Koduri Amukthamalyada, Kakumani Jagadeswar, S Magesh Kumar
General Medicine, Saveetha Medical College, Chennai, IND.
Cureus. 2024 Oct 30;16(10):e72697. doi: 10.7759/cureus.72697. eCollection 2024 Oct.
Wernicke's encephalopathy (WE) is an acute neurological disorder arising from thiamine (vitamin B1) deficiency, characterized by a classic triad of ophthalmoplegia, ataxia, and altered mental status. While it is more common in males, it can occur in various contexts, including pregnancy. Leptospirosis, a zoonotic infection, can co-occur with other illnesses such as scrub typhus. We present a case of a 27-year-old primigravida in her second trimester who developed WE, presenting with altered sensorium, fever, and neurological deficits. Initial examination revealed ophthalmoplegia and confusion, with MRI confirming typical findings of WE. Investigations indicated co-infection with leptospirosis and scrub typhus, along with abnormal liver function tests. Treatment with intravenous thiamine resulted in symptomatic improvement. This case underscores the critical role of early diagnosis and treatment of WE, especially in pregnant patients with poor nutritional intake or hyperemesis gravidarum. Imaging studies, particularly MRI, enhance diagnostic accuracy. The patient's condition was exacerbated by concurrent infections affecting liver function and thiamine reserves. WE, though rare in pregnancy, should be suspected in cases of nutritional deficiency and acute illness. Prompt recognition and thiamine supplementation are essential to prevent severe complications, including motor deficits and mortality.
韦尼克脑病（WE）是一种因硫胺素（维生素B1）缺乏引起的急性神经障碍，其特征为眼肌麻痹、共济失调和精神状态改变这一经典三联征。虽然男性中更为常见，但它可发生于包括妊娠在内的各种情况下。钩端螺旋体病是一种人畜共患感染，可与其他疾病如恙虫病同时发生。我们报告一例27岁初产妇，孕中期发生韦尼克脑病，表现为意识改变、发热和神经功能缺损。初始检查发现眼肌麻痹和意识模糊，磁共振成像（MRI）证实了韦尼克脑病的典型表现。检查表明同时感染钩端螺旋体病和恙虫病，以及肝功能检查异常。静脉注射硫胺素治疗后症状改善。该病例强调了韦尼克脑病早期诊断和治疗的关键作用，尤其是在营养摄入不良或妊娠剧吐的孕妇中。影像学检查，特别是MRI，可提高诊断准确性。同时存在的感染影响肝功能和硫胺素储备，使患者病情加重。韦尼克脑病虽然在妊娠中罕见，但在营养缺乏和急性疾病的情况下应予以怀疑。迅速识别并补充硫胺素对于预防包括运动功能缺损和死亡在内的严重并发症至关重要。
