Wernicke’s encephalopathy as a complication of hyperemesis gravidarum

DOI

https://dx.doi.org/10.18565/aig.2025.199

Kostareva O.V., Makarenko T.A., Ermoshkin O.A., Zotin E.A., Dyachenko N.A.
1) Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Ministry of Health of Russia, Krasnoyarsk, Russia; 2) N.S. Karpovich Krasnoyarsk Interregional Clinical Emergency Hospital, Krasnoyarsk, Russia

Background: Wernicke’s encephalopathy (WE) is an acute neuropsychiatric disorder, best known as a complication of chronic alcoholism, but it can also occur in pregnant women with excessive vomiting due to thiamine deficiency. This condition requires urgent intervention to prevent irreversible neurological damage and fatal outcomes. WE is characterized by the classic triad of symptoms: oculomotor disturbances, cerebellar dysfunction, and altered mental status. Despite the good understanding of WE due to alcoholism, this condition is often undiagnosed in pregnant women since it has nonspecific clinical presentation and it may be similar to other pregnancy complications.
The article provides a review of the pathogenesis, diagnosis, and treatment of WE in pregnant women, as well as a clinical observation of a patient with WE in the first trimester.
Case report: A pregnant woman in her first trimester presented with complaints of persistent vomiting, confusion, and ataxia. Severe hyperemesis gravidarum, metabolic disorders, and neurological pathology were considered during the differential diagnosis. Laboratory tests revealed thiamine deficiency, and MRI scans confirmed the diagnosis of Wernicke’s encephalopathy. The patient was immediately treated with high doses of intravenous thiamine, which led to her recovery. This observation demonstrates the difficulties in diagnosing WE during pregnancy, especially in differentiating it from other causes of neurological symptoms. Timely recognition and thiamine replacement therapy played a significant role in preventing irreversible consequences.
Conclusion: Although rare, Wernicke’s encephalopathy is a life-threatening complication of hyperemesis gravidarum that requires immediate thiamine administration. Clinicians should remain highly alert to this condition in pregnant women who experience prolonged vomiting and neurological symptoms, as delayed diagnosis can lead to irreversible cognitive and motor impairments. The presented case emphasizes the significance of early administration of thiamine for patients at risk, and the need to increase awareness of this condition among obstetricians, gynecologists, and neurologists. It is necessary to carry out further research to develop standardized protocols for the diagnosis and treatment of WE during pregnancy.

Authors’ contributions: Kostareva O.V. – developing the design of the article, literature review; Makarenko T.A. – developing the design of the article, editing the text of the article; Ermoshkin O.A., Zotin E.A., Dyachenko N.A. – presentation and description of the clinical case.
Conflicts of interest: The authors declare that there are no conflicts of interest.
Funding: The study was conducted without sponsorship.
Patient Consent for Publication: The patient signed informed consent for the publication of her data and associated images.
For citation: Kostareva O.V., Makarenko T.A., Ermoshkin O.A., Zotin E.A., Dyachenko N.A.
Wernicke’s encephalopathy as a complication of hyperemesis gravidarum.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2025; (11): 164-171 (in Russian)
https://dx.doi.org/10.18565/aig.2025.199

hyperemesis gravidarum

Wernicke’s syndrome

Wernicke’s encephalopathy

Korsakoff syndrome and pregnancy

thiamine deficiency

Full text (in Russian)

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Received 21.07.2025

Accepted 11.11.2025

Olga V. Kostareva, PhD, Associate Professor, Department of Operative Gynecology, Institute of Postgraduate Education, Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Ministry of Health of Russia, 1 Partizana Zheleznyaka str., Krasnoyarsk, 660022, Russia, +7(913)590-72-90, olgakostar@yandex.ru,
https://orcid.org/0000-0003-2396-2475
Tatyana A. Makarenko, Dr. Med. Sci., Professor, Head of the Department of Operative Gynecology, Institute of Postgraduate Education, Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Ministry of Health of Russia, 1 Partizana Zheleznyaka str., Krasnoyarsk, 660022, Russia, +7(904)895-47-99,
makarenko7777@yandex.ru, https://orcid.org/0000-0002-2899-8103
Oleg A. Ermoshkin, Obstetrician-Gynecologist, Head of the Gynecological Department, N.S. Karpovich Krasnoyarsk Interregional Clinical Emergency Hospital,
17 Kurchatov str., Krasnoyarsk, 660062, Russia, +7(913)835-30-87, disser24@rambler.ru
Evgeny A. Zotin, Anesthesiologist-Intensivist, Department of Anesthesiology and Intensive Care Unit No. 3, N.S. Karpovich Krasnoyarsk Interregional
Clinical Emergency Hospital, 17 Kurchatov str., Krasnoyarsk, 660062, Russia, +7(904)894-34-53, zotin_evgen@mail.ru
Natalya A. Dyachenko, Neurologist, Head of the Neurology Department for Patients with Acute Cerebrovascular Disorders, N.S. Karpovich Krasnoyarsk Interregional
Clinical Emergency Hospital, 17 Kurchatov str., Krasnoyarsk, 660062, Russia, +7(950)973-77-49, dyanaa@yandex.ru
For correspondence: Darya E. Churina, dashsemch@mail.ru

Wernicke’s encephalopathy as a complication of hyperemesis gravidarum

Kostareva O.V., Makarenko T.A., Ermoshkin O.A., Zotin E.A., Dyachenko N.A.

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