Subacute gestational neuropathy: role of thiamine deficiency.

A 28-year old woman was admitted to our hospital at 5 months of a pregnancy complicated by daily vomiting. At 3 months of pregnancy, she started experiencing paresthesias in the lower limbs followed by progressive ascending weakness. Two weeks before admission in our hospital, while she was receiving a course of parenteral rehydration (IV solution unknown), she developed Wernicke encephalopathy (WE). She was given oral thiamine and pyridoxin and was transferred to our hospital. On physical examination, tachycardia and pitting oedema in the legs were noted. On neurological examination, she was disoriented. A bilateral horizontal gaze-evoked nystagmus was noted as well as flaccid paraplegia with weakness of the distal upper limbs, generalized areflexia and decreased sensation to all modalities in the lower limbs. Plantar responses were flexor. Tests for antinuclear antibodies, anti-neutrophil cytoplasmic antibodies, anti-ganglioside antibodies, cryoglobulin, HIV, hepatitis B and C virus, lead and urine porphobilinogen were all negative. Thyroïd studies, B12 and folate levels were normal. CSF studies were normal. Electrophysiological studies revealed a severe axonal sensory-motor polyneuropathy (Table 1). Brain MRI with FLAIR sequences demonstrated hypersignals in the medial thalamus and the periaqueductal gray matter, typical of WE (Fig. 1). She was given parenteral thiamine (300 mg daily) supplementation. At follow-up one year after discharge , she was ambulatory with a walking aid and was still recovering.