubmed/36726136 http://dx.doi.org/10.1186/s13256-022-03748-2 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Case Report
Olmsted, Alisa
DeSimone, Andrea
Lopez-Pastrana, Jahaira
Becker, Madeleine
Fetal demise and Wernicke–Korsakoff syndrome in a patient with hyperemesis gravidarum: a case report
title Fetal demise and Wernicke–Korsakoff syndrome in a patient with hyperemesis gravidarum: a case report
title_full Fetal demise and Wernicke–Korsakoff syndrome in a patient with hyperemesis gravidarum: a case report
title_fullStr Fetal demise and Wernicke–Korsakoff syndrome in a patient with hyperemesis gravidarum: a case report
title_full_unstemmed Fetal demise and Wernicke–Korsakoff syndrome in a patient with hyperemesis gravidarum: a case report
title_short Fetal demise and Wernicke–Korsakoff syndrome in a patient with hyperemesis gravidarum: a case report
title_sort fetal demise and wernicke–korsakoff syndrome in a patient with hyperemesis gravidarum: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9893614/
https://www.ncbi.nlm.nih.gov/pubmed/36726136
http://dx.doi.org/10.1186/s13256-022-03748-2
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