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Título

Hyperemesis gravidarum and Wernicke's encephalopathy - a case report.

RESUMO

CASE REPORT: Two cases of pregnant patients are described, who presented with hyperemesis gravidarum (HG), evolving with Wernicke's Encephalopathy (WE). In the 1st case, a 33-year-old patient, with gestational diabetes, started presenting HG during the 2nd trimester of pregnancy. Denied alcoholism and drug use. During the 15th gestational week, she underwent a laparoscopic cholecystectomy procedure due to acute cholecystitis, without complications. She had a miscarriage at 20 weeks and 6 days of pregnancy. After the abortion, she evolved with temporo-spatial disorientation, bradypsychism and bradykinesia, and with bilateral decomposition of eye movement. In the 2nd case, a 24-year-old patient with hyperthyroidism developed HG during the 3rd trimester of pregnancy, with gait ataxia, nystagmus with horizontal and vertical downward gazes, and loss of recent memory, with improvement in symptoms after 4 days of Thiamine replacement. DISCUSSION: Nausea and vomiting are typical symptoms of the gestational period, affecting up to 70% of patients. A small portion of this population - about 0.3-10.8% - has a worsening of this condition, called HG. In this context, due to the restrictive condition, some patients may develop episodes of hypovitaminosis, such as Thiamine Deficiency (vitamin B1), which is associated with WE. WE is an acute neurological syndrome, with a reversible characteristic, which leads to changes in mental status, ocular abnormalities and cerebellar dysfunction. The association of HG with WE is rare, however, it is capable of causing serious complications if not diagnosed early, with fetal death in up to 50% of cases and maternal death in 10-20%. FINAL COMMENTS: Among the differential diagnoses regarding neurological alterations during pregnancy, the hypothesis of WE should be considered. This study is relevant because it exposes cases of the rare correlation between HG and WE, whose delay in diagnosis can lead to morbid complications, and whose treatment is often simple, capable of reversing neurological symptoms in their entirety and minimizing damage to pregnancy.

Palavras Chave

Wernicke's encephalopathy; Hyperemesis gravidarum; Thiamine deficiency; Cerebellar disfunction.