RESUMO
A report is presented on a patient with Wernicke's encephalopathy secondary to hyperemesis gravidarum. The 25-year-old female presented 11 weeks into pregnancy with prolonged vomiting. Neurological examination 8 weeks later demonstrated obtunded sensations, nystagmus and ataxia of gait. MR imaging revealed bilateral lesions in the mediodorsal nuclei of thalami, in the hypothalamus and in the periaqueductal gray matter (1). The neurological signs and the MRI findings pointed to a diagnosis of Wernicke's encephalopathy. The patient was treated with intramuscular vitamin B1 followed by oral thiamine until the end of pregnancy. The subsequent course of the pregnancy was uncomplicated, and resulted in the delivery of a healthy 2970 g male infant. A review of the literature published during the last 30 years revealed an additional 20 cases of Wernicke's encephalopathy induced by hyperemesis gravidarum. Only half of these pregnancies resulted in the birth of a normal infant.
Assuntos
Hiperêmese Gravídica/complicações , Encefalopatia de Wernicke/etiologia , Adulto , Feminino , Humanos , Imageamento por Ressonância Magnética , Gravidez , Encefalopatia de Wernicke/diagnósticoAssuntos
Anabolizantes/efeitos adversos , Arteriopatias Oclusivas/etiologia , Artéria Basilar , Transtornos Relacionados ao Uso de Substâncias , Adolescente , Amantadina/uso terapêutico , Arteriopatias Oclusivas/diagnóstico , Arteriopatias Oclusivas/terapia , Artéria Basilar/diagnóstico por imagem , Artéria Basilar/patologia , Angiografia Cerebral , Glicerol/uso terapêutico , Hematócrito , Humanos , Imageamento por Ressonância Magnética , Masculino , Manitol/uso terapêutico , Fatores de Tempo , Tomografia Computadorizada por Raios XRESUMO
The simultaneous occurrence of multiple sclerosis and transverse myelitis is known in the literature. Apart from the spinal symptoms, other neurological signs of brain involvement are usually found and magnetic resonance imaging (MRI) reveals disseminated foci in the brain. The positive evoked responses, the immunological abnormalities of the cerebrospinal fluid (CSF), and the oligoclonality together prove the presence of multiple sclerosis. In these cases the symptoms of transverse myelitis can separately precede other signs of multiple sclerosis, or appear as a relapse. Recurrent transverse myelitis as an independent entity, with negative MRI and CSF immunology, is an exciting topic in terms of the etiological factors and therapeutic considerations. The view in the literature is that the occurrence of transverse myelitis as an independent entity is rather rare. The present article reports the case of a female patient with recurrent spinal cord signs, and negative MRI and CSF immunology. During a ten-year follow-up observation period, symptoms of multiple sclerosis did not develop. Further studies of such cases are needed in order to clarify the etiological factors, the pathomechanism and the therapeutic considerations relating to this relatively new and probably independent clinical entity.
