Image of the quarter: Hyperemesis gravidarum-induced Wernicke’s encephalopathy

Wernicke’s  encephalopathy  is  a  potentially  fatal  but  readily  reversible medical  emergency  caused  by  thiamine  deficiency.  A  30-year-old,  14  weeks pregnant  South  Indian  woman  presented  with  confusion,  diplopia,  blurring  of vision,  gait  ataxia,  nystagmus  and  conjugate  gaze  palsy  with  a  background  of intractable  hyperemesis  gravidarum.  With  clinical  suspicion  and  radiological confirmation,  she  was  diagnosed  to  have Wernicke’s  encephalopathy.  Immediate intervention  with  parenteral  thiamine  restored  her  neurological  status  with amelioration of nystagmus, diplopia and ataxia without any neurological sequelae. Here we report this case to illustrate the importance of early recognition of this extremely rare illness in order to avoid permanent neurological deficit.