Wernicke's encephalopathy post hyperemesis gravidarum misdiagnosed as Guillain-Barre syndrome: lessons for the frontline

Abstract

We report a case of a 26-year-old pregnant woman, who presented with subacute limb weakness. This was initially suspected to be Guillain-Barre syndrome but subsequently found to be the motor neuropathy of dry beriberi (vitamin B1, thiamine deficiency) along with associated Wernicke's encephalopathy (WE). The underlying cause was revealed as hyperemesis gravidarum (HG). HG complicates up to 3% of pregnancies and if severe, without nutritional supplements, may lead to electrolyte disturbances, calorie loss and vitamin deficiency. Although the association of HG and WE was first reported in 1939, it remains an under diagnosed condition with potential for serious and permanent neurological deficits, and some mortality, in both mother and baby. Early recognition of the problem, with timely and careful fluid, electrolyte, glucose and vitamin replacement is needed to avoid complications. We highlight current best practice in the treatment of WE. An open mind to the possibility of HG complications in any pregnant woman presenting with neurological symptoms is probably the most important lesson to learn from the front line.

Keywords: neurology (drugs and medicines); nutrition; peripheral nerve disease.

Figure 1

(A and B) Before treatment. (A) Axial T2 FLAIR showing symmetrically increased signal intensity in the periventricular thalamic area (1). (B) Axial T2 FLAIR showing increased signal intensity in the mammillary bodies (2) and colliculi (3). (C–D) After treatment axial T2 FLAIR showing complete resolution of previous abnormalities. FLAIR, Fluid attenuated inversion recovery