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Singh P, Gupta A, Gupta A, Turlapati Padmavathi S. Visual loss and encephalopathy in a pregnant patient with hyperemesis gravidarum. BMJ Case Rep 2024; 17:e259840. [PMID: 38816012 DOI: 10.1136/bcr-2024-259840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024] Open
Abstract
A pregnant woman in her 20s at 17 weeks of gestation, presented with symptoms of painless diminution of vision preceded by 8 weeks history of hyperemesis gravidarum. On examination, she was confused, disoriented and had gait ataxia with complete loss of vision in both eyes. Fundus examination revealed grade 4 disc oedema with superficial retinal haemorrhages. Possibilities kept were cerebral venous sinus thrombosis, neuromyelitis optica spectrum disorder, posterior reversible encephalopathy syndrome and Wernicke's encephalopathy (WE). Thiamine levels were low. MRI brain with MR venography revealed symmetrical areas of hyperintensities in bilateral medial thalami, hypothalamus, mammillary body and area postrema. She was managed as a case of WE with intravenous thiamine with complete clinical and radiological resolution within 2 weeks of treatment. Therefore, we conclude that a high index of suspicion of WE in appropriate clinical settings leading to early treatment can potentially reverse its grave clinical symptoms and complications.
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Affiliation(s)
- Purushottam Singh
- Neurology, Army Hospital Research and Referral, New Delhi, Delhi, India
| | - Aditya Gupta
- Army Hospital Research and Referral, New Delhi, Delhi, India
| | - Anirban Gupta
- Neurology, Army Hospital Research and Referral, New Delhi, Delhi, India
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2
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Bretón I, Ballesteros-Pomar MD, Calle-Pascual A, Alvarez-Sala LA, Rubio-Herrera MA. Micronutrients in Pregnancy after Bariatric Surgery: A Narrative Review. J Clin Med 2023; 12:5429. [PMID: 37629473 PMCID: PMC10455502 DOI: 10.3390/jcm12165429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
Bariatric surgery is increasingly used in women of childbearing age due to the rising prevalence of obesity and the effectiveness and availability of this treatment. Pregnancy in women with previous bariatric surgery deserves special attention. Weight loss induced by surgery reduces the risks that obesity poses to pregnancy. But on the other hand, decreased intake and malabsorption may increase the risk of malnutrition and micronutrient deficiency and negatively affect maternal and foetal health. The aim of this narrative review is to provide an updated analysis of the impact of different bariatric surgery techniques on mineral and micronutrient nutritional status during pregnancy and the possible effect on maternal-foetal health.
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Affiliation(s)
- Irene Bretón
- Department of Endocrinology and Nutrition, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
- Department of Medicine, Facultad de Medicina, Universidad Complutense, 28040 Madrid, Spain
| | - María D. Ballesteros-Pomar
- Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, 24008 León, Spain
| | - Alfonso Calle-Pascual
- Department of Medicine, Facultad de Medicina, Universidad Complutense, 28040 Madrid, Spain
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, 28040 Madrid, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28029 Madrid, Spain
| | - Luis Antonio Alvarez-Sala
- Department of Medicine, Facultad de Medicina, Universidad Complutense, 28040 Madrid, Spain
- Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Miguel Angel Rubio-Herrera
- Department of Medicine, Facultad de Medicina, Universidad Complutense, 28040 Madrid, Spain
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, 28040 Madrid, Spain
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Micronutrient Deficiencies Presenting with Optic Disc Swelling Associated with or without Intracranial Hypertension: A Systematic Review. Nutrients 2022; 14:nu14153068. [PMID: 35893919 PMCID: PMC9331791 DOI: 10.3390/nu14153068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/19/2022] [Accepted: 07/22/2022] [Indexed: 11/17/2022] Open
Abstract
Idiopathic intracranial hypertension (IIH) is a neurological disorder characterised by optic disc swelling secondary to raised intracranial pressure (ICP) of unknown cause. Obesity is the most established and prevalent risk factor in developed countries. As obesogenic diets are high in calories and nutrient-poor, there may be associated nutritional deficiencies that contribute to the clinical presentation of IIH. Yet none, aside from iron deficiency, are currently included in the inclusion or exclusion criteria for the diagnosis of IIH. Our primary aim was to determine which micronutrient deficiencies, aside from iron deficiency, could present with optic disc swelling associated with or without intracranial hypertension that could potentially meet current IIH diagnostic criteria. To this end, we conducted a systematic search of articles published between 1 January 1980 and 18 December 2020 reporting cases of optic disc swelling associated with micronutrient deficiencies. In total, 65 cases met the eligibility criteria from initial searches: all were case reports and case series with a high risk of bias. Our findings suggest that patients with IIH or unexplained optic disc swelling ought to be screened, investigated, and treated for associated micronutrient deficiencies in vitamin A, B1 and B12; and weight loss interventions in IIH patients ought to promote better nutrition in addition to overall calorie restriction.
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Westermeyer JJ, Soukup B, Mayer J, Lee K. Identifying, Assessing, and Treating Korsakoff Syndrome Patients: Updated Perspectives. J Nerv Ment Dis 2021; 209:592-599. [PMID: 34397759 DOI: 10.1097/nmd.0000000000001351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
ABSTRACT Objectives consist of updating published reports on the recognition, assessment, and care of patients with Wernicke-Korsakoff syndrome (WKS). Methods included defining relevant terms, describing core clinical phenomena, conducting meaningful reviews for latter-day WKS publications, and selecting instructive case examples. Findings covered epidemiology, precipitants, neuroimaging studies, alternate learning strategies in WKS, adjunctive treatments, and promising research. In conclusion, patients, their family members, clinicians, and public health experts should benefit from this updated knowledge. Countries with substantial alcohol consumption should consider emulating Holland in designating WKS research centers, founding regional clinical facilities, and funding multidisciplinary expert teams.
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Affiliation(s)
| | | | | | - Kathryn Lee
- Minneapolis VA Health Care Center, Minneapolis
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5
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Rane MA, Boorugu HK, Ravishankar U, Tarakeswari S, Vadlamani H, Anand H. Wernicke's encephalopathy in women with hyperemesis gravidarum - Case series and literature review. Trop Doct 2021; 52:98-100. [PMID: 34167385 DOI: 10.1177/00494755211014396] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Whilst nausea affects around 80% of pregnant women, hyperemesis gravidarum, an extreme form of the same, affects only 0.5% to 3%, but may lead to severe nutritional deficiency. Wernicke's encephalopathy is an acute neuropsychiatric disorder which occurs due to thiamine deficiency and needs emergency treatment to prevent neurological morbidity and mortality. Wernicke's encephalopathy is characterised by a clinical triad of oculomotor abnormalities, cerebellar dysfunction and altered mental state. Korsakoff's psychosis is a chronic condition and consequence of Wernicke's encephalopathy, resulting from its delayed treatment. Wernicke's encephalopathy is a well-known complication of chronic alcohol abuse. Not many are aware of its association with hyperemesis gravidarum. Although it is a rare complication, if not diagnosed and treated promptly, it may result in permanent and irreversible neurological sequelae. The objective of our retrospective observational study was to analyse the clinical profile and outcome (short and long term) in a rare yet preventable complication of pregnancy.
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Affiliation(s)
- Makarand Anil Rane
- Senior Resident, Department of Obstetric Medicine, Fernandez Hospital, Hyderabad, India
| | - Hari Kishan Boorugu
- Consultant Physician, Department of Obstetric Medicine, Fernandez Hospital, Hyderabad, India
| | - Usha Ravishankar
- Consultant Physician, Department of Obstetric Medicine, Fernandez Hospital, Hyderabad, India
| | - S Tarakeswari
- Consultant Obstetrician, Head, Department of Obstetric Medicine, Fernandez hospital, Hyderabad, India
| | | | - Hemalatha Anand
- Consultant Physician, Department of Obstetric Medicine, Fernandez Hospital, Hyderabad, India
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Ghosh R, Mandal A, Roy D, Chatterjee S, Ghosh MK, Dubey S, Lahiri D, Finsterer J, Ray BK. Seizure as a presenting manifestation of Wernicke's encephalopathy induced by hyperemesis gravidarum. J Family Med Prim Care 2021; 10:567-571. [PMID: 34017792 PMCID: PMC8132766 DOI: 10.4103/jfmpc.jfmpc_1466_20] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/17/2020] [Accepted: 10/28/2020] [Indexed: 11/04/2022] Open
Abstract
Wernicke's encephalopathy (WE) is an acute neurological condition characterized by the triad of ophthalmoparesis with nystagmus, ataxia, and global confusion. WE is a life-threatening illness caused by thiamine deficiency, primarily affecting the peripheral and central nervous systems. Thiamine deficiency is predominantly associated with chronic alcoholism, but various other causes have also been reported, including severe malnutrition, prolonged parenteral nutrition, malignancies, immunodeficiency syndromes, liver disease, hyperthyroidism and severe anorexia nervosa, and hyperemesis gravidarum. We, hereby, report a unique case of WE induced by hyperemesis gravidarum that presented in mid-trimester of pregnancy in a rather extremely unusual way with focal seizures and secondary generalization but fortunately ended up with a good feto-maternal outcome.
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Affiliation(s)
- Ritwik Ghosh
- Department of General Medicine, Burdwan Medical College & Hospital, Burdwan, West Bengal, India
| | - Arpan Mandal
- Department of General Medicine, Burdwan Medical College & Hospital, Burdwan, West Bengal, India
| | - Devlina Roy
- Department of General Medicine-Infectious Disease and Beleghata General Hospital, Kolkata, West Bengal, India
| | - Subhankar Chatterjee
- Department of General Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Mrinal Kanti Ghosh
- Department of Radiodiagnosis, Burdwan Medical College & Hospital, Burdwan, West Bengal, India
| | - Souvik Dubey
- Department of Neuromedicine, Bangur Institute of Neurosciences, Institute of Postgraduate Medical Education & Research and SSKM Hospital, Kolkata, West Bengal, India
| | - Durjoy Lahiri
- Department of Neuromedicine, Bangur Institute of Neurosciences, Institute of Postgraduate Medical Education & Research and SSKM Hospital, Kolkata, West Bengal, India
| | - Josef Finsterer
- Department of Neurology, Krankenanstalt Rudolfstiftung, Messerli Institute, Vienna, Austria
| | - Biman Kanti Ray
- Department of Neuromedicine, Bangur Institute of Neurosciences, Institute of Postgraduate Medical Education & Research and SSKM Hospital, Kolkata, West Bengal, India
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7
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Dasari P, Priyadarshini S. Neglected woman with hyperemesis gravidarum leading to Wernicke encephalopathy. BMJ Case Rep 2020; 13:13/12/e238545. [PMID: 33310834 PMCID: PMC7735111 DOI: 10.1136/bcr-2020-238545] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
A teenage primigravida at 13 weeks of gestation presented with hyperemesis gravidarum of 45 days and a history of giddiness and inability to walk due to involuntary movements of limbs and eyes since 2 days. She was treated with intravenous fluids, thiamine and antiemetics. MRI brain showed hyperintensities in bilateral dorsomedial thalami, periaqueductal grey matter in T2-weighted and FLAIR images. A diagnosis of Wernicke encephalopathy was made and she was managed in intensive care unit and received injection thiamine as per the guidelines and her weakness and ataxia improved over 3 weeks and she was discharged at 17 weeks of pregnancy in good state of health.
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Affiliation(s)
- Papa Dasari
- Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education, Puducherry, India
| | - Smitha Priyadarshini
- Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education, Puducherry, India
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Shah R, Malhamé I, Fayek M, Merolli A, Mehta N. Wernicke's encephalopathy: An uncommon complication from hyperemesis gravidarum. Obstet Med 2020; 13:198-200. [PMID: 33343698 PMCID: PMC7726169 DOI: 10.1177/1753495x18811515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 10/16/2018] [Indexed: 11/15/2022] Open
Abstract
Hyperemesis gravidarum is a complication of pregnancy associated with severe nausea and vomiting that can lead to fluid-electrolyte imbalances and nutritional deficiencies. Wernicke's encephalopathy is a neurologic manifestation of acute thiamine (vitamin B1) deficiency. We describe a case of hyperemesis gravidarum presenting with gait ataxia and nystagmus which led to a diagnosis of Wernicke's encephalopathy.
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Affiliation(s)
- Roshan Shah
- Department of Medicine, Women and Infants Hospital, Providence, USA
| | - Isabelle Malhamé
- Department of Medicine, Women and Infants Hospital, Providence, USA
| | - Mariam Fayek
- Department of Medicine, Women and Infants Hospital, Providence, USA
| | | | - Niharika Mehta
- Department of Medicine, Women and Infants Hospital, Providence, USA
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9
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Damaso ÊL, Reis ETSD, Jesus FAD, Marcolin AC, Cavalli RDC, Moisés ECD. Wernicke Encephalopathy as a Complication of Hyperemesis Gravidarum: Case Report. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2020; 42:672-675. [PMID: 33129223 DOI: 10.1055/s-0040-1714721] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Wernicke encephalopathy (WE) is an acute neurological disorder resulting from vitamin B1 deficiency, which is common in chronic alcoholism. We report a rare case of WE due to hyperemesis gravidarum in a 25-year-old pregnant patient at 13 weeks and 5 days of gestation. Initially, the disease manifested as weakness, mental confusion, anterograde amnesia, and visual and auditory hallucinations. The diagnosis was established after the detection of suggestive findings of WE in the thalamus by magnetic resonance imaging (MRI) and a rapid improvement in the patient's clinical status subsequent to treatment with thiamine. Hyperemesis is a rare cause of WE, which makes the reported case important in the literature and reinforces the need for attention in clinical practice to rare but important complications of this common condition (hyperemesis gravidarum).
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Affiliation(s)
- Ênio Luis Damaso
- Department of Gynecology and Obstetrics, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | | | - Felipe Alves de Jesus
- Department of Medical Imaging, Hematology, and Clinical Oncology, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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10
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Mishra VV, Verneker RA. Hyperemesis gravidarum causing Wernicke–Korsakoff syndrome: A rare complication. J Obstet Gynaecol Res 2019; 45:1929-1931. [DOI: 10.1111/jog.14039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 05/27/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Vineet V. Mishra
- Department of Obstetrics and GynaecologyInstitute of Kidney Disease and Research Centre Ahmedabad India
| | - Ruchika A. Verneker
- Department of Obstetrics and Gynaecology, Reproductive Medicine and LaparoscopyMothercare Hospital Margao Goa India
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11
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Palakkuzhiyil N, Rehiman S, Manoj PPB, Hameed S, Uvais NA. Visual loss and optic neuropathy associated with Wernicke's encephalopathy in hyperemesis gravidarum. J Family Med Prim Care 2019; 8:1243-1245. [PMID: 31041282 PMCID: PMC6482737 DOI: 10.4103/jfmpc.jfmpc_121_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Wernicke's encephalopathy (WE) is a potentially fatal neuropsychiatric syndrome precipitated by thiamine deficiency due to a variety of causes such as chronic severe alcoholism, starvation, and prolonged intravenous feeding. WE has also been observed rarely in the clinical setting of hyperemesis gravidarum. Here, we report the case of a 34-year-old pregnant woman who presented with reduced vision, gaze-evoked nystagmus, and postural imbalance preceded by 2 weeks of hyperemesis. Fundus examination showed features consistent with papillitis. Magnetic resonance imaging (MRI) showed T2WI, FLAIR, and diffusion-weighted imaging MR images showing hyperintensity in dorsomedial thalami and periaqueductal grey matter with diffusion restriction. She was diagnosed with WE based on history, clinical examination findings, and MRI findings and was treated with injectable thiamine. She showed marked improvement in vision and nystagmus within 3 days. Our case is a rare presentation of WE in a pregnant woman with hyperemesis gravidarum.
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Affiliation(s)
- Naseem Palakkuzhiyil
- Department of Neurology, Iqraa International Hospital and Research Centre, Calicut, Kerala, India
| | - Sherinas Rehiman
- Department of Radiology, Iqraa International Hospital and Research Centre, Calicut, Kerala, India
| | - P P Baby Manoj
- Department of Radiology, Iqraa International Hospital and Research Centre, Calicut, Kerala, India
| | - Shahul Hameed
- Department of Radiology, Iqraa International Hospital and Research Centre, Calicut, Kerala, India
| | - N A Uvais
- Department of Psychiatry, Iqraa International Hospital and Research Centre, Calicut, Kerala, India
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12
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Oudman E, Wijnia JW, Oey M, van Dam M, Painter RC, Postma A. Wernicke’s encephalopathy in hyperemesis gravidarum: A systematic review. Eur J Obstet Gynecol Reprod Biol 2019; 236:84-93. [DOI: 10.1016/j.ejogrb.2019.03.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 03/04/2019] [Accepted: 03/04/2019] [Indexed: 12/13/2022]
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13
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Kondo T, Nakamura M, Kawashima J, Matsumura T, Ohba T, Yamaguchi M, Katabuchi H, Araki E. Hyperemesis gravidarum followed by refeeding syndrome causes electrolyte abnormalities induced rhabdomyolysis and diabetes insipidus. Endocr J 2019; 66:253-258. [PMID: 30700639 DOI: 10.1507/endocrj.ej18-0496] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Although hyperemesis gravidarum (HG), an extreme form of morning sickness, is a common complication during pregnancy, HG associated simultaneous onset of rhabdomyolysis and diabetes insipidus due to electrolyte abnormalities are rare. A 34-year-old woman with severe HG at 17 weeks of gestation complicated with appetite loss, weight reduction by 17 kg, general fatigue, myalgia, weakness and polyuria was identified to have simultaneous hypophosphatemia (1.6 mg/dL) and hypokalemia (2.0 mEq/L). Appetite recovery and the improvement of the hypophosphatemia (3.2 mg/dL) were observed prior to the first visit to our department. At the admission, she presented polyuria around 7,000~8,000 mL/day with impaired concentrating activity (U-Osm 185 mOsm/L), and abnormal creatine kinase elevation (4,505 U/L). The electrolyte disturbances and physio-metabolic abnormalities in undernourished state due to HG let us diagnose this case as refeeding syndrome (RFS). In this case, abnormal loss by vomiting, insufficient intake and previous inappropriate fluid infusion as well as the development of RFS may accelerate the severity of hypokalemia due to HG. Thus, as her abnormalities were considered as results of rhabdomyolysis and diabetes insipidus due to severe HG associated hypokalemia based on RFS, oral supplementation of potassium chloride was initiated. After 6 days of potassium supplementation, her symptoms and biochemical abnormalities were completely resolved. Severe HG followed by RFS can be causes of electrolyte abnormalities and subsequent complications, including rhabdomyolysis and renal diabetes insipidus. Appropriate diagnosis and prompt interventions including adequate nutrition are necessary to prevent electrolyte imbalance induced cardiac, neuromuscular and/or renal complications.
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Affiliation(s)
- Tatsuya Kondo
- Department of Metabolic Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Miwa Nakamura
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Junji Kawashima
- Department of Metabolic Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Takeshi Matsumura
- Department of Metabolic Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Takashi Ohba
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Munekage Yamaguchi
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Hidetaka Katabuchi
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Eiichi Araki
- Department of Metabolic Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan
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14
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Nikolakaros G, Kurki T, Myllymäki A, Ilonen T. A patient with Korsakoff syndrome of psychiatric and alcoholic etiology presenting as DSM-5 mild neurocognitive disorder. Neuropsychiatr Dis Treat 2019; 15:1311-1320. [PMID: 31190835 PMCID: PMC6535456 DOI: 10.2147/ndt.s203513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/04/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Wernicke's encephalopathy (WE) and Korsakoff syndrome (KS) are underdiagnosed. The DSM-5 has raised the diagnostic threshold by including KS in the major neurocognitive disorders, which requires that the patient needs help in everyday activities. Methods: We report clinical, neuropsychological, and radiological findings from a patient who developed Wernicke-Korsakoff syndrome as a result of alcohol use and weight loss due to major depression. We assess the diagnosis in the context of the scientific literature on KS and according to the DSM-IV and the DSM-5. Results: The patient developed ataxia during a period of weight loss, thus fulfilling current diagnostic criteria of WE. WE was not diagnosed, but the patient partially improved after parenteral thiamine treatment. However, memory problems became evident, and KS was considered. In neuropsychological examination, the Logical Memory test and the Word List test were abnormal, but the Verbal Pair Associates test was normal (Wechsler Memory Scale-III). There were intrusions in the memory testing. The Wisconsin Card Sorting Test was broadly impaired, but the other test of executive functions (difference between Trail Making B and Trail Making A tests) was normal. There was atrophy of the mammillary bodies, the thalamus, the cerebellum, and in the basal ganglia but not in the frontal lobes. Diffusion tensor imaging showed damage in several tracts, including the uncinate fasciculi, the cinguli, the fornix, and the corona radiata. The patient remained independent in everyday activities. The patient can be diagnosed with KS according to the DSM-IV. According to the DSM-5, the patient has major neurocognitive disorders. Conclusions: Extensive memory testing is essential in the assessment of KS. Patients with a history of WE and typical clinical, neuropsychological, and radiological KS findings may be independent in everyday activities. Strict use of the DSM-5 may worsen the problem of Wernicke-Korsakoff syndrome underdiagnosis by excluding clear KS cases that do not have very severe functional impairment.
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Affiliation(s)
- Georgios Nikolakaros
- Satakunta Hospital District, Psychiatric Care Division, General Psychiatry Outpatient Clinic, Pori, Finland.,HUS Medical Imaging Center, Department of Clinical Neurophysiology, Helsinki University Hospital, Helsinki, Finland
| | - Timo Kurki
- Terveystalo Pulssi Medical Center, Turku, Finland.,Department of Radiology, University of Turku, Turku, Finland
| | - Arttu Myllymäki
- Satakunta Hospital District, Psychiatric Care Division, General Psychiatry Outpatient Clinic, Pori, Finland
| | - Tuula Ilonen
- Department of Psychiatry, University of Turku, Turku, Finland
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15
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Affiliation(s)
- Kerstin Austin
- Department of Gastroenterology and Hepatology; University of Wisconsin School of Medicine and Public Health; Madison Wisconsin USA
| | - Kelley Wilson
- Clinical Nutrition Services; University of Wisconsin Hospital and Clinics; Madison Wisconsin USA
| | - Sumona Saha
- Department of Gastroenterology and Hepatology; University of Wisconsin School of Medicine and Public Health; Madison Wisconsin USA
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16
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Talib V, Sultana S, Hamad A, Yaqoob U. Wernicke Encephalopathy Due to Hyperemesis Gravidarum in Pregnancy: A Case Report. Cureus 2018; 10:e2991. [PMID: 30237950 PMCID: PMC6141217 DOI: 10.7759/cureus.2991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 07/17/2018] [Indexed: 11/23/2022] Open
Abstract
Wernicke's encephalopathy (WE) is a life-threatening acute or sub-acute neurological emergency characterized by ataxia, confusion, nystagmus, and ophthalmoparesis caused by thiamine deficiency. It was first described in 1881 by Carl Wernicke with alcohol being the most common cause. We present a rare case of a 35-year-old pregnant female who presented to our emergency department with a history of vomiting and loose motions for two weeks. She later developed fever, confusion, slurred speech and blurring of vision. Magnetic resonance imaging (MRI) of the brain revealed typical lesions of WE. She was immediately treated with thiamine and her symptoms improved in a few days.
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Affiliation(s)
- Vikash Talib
- Accident & Emergency, Jinnah Sindh Medical University (SMC), Karachi, PAK
| | - Shazia Sultana
- Obstetrics and Gynecology, Ziauddin University, Karachi, PAK
| | - Ahmed Hamad
- Medical Student, Ziauddin University, Karachi, PAK
| | - Uzair Yaqoob
- Surgery, Jinnah Postgraduate Medical Centre, Karachi, PAK
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17
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Mun-Wei L, Gayathri G, Kwang Hwee G, Ruban K, Suresh Kumar V, Shatriah I. Optic Discs Swelling Procrastinates Wernicke's Encephalopathy Associated with Hyperemesis Gravidarum: A Case Report and Review of Literature. Cureus 2018; 10:e2793. [PMID: 30112269 PMCID: PMC6089490 DOI: 10.7759/cureus.2793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Wernicke’s encephalopathy following severe hyperemesis gravidarum is an uncommon clinical entity. We describe a rare manifestation of optic discs swelling in a pregnant woman that has caused a diagnostic dilemma. With high index of suspicion of clinical manifestations and radiological evidences, a clinical diagnosis of Wernicke’s encephalopathy was made. Intravenous thiamine therapy was instituted, and prompt improvement of clinical signs was observed. The association of optic discs swelling and Wernicke’s encephalopathy after hyperemesis gravidarum is discussed.
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Affiliation(s)
- Lam Mun-Wei
- Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, MYS
| | | | | | | | | | - Ismail Shatriah
- Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, MYS
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Nagarajan E, Rupareliya C, Bollu PC. Wernicke's Encephalopathy as a Rare Complication of Hyperemesis Gravidarum: A Case Report and Review of Literature. Cureus 2018; 10:e2597. [PMID: 30013861 PMCID: PMC6039156 DOI: 10.7759/cureus.2597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 05/09/2018] [Indexed: 11/05/2022] Open
Abstract
Wernicke's encephalopathy (WE) is a rare neurological syndrome that presents in the setting of thiamine deficiency. Though alcoholism is the most common cause of this condition, a few other etiologies include malnutrition from other causes, hemodialysis, and hyperemesis gravidarum. In this case report, we aim to report a case of a young woman who developed WE in the setting of hyperemesis gravidarum (HG) that improved with thiamine replacement. This manuscript details her presentation and clinical examination and includes a spontaneous upbeat nystagmus and goes over the condition along with a review of the literature.
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Affiliation(s)
| | | | - Pradeep C Bollu
- Department of Neurology, University of Missouri, Columbia, USA
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Stephens A, Patel K, Rao A, Browne P, Raley S, Street L. Recurrent Wernicke’s encephalopathy in pregnancy: A case report. Nutr Neurosci 2017; 22:528-530. [DOI: 10.1080/1028415x.2017.1416941] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Angela Stephens
- Department of Obstetrics and Gynecology, Augusta University, Augusta, GA, USA
| | - Khilen Patel
- Department of Obstetrics and Gynecology, Augusta University, Augusta, GA, USA
| | - Ashwin Rao
- Department of Radiology and Imaging, Augusta University, Augusta, GA, USA
| | - Paul Browne
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Augusta University, Augusta, GA, USA
| | - Susanna Raley
- Department of Obstetrics and Gynecology, Augusta University, Augusta, GA, USA
| | - Linda Street
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Augusta University, Augusta, GA, USA
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