Wernicke’s encephalopathy is a potentially life-threatening neurological complication of thiamine deficiency that can develop during pregnancy in patients with prolonged vomiting. Published in Cureus, a medical case report details a 19-year-old patient at 24 weeks of gestation admitted to an intensive care unit with severe preeclampsia, confusion, and ataxia, whose MRI confirmed the diagnosis.
In Plain English: The Clinical Takeaway
- What happened: A pregnant teenager experiencing severe, prolonged vomiting developed a brain disorder caused by a lack of vitamin B1 (thiamine), masked initially by severe pregnancy-related high blood pressure (preeclampsia).
- Why standard tests missed it: An initial computerized tomography (CT) brain scan showed no abnormalities, highlighting that routine scans can fail to spot this deficiency until advanced magnetic resonance imaging (MRI) is performed.
- How it was resolved: Doctors terminated the pregnancy via cesarean section, immediately administered high-dose intravenous thiamine, and corrected her metabolic imbalances, leading to a full neurological recovery.
Diagnostic Obstacles in Pregnant Patients With Preeclampsia
The 19-year-old primigravida arrived at the intensive care unit exhibiting altered consciousness, a Glasgow Coma Scale score of 12 out of 15, motor coordination issues, and cerebellar ataxia. She also presented with severe hypertension at 161/95 mmHg, tachycardia at 126 beats per minute, and 3+ proteinuria. Laboratory investigations revealed significant metabolic disturbances, including liver enzyme elevations with aspartate aminotransferase (AST) at 322 U/L and alanine aminotransferase (ALT) at 287 U/L, alongside hypokalemia and elevated serum creatinine.
Because the patient suffered from severe hypertension paired with neurological symptoms, clinicians first investigated eclampsia and posterior reversible encephalopathy syndrome (PRES). However, her persistent nystagmus and ataxia, driven by weeks of prolonged vomiting and malnutrition, pointed toward thiamine depletion. While an initial brain computed tomography scan revealed no abnormalities, a subsequent brain magnetic resonance imaging scan displayed symmetrical lesions in the mammillary bodies, periaqueductal region, thalami, and periventricular areas—findings consistent with Wernicke’s encephalopathy.
| Clinical Parameter | Patient Value | Reference Range |
|---|---|---|
| Hemoglobin | 11.3 g/dL | 11-14 g/dL |
| Platelets | 182,000/µL | 150,000-400,000/µL |
| Prothrombin Time (PT) | 55% | 70-100% |
| AST | 322 U/L | 10-40 U/L |
| ALT | 287 U/L | 7-56 U/L |
| Serum Creatinine | 11.31 mg/L | 0.6-1.2 mg/L |
Immediate Intervention and Clinical Recovery
Following the MRI findings, emergency medical management commenced with the immediate intravenous administration of thiamine at a dosing regimen of 200 to 500 mg three times daily for three to five days. This was followed by oral maintenance doses ranging from 250 to 1,000 mg daily. Medical teams also corrected the patient’s hydro-electrolytic disorders and provided tailored nutritional support alongside continuous neurological monitoring.
Due to the deteriorating neurological condition despite initial therapeutic measures, physicians performed an emergency cesarean section at 24 weeks of gestation. Following the combined surgical delivery and aggressive thiamine therapy, the patient’s neurological status improved progressively. Her level of consciousness normalized, laboratory abnormalities resolved, and she was discharged from the hospital five days later.
Contraindications & When to Consult a Doctor
Pregnant individuals experiencing prolonged, intractable vomiting, hyperemesis gravidarum, or acute neurological changes such as double vision, unsteadiness, or confusion must seek urgent medical evaluation in an emergency department setting rather than relying on outpatient management.
Wernicke’s encephalopathy remains a preventable yet severe complication when nutritional support and vitamin B1 replacement are delayed. Recognizing the overlap between nutritional deficiencies and hypertensive disorders of pregnancy prevents missed diagnoses and irreversible neurological deficits.
References
- Cureus: A Case Report of Wernicke’s Encephalopathy During a Pregnancy Complicated by Preeclampsia
- European Federation of Neurological Societies (EFNS) Guidelines on the Prevention, Diagnosis, and Treatment of Wernicke’s Encephalopathy
