Document Detail


Hyperemesis gravidarum complicated by Wernicke encephalopathy: background, case report, and review of the literature.
MedLine Citation:
PMID:  16551377     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Wernicke encephalopathy (WE) is a rare but known complication of severe hyperemesis gravidarum caused by thiamine deficiency. This article presents an unusual case that occurred at our institution and reviews the 48 previously published cases of WE in pregnancy. Considering all the 49 cases, the mean (+/-standard deviation) patients' age was 26.7 +/- 4.9 years, the mean gestational age when WE manifested was 14.3 +/- 3.4 weeks, and the mean duration of vomiting and feeding difficulties was 7.7 +/- 2.8 weeks. Wernicke's classic triad (confusion, ocular abnormalities, and ataxia) manifested in only 46.9% (23 of 49) of the patients. Confusion affected 63.3% (31 of 49) of the patients, ocular signs 95.9% (47 of 49) and symptoms 57.1% (28 of 49), and ataxia 81.6% (40 of 49). Deterioration of consciousness affected 53.1% (26 of 49) of the subjects and memory impairment 61.2% (30 of 49). Complete remission of the disease occurred in only 14 of 49 cases. Symptom resolution required months and permanent impairments were common. The overall pregnancy loss rate, directly (spontaneous fetal loss) and indirectly (planned abortion) attributable to WE, was 47.9% (23 of 49). The diagnosis of WE is clinical and can be rapidly confirmed by magnetic resonance imaging. We emphasize the importance of thiamine supplementation to women with prolonged vomiting in pregnancy, especially before intravenous or parenteral nutrition. We also underline the necessity to promptly replace vitamin B1 when neurologic symptoms and/or signs develop in a patient with hyperemesis gravidarum.
Authors:
Giuseppe Chiossi; Isabella Neri; Milena Cavazzuti; Gianpaolo Basso; Fabio Facchinetti
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Publication Detail:
Type:  Case Reports; Journal Article; Review    
Journal Detail:
Title:  Obstetrical & gynecological survey     Volume:  61     ISSN:  0029-7828     ISO Abbreviation:  Obstet Gynecol Surv     Publication Date:  2006 Apr 
Date Detail:
Created Date:  2006-03-22     Completed Date:  2006-08-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0401007     Medline TA:  Obstet Gynecol Surv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  255-68     Citation Subset:  IM    
Affiliation:
Obstetrics and Gynecology Residency Program, Modena Policlinico Hospital, University of Modena and Reggio Emilia, Modena, Italy.
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MeSH Terms
Descriptor/Qualifier:
Adult
Diagnosis, Differential
Female
Humans
Hyperemesis Gravidarum* / diagnosis,  therapy
Pregnancy
Pregnancy Complications / diagnosis,  therapy
Pregnancy Outcome
Prognosis
Thiamine Deficiency / complications*,  diagnosis,  drug therapy
Wernicke Encephalopathy / diagnosis,  etiology*,  therapy

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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