Wernicke's encephalopathy with visual loss in a patient with hyperemesis gravidarum.

OBJECTIVE We describe a case of Wernicke's encephalopathy associated with visual loss that was caused by hyperemesis gravidarum. METHODS A 25 year old lady in her 20th week of her pregnancy consulted us. She had history of nausea and vomiting for 3 months with resultant weight loss. She now presented with sub-acute onset of visual loss in both her eyes, and gait disturbance with unsteadiness. Upon ophthalmologic examination she was found to have a visual acuity of 6/60 in both eyes; abduction restriction, nystagmus and retinal hemorrhages and macular oedema in both eyes. She also had truncal, stance and gait ataxia. RESULTS She was treated with parenteral thiamine and her visual loss reversed and her ataxia improved dramatically. Magnetic resonance imaging (MRI) brain with diffusion weighted imaging showed findings consistent with Wernicke's Encephalopathy. CONCLUSION Wernicke's Encephalopathy can occur in many hitherto under-recognised clinical scenarios associated with inadequate oral intake like hyperemesis gravidarum, after gastric bypass surgeries and those on total parenteral nutrition. Visual loss is increasingly being recognized as the additional, reversible feature of Wernicke's Encephalopathy. The changes that occur on MRI brain, especially on the diffusion weighted images, are characteristic and considered diagnostic of Wernicke's Encephalopathy.