Uncommon bilateral optic neuropathy in Wernicke’s encephalopathy complicating gravidarum hyperemesis

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Published Sep 27, 2023
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Vol. 101 No. 5 (2023): Tunis med may 2023

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Mejda Bouladi
Ophthalmology Department, Mongi Slim University Hospital, La Marsa, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia.
Lajmi
Ophtalmology Department, Security Forces Hospital, La Marsa, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia.
Amal Ben Othmen
Ophthalmology Department, Mongi Slim University Hospital, La Marsa, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia.
Lamia El Fekih
Ophthalmology Department, Mongi Slim University Hospital, La Marsa, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia.

Abstract

Wernicke encephalopathy (WE) is a rare neurological disorder that results from vitamin B1 (Thiamin) deficiency, classically characterized by the triad of ophtalmoplagia, altered consciousness, and ataxia. WE is often associated with alcoholism, malnutrition, or gastrointestinal diseases with malabsorption. The association of «gravidarum hyperemesis» and WE seems to be underestimated. We report a 24-year-old pregnant woman with hyperemesis gravidarum, who presented with decreased visual acuity of both eyes. Fundus examination showed a bilateral stage 2 papillary edema. brain magnetic resonance imaging (MRI) showed bilateral and symmetrical hyper intense lesions on T2-weighted and FLAIR sequences in periaqueductal gray matter, thalamus, and mammillary bodies, which confirmed WE complicated by bilateral optic neuropathy. Her symptoms resolved after thiamine treatment. This case raises of the possibility of optic neuropathy in WE, which is a diagnostic emergency requiring early treatment to prevent complications.

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