Wernicke's encephalopathy: beyond alcoholism

Background A 17-year-old pregnant woman presented to hospital at 19 weeks' gestation with an 8-week history of hyperemesis gravidarum, 16.8 kg of weight loss, and new-onset weakness, dizziness and blurred vision. Examination of the patient showed confusion, papilledema, ophthalmoparesis, nystagmus, reduced hearing and truncal ataxia. Investigations Physical examination, abdominal ultrasound, fetal ultrasound, brain MRI, magnetic resonance angiography, magnetic resonance venography and cerebrospinal-fluid analysis. Diagnosis Wernicke's encephalopathy, hyperemesis gravidarum and fetal loss. Management Intravenous thiamine repletion and elimination of deficiency risk factors.