A Rare Case of Wernicke's Encephalopathy and Dry Beri-beri Complicating Hyperemesis Gravidarum.

N.A. Ahmad Tarmizi¹, A. Abdullah¹, M. S. Abdul Hakim¹, T. M. S. Tunku Jaafar Laksamana²

¹Department of Internal Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, and ²Department of Internal Medicine, Hospital Selayang, Selangor, Malaysia

ABSTRACT      

Hyperemesis gravidarum occurs in approximately 0.3-2.0% of pregnancies. We present a rare case of Wernicke’s encephalopathy and dry beriberi as a complication of hyperemesis gravidarum. A 23-year-old female, at 19 weeks gestation, presented with persistent vomiting since early pregnancy and feeling generally weak. Transabdominal ultrasound on presentation confirmed a non-viable foetus which was surgically removed. Throughout admission, she was noted to have confusion lasting a few days, horizontal nystagmus and progressive weakness with peripheral neuropathy of bilateral lower limbs. Her CT brain and lumbar puncture was normal. Nerve conduction studies was done, and coupled with her neurological findings, conclusion of thiamine deficiency was made. She was treated with thiamine and with rehabilitation she has currently made significant improvement. Thiamine deficiency manifesting with features suggestive of an overlap between Wernicke’s encephalopathy and dry beriberi in patients with hyperemesis gravidarum is rare.

Key words: Wernicke encephalopathy, Beriberi, thiamine deficiency, hyperemesis gravidarum

Correspondence author: Dr. Noor Azleen Ahmad Tarmizi, Department of Internal Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia

Phone: +60361265000  Fax03-61265224

Email: noorazleen.ahmadtarmizi@gmail.com

Brunei Int Med J. 2017; 13 (3): 105-108