Wernicke's encephalopathy following hyperemesis gravidarum
A 25-year-old woman, at 22 weeks gestation, presented with excessive vomiting for several weeks followed by progressive weakness of lower limbs, altered sensorium, and blurred vision. Her previous pregnancy had resulted in fetal loss, due to hyperemesis. On admission, she had stable vitals, with 7/15 Glasgow Coma Scale (GCS). Physical examination revealed sluggishly reacting pupils with papilledema, left sided facial twitching with ptosis of the eye, bilateral conjugate palsies with nystagmus, and flaccid paralysis of all four limbs with bilateral flexor plantar reflexes. Fetal sonography was normal. Her serum biochemistry during her stay is shown in . MRI finding was suggestive of WE [Figures and ]. She was electively intubated and ventilated and was administered intravenous thiamine 100 mg thrice daily along with other vitamins, electrolytes, and trace elements. Gradually, her ocular signs disappeared and she showed neurological recovery with improvement in muscle power.\nHowever, within next few days, her general condition deteriorated and she became hyperpyrexic (>40° C). A repeat MRI (brain) was highly suggestive of CPM []. She underwent lower segment cesarean section (LSCS) at 30 weeks and a male baby was delivered (weight 800 g, APGAR 6 and 8). Unfortunately, patient died of multiorgan failure on 4th postoperative day.