Wernicke's Encephalopathy Induced by Hyperemesis Gravidarum: Steroid Therapy and FLAIR MR Technic

ABSTRACT

A 39-year-old woman developed Wernicke's encephalopathy in the sixteenth week of her pregnancy after eight weeks of severe nausea and vomiting. Because of her protracted severe vomiting, she had inpatient treatment with intravenous dextrose and electrolytes without thiamine. In her fourteenth week of pregnancy, she began showing neurologic symptoms such as dizziness, tinnitus, hearing impairment, nystagmus and ataxia. To rule out possibility of brain stem lesions, MRI of brain was performed. MRI showed tectal lesions as well as bilateral symm-etric midline lesions along the third ventricle and cerebral aqueduct. Further evaluate for these lesions, FLAIR(fluid-attenuated inversion-recovery) MR imaging was performed. Based on her clinical symptoms and FLAIR MR imaging, she was diagnosed as Wernicke's encephalopathy. Combined therapy with vitamin B1(50mg/day) and steroid(met-hylprednosolone 1g/day) was immediately started. Two days later, her neurologic symptoms improved. FLAIR imaging technique allows easier identification of specific periventricular distribution of the lesions. The preventive steroid therapy may have resulted in beneficial outcome on Wernicke's encephalopathy.