From vision loss to paralysis: a striking case of Wernicke’s encephalopathy in pregnancy

Abstract

Introduction: Wernicke's encephalopathy (WE) is a neurological emergency caused by thiamine deficiency, most often associated with chronic alcoholism, but it can also occur in non-alcoholic settings such as hyperemesis gravidarum. Case presentation: We report the case of a 37-year-old pregnant woman with intractable vomiting who developed blurred vision, ophthalmoplegia, and subsequently acute flaccid paraparesis. Brain MRI showed typical lesions of WE, and laboratory tests revealed profound hypokalemia. Clinical improvement followed intravenous thiamine and potassium supplementation. Clinical discussion: This case illustrates the dual neurological complications of hyperemesis gravidarum: Wernicke's encephalopathy and hypokalemic paralysis, both resulting from severe nutritional and electrolyte depletion. Conclusion: Hyperemesis gravidarum can cause both thiamine deficiency and severe hypokalemia. Early recognition and combined correction are essential to prevent permanent neurological sequelae.