Wernicke-Korsakoff syndrome, associated with acute axonal polyneuropathy, induced by hyperemesis gravidarum
Eugenia Rota, Cristina Mocellini, Luigi Gozzoli, Maria Gabriella Rosso, Enzo Grasso
Am J Case Rep 2008; 9:113-116
Background: Wernicke-Korsakoff syndrome (W-KS) is mainly caused by vitamin B1 (thiamine) deficiency. Although usually associated to alcoholism, W-KS may also occur in a variety of clinical settings, resulting in a poor nutritional state.
Case Report: This report describes the case of a 22-year-old pregnant woman, who developed neurological signs and MRI imaging typical of W-KS, associated to acute, predominantly motor, axonal polyneuropathy. The patient, admitted to hospital for severe vomiting, in the 13th week of her first pregnancy developed weakness of the lower limbs and increasing diffi culties in walking. Mental slowing and amnesia occurred within very few days and a horizontal nystagmus became evident; the weakness of the lower limbs aggravated, and deep tendon refl exes were absent. Nerve conduction studies revealed motor, axonal polyneuropathy at the lower limbs. MRI imaging detected altered signal intensity involving medial thalami, corpi mammillari and quadrigemini tubercoli. A diagnosis of a W-KS was made and intravenous high-dose thiamine started. Her consciousness and the oculomotor disturbance improved promptly the antero-retrogade amnesia, ataxia and limb weakness improved later.
Conclusions: A diagnosis of W-KS should be considered not only in alcoholic populations, but also in hypermesis gravidarum and other poor nutritional states, even jatrogenic, where thiamine supplementation should be provided, before the infusion of glucose solutions, to avoid precipitating both the central and peripheral neurological damage caused by the thiamine deficiency state.
Keywords: Wernicke-Korsakoff syndrome, vitamin B1 (thiamine) deficiency ptosis, Hyperemesis Gravidarum, Wernicke’s encephalopathy