Wernicke′s encephalopathy (WE) is a potentially reversible yet serious neurological manifestation caused by vitamin B 1 (thiamine) deficiency. It is commonly associated with heavy alcohol consumption. Other clinical associations are with hyperemesis gravidarum (HG), starvation, and prolonged intravenous feeding. Most patients present with the triad of ocular signs, ataxia, and confusion. It can be associated with life-threatening complication like central pontine myelinolysis (CPM). We report two cases of WE following HG, with two different outcomes.
Cirignotta F, Manconi M, Mondini S, Buzzi G, Ambrosetto P. Wernicke-Korsakoff encephalopathy and polyneuropathy after gastroplasty for morbid obesity: Report of a case. Arch Neurol 2000; 57:1356-9.
Netravathi M, Sinha S, Taly AB, Bindu PS, Bharath RD. Hyperemesis-gravidarum-induced Wernicke′s encephalopathy: Serial clinical, electrophysiological and MR imaging observations. J Neurol Sci 2009; 284:214-6.
Harper C. The incidence of Wernicke′s encephalopathy in Australia: A neuropathological study of 131 cases. J Neurol Neurosurg Psychiatry 1983; 46:593-8.
Sulaiman W, Othman A, Mohamad M, Salleh HR, Mushahar L. Wernicke›s encephalopthy associated with hyperemesis gravidarum-A case report. Malays J Med Sci 2002; 9:43-6.
Chiossi G, Neri I, Cavazzuti M, Basso G, Facchinetti F. Hyperemesis gravidarum complicated by Wernicke encephalopathy: Background, case report, and review of the literature. Obstet Gynecol Surv 2006; 61:255-68.
Baker H, Frank O, Thomson AD, Langer A, Munves ED, De Angelis B, et al. Vitamin profile of 174 mothers and newborns at parturition. Am J Clin Nutr 1975; 28:59-65.
Michel ME, Alanio E, Bois E, Gavillon N, Graesslin O. Wernicke encephalopathy complicating hyperemesis gravidarum: A case report. Eur J Obstet Gynecol Reprod Biol 2010; 149:118-9.
Patel SV, Parish DC, Patel RM, Grimsley EW. Resolution of MRI findings in central pontine myelinosis associated with hypokalemia. Am J Med Sci 2007; 334:490-2.
Adams RD, Victor M, Mancall EL. Central pontine myelinolysis: A hitherto undescribed disease occurring in alcoholic and malnourished patients. AMA Arch Neurol Psychiatry 1959; 81:154-72.
Tonelli J, Zurrú MC, Castillo J, Casado J, Di Prizito C, Gutfraind E. Central pontine myelinolysis induced by hyperemesis gravidarum. Medicina (B Aires) 1999; 59:176-8.
Galvin R, Brathen G, Ivashynka A, Hillbom M, Tanasescu R, Leone MA. EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy. Eur J Neurol 2010; 17:1408-18.
Manzanares W, Hardy G. Thiamine supplementation in the critically ill. Curr Opin Clin Nutr Metab Care 2011; 14:610-7.