Objective: This report aims to bring awareness of Hyperemesis Gravidarum induced Wernicke’s Encephalopathy as a rare cause of ataxia.

Background: Wernicke’s Encephalopathy is a neuropsychiatric disorder caused by deficiency of intracellular thiamine presenting with a clinical triad of ataxia, confusion, and opthalmoparesis with nystagmus. Thiamine is a necessary cofactor of transketolase for the maintenance of myelin sheaths, lipid and glucose metabolism, and production of branched chain amino acids. Wernicke’s Encephalopathy is classically seen in patients with nutritional deficiency or alcohol abuse. Here, we highlight a unique case of thiamine deficiency and Wernicke’s encephalopathy after hyperemesis gravidarum presenting with ataxia to the movement disorders clinic.

Method: Data was collected through thorough chart review, patient interviews, and physical examination. Patient consent was received.

Results: A 38-year-old African American female was brought to movement disorders clinic by her mother for evaluation of ataxia, tremor, and gait difficulty. In reviewing history, patient was recently hospitalized for altered mental status in the setting of pregnancy with symptoms of poor oral intake, dehydration, and intractable vomiting. At time of admission, she was found to be in acute renal failure with lactic acidosis and hypernatremia with fetal ultrasound notable for intrauterine demise. Despite induction of labor and treatment of metabolic disturbances, encephalopathy persisted. Subsequent neurologic examinations demonstrated limb ataxia and nystagmus in all planes. Serologic evaluation revealed an undetectable thiamine level and MRI demonstrated hyperintensities in bilateral thalami, mammillary bodies, and periaqueductal gray that were characteristic of Wernicke’s encephalopathy. Despite repletion of thiamine levels, nystagmus, limb and gait ataxia, and anterograde/retrograde amnesia persisted.  One-year follow-up demonstrated bilateral mamillary body atrophy.

Conclusion: Wernicke’s Encephalopathy is a medical emergency that can lead to irreversible neurologic deficits, coma, and death. Heightened suspicion is necessary when patients present with alteration in mental status and acute onset movement disorders such as ataxia and nystagmus. This case highlights the importance of a prompt work up for thiamine deficiency in female patients experiencing Hyperemesis Gravidarum.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/hyperemesis-gravidarum-induced-wernickes-encephalopathy-a-case-report/