title: Clinical awareness for health care professionals: Fatal encephalopathy complicating persistent vomiting in pregnancy.
abstract: Women with persistent vomiting during pregnancy need early referral to appropriate health facilities. Delayed referral and inappropriate management may lead to metabolic encephalopathy from a variety of causes, including electrolyte derangements or thiamine deficiency (Wernicke's encephalopathy) (WE). We present a case of persistent vomiting in pregnancy in which there was delayed referral, inappropriate treatment and failure to associate neurological signs such as terminal neck stiffness with WE, resulting in poor fetomaternal outcomes. In this report, we discuss the following lessons: (i) the need for early transfer of a patient with persistent vomiting and enigmatic clinical features to a higher healthcare facility; (ii) failure to associate neurological signs with complications of hyperemesis gravidarum/WE; (iii) lack of thiamine supplementation; and (iv) the advantages of magnetic resonance imaging over a computed tomography scan in the diagnosis of WE.
authors: Department of Obstetrics and Gynaecology, School of Clinical Medicine, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa. ngenenc@gmail.com.
authors: Nnabuike Chibuoke
authors: NC
authors: Ngene
authors: Jack
authors: J
authors: Moodley
mesh_terms: D000328:Adult; D001928:Brain Diseases, Metabolic / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D000066491:Clinical Decision-Making; D057210:Delayed Diagnosis / Q000009:adverse effects / Q000517:prevention & control; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D006939:Hyperemesis Gravidarum / Q000150:complications*; D008279:Magnetic Resonance Imaging / Q000379:methods; D011247:Pregnancy; D011256:Pregnancy Outcome; D012121:Respiration, Artificial / Q000379:methods; D061665:Time-to-Treatment; D014057:Tomography, X-Ray Computed / Q000379:methods; D014899:Wernicke Encephalopathy / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy