Department of Neurosciences, University of Padova, via Giustiniani, 5, 35128 Padua, Italy.
Neurol Sci. 2012 Feb;33(1):133-5. doi: 10.1007/s10072-011-0660-y. Epub 2011 Jul 1.
Hyperemesis gravidarum can impair correct absorption of an adequate amount of thiamine and can cause electrolyte imbalance. This study investigated the neurological complications in a pregnant woman with hyperemesis gravidarum. A 29-year-old pregnant woman was admitted for hyperemesis gravidarum. Besides undernutrition, a neurological examination disclosed weakness with hyporeflexia, ophthalmoparesis, multidirectional nystagmus and optic disks swelling; the patient became rapidly comatose. Brain MRI showed symmetric signal hyperintensity and swelling of periaqueductal area, hypothalamus and mammillary bodies, medial and posterior portions of the thalamus and columns of fornix, consistent with Wernicke encephalopathy (WE). Neurophysiological studies revealed an axonal sensory-motor polyneuropathy, likely due to thiamine deficiency or critical illness polyneuropathy. Sodium and potassium supplementation and parenteral thiamine were administered with improvement of consciousness state in a few days. WE evolved in Korsakoff syndrome. A repeat MRI showed a marked improvement of WE-related alterations and a new hyperintense lesion in the pons, suggestive of central pontine myelinolysis. No sign or symptom due to involvement of the pons was present.
妊娠剧吐可导致体内摄入的足够量的硫胺素吸收不良，并可能导致电解质失衡。本研究调查了一名妊娠剧吐孕妇的神经系统并发症。一名 29 岁的孕妇因妊娠剧吐入院。除了营养不良外，神经系统检查显示有无力和反射减弱、眼肌瘫痪、多向性眼球震颤和视盘肿胀；患者很快陷入昏迷。脑 MRI 显示导水管周围区、下丘脑和乳头体、丘脑内侧和后部以及穹窿柱对称信号高信号和肿胀，符合 Wernicke 脑病（WE）。神经生理学研究显示感觉运动轴索性多发性神经病，可能是由于硫胺素缺乏或危重病多发性神经病引起的。补充钠和钾以及静脉注射硫胺素后，患者的意识状态在几天内得到改善。WE 发展为柯萨科夫综合征。重复 MRI 显示 WE 相关改变明显改善，桥脑出现新的高信号病变，提示中央桥脑髓鞘溶解。桥脑没有出现与病变相关的体征或症状。
