Hyperemesis gravidarum complicated by Wernicke encephalopathy: Background, case report, and review of the literature

Giuseppe Chiossi, Isabella Neri, Milena Cavazzuti, Gianpaolo Basso, Fabio Facchinetti

Research output: Contribution to journalArticle

131 Citations (Scopus)

Abstract

Wernicke encephalopathy (WE) is a rare but known complication of severe hyperemesis gravidarum caused by thiamine deficiency. This article presents an unusual case that occurred at our institution and reviews the 48 previously published cases of WE in pregnancy. Considering all the 49 cases, the mean (±standard deviation) patients' age was 26.7 ± 4.9 years, the mean gestational age when WE manifested was 14.3 ± 3.4 weeks, and the mean duration of vomiting and feeding difficulties was 7.7 ± 2.8 weeks. Wernicke's classic triad (confusion, ocular abnormalities, and ataxia) manifested in only 46.9% (23 of 49) of the patients. Confusion affected 63.3% (31 of 49) of the patients, ocular signs 95.9% (47 of 49) and symptoms 57.1% (28 of 49), and ataxia 81.6% (40 of 49). Deterioration of consciousness affected 53.1 % (26 of 49) of the subjects and memory impairment 61.2% (30 of 49). Complete remission of the disease occurred in only 14 of 49 cases. Symptom resolution required months and permanent impairments were common. The overall pregnancy loss rate, directly (spontaneous fetal loss) and indirectly (planned abortion) attributable to WE, was 47.9% (23 of 49). The diagnosis of WE is clinical and can be rapidly confirmed by magnetic resonance imaging. We emphasize the importance of thiamine supplementation to women with prolonged vomiting in pregnancy, especially before intravenous or parenteral nutrition. We also underline the necessity to promptly replace vitamin B1 when neurologic symptoms and/or signs develop in a patient with hyperemesis gravidarum.

Original languageEnglish (US)
Pages (from-to)255-268
Number of pages14
JournalObstetrical and Gynecological Survey
Volume61
Issue number4
DOIs
StatePublished - Apr 2006
Externally publishedYes

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Hyperemesis Gravidarum
Wernicke Encephalopathy
Confusion
Thiamine
Ataxia
Vomiting
Eye Abnormalities
Thiamine Deficiency
Pregnancy
Parenteral Nutrition
Pregnancy Rate
Neurologic Manifestations
Consciousness
Gestational Age
Magnetic Resonance Imaging

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Hyperemesis gravidarum complicated by Wernicke encephalopathy : Background, case report, and review of the literature. / Chiossi, Giuseppe; Neri, Isabella; Cavazzuti, Milena; Basso, Gianpaolo; Facchinetti, Fabio.

In: Obstetrical and Gynecological Survey, Vol. 61, No. 4, 04.2006, p. 255-268.

Research output: Contribution to journalArticle

Chiossi, Giuseppe ; Neri, Isabella ; Cavazzuti, Milena ; Basso, Gianpaolo ; Facchinetti, Fabio. / Hyperemesis gravidarum complicated by Wernicke encephalopathy : Background, case report, and review of the literature. In: Obstetrical and Gynecological Survey. 2006 ; Vol. 61, No. 4. pp. 255-268.
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