Open AccessVisual loss and optic neuropathy associated with Wernicke's encephalopathy in hyperemesis gravidarum
Author(s) -
Naseem Palakkuzhiyil,
Sherinas Rehiman,
P P. Baby Manoj,
Shahul Hameed,
N. A. Uvais
Publication year - 2019
Publication title -
journal of family medicine and primary care
Language(s) - English
Resource type - Journals
eISSN - 2278-7135
pISSN - 2249-4863
DOI - 10.4103/jfmpc.jfmpc_121_19
Subject(s) - hyperemesis gravidarum , medicine , wernicke's encephalopathy , nystagmus , thiamine , wernicke encephalopathy , magnetic resonance imaging , fluid attenuated inversion recovery , encephalopathy , neurological examination , hyperintensity , physical examination , pediatrics , radiology , anesthesia , vomiting , surgery , thiamine deficiency
Wernicke's encephalopathy (WE) is a potentially fatal neuropsychiatric syndrome precipitated by thiamine deficiency due to a variety of causes such as chronic severe alcoholism, starvation, and prolonged intravenous feeding. WE has also been observed rarely in the clinical setting of hyperemesis gravidarum. Here, we report the case of a 34-year-old pregnant woman who presented with reduced vision, gaze-evoked nystagmus, and postural imbalance preceded by 2 weeks of hyperemesis. Fundus examination showed features consistent with papillitis. Magnetic resonance imaging (MRI) showed T2WI, FLAIR, and diffusion-weighted imaging MR images showing hyperintensity in dorsomedial thalami and periaqueductal grey matter with diffusion restriction. She was diagnosed with WE based on history, clinical examination findings, and MRI findings and was treated with injectable thiamine. She showed marked improvement in vision and nystagmus within 3 days. Our case is a rare presentation of WE in a pregnant woman with hyperemesis gravidarum.