Fetal Demise and Wernicke–Korsakoff Syndrome in a Patient with Hyperemesis Gravidarum: A Case Report
Document Type
Article
Publication Date
2-2-2023
Abstract
Background: Wernicke–Korsakoff syndrome is a neuropsychiatric disorder caused by thiamine deficiency composed of two related disorders accounting for an acute presentation and chronic progression. Hyperemesis gravidarum presents a significant risk factor for Wernicke–Korsakoff syndrome as symptoms may rapidly progress in the setting of pregnancy. We present the first-reported case of hyperemesis-gravidarum-associated Wernicke encephalopathy in a patient in the first half of pregnancy in which a missed diagnosis led to septic shock, fetal demise, and eventual profound Korsakoff syndrome.
Case Presentation: We present the case of a 33-year-old primigravid African American woman at 15 weeks gestational age who initially presented at a community emergency department with nausea and vomiting that ultimately progressed to severe hyperemesis-gravidarum-associated Wernicke–Korsakoff syndrome, fetal demise, and septic shock. The patient received a total of 6 weeks of high-dose parenteral thiamine. Magnetic resonance imaging of the head and formal neuropsychological assessment following treatment plateau confirmed the diagnosis of Wernicke–Korsakoff syndrome.
Conclusions: The multisystem complications seen in severe thiamine deficiency can delay timely administration of high-dose thiamine, particularly in pregnancy, in which the classic triad of Wernicke–Korsakoff syndrome may not raise clinical suspicion due to rapid progression of neurological sequelae in this population. We advise a low threshold for parenteral thiamine repletion in pregnant women with persistent vomiting as hyperemesis gravidarum-induced severe thiamine deficiency can result in Wernicke–Korsakoff syndrome, sepsis, and fetal demise.
Recommended Citation
Olmsted, Alisa; DeSimone, Andrea; Lopez-Pastrana, Jahaira; and Becker, Madeleine, "Fetal Demise and Wernicke–Korsakoff Syndrome in a Patient with Hyperemesis Gravidarum: A Case Report" (2023). Department of Psychiatry and Human Behavior Faculty Papers. Paper 72.
https://jdc.jefferson.edu/phbfp/72
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
Language
English
Comments
This article is the authors’ final published version in Journal of Medical Case Reports, Volume 17, Issue 32, February 2023.
The published version is available at https://doi.org/10.1186/s13256-022-03748-2. Copyright © The Author(s).
Publication made possible in part by support from the Jefferson Open Access Fund