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Visual loss and encephalopathy in a pregnant patient with hyperemesis gravidarum
  1. Purushottam Singh1,
  2. Aditya Gupta2,
  3. Anirban Gupta1 and
  4. Shashikala Turlapati Padmavathi1
  1. 1Neurology, Army Hospital Research and Referral, New Delhi, Delhi, India
  2. 2Army Hospital Research and Referral, New Delhi, Delhi, India
  1. Correspondence to Dr Purushottam Singh; pspposwal{at}


A pregnant woman in her 20s at 17 weeks of gestation, presented with symptoms of painless diminution of vision preceded by 8 weeks history of hyperemesis gravidarum. On examination, she was confused, disoriented and had gait ataxia with complete loss of vision in both eyes. Fundus examination revealed grade 4 disc oedema with superficial retinal haemorrhages. Possibilities kept were cerebral venous sinus thrombosis, neuromyelitis optica spectrum disorder, posterior reversible encephalopathy syndrome and Wernicke’s encephalopathy (WE). Thiamine levels were low. MRI brain with MR venography revealed symmetrical areas of hyperintensities in bilateral medial thalami, hypothalamus, mammillary body and area postrema. She was managed as a case of WE with intravenous thiamine with complete clinical and radiological resolution within 2 weeks of treatment. Therefore, we conclude that a high index of suspicion of WE in appropriate clinical settings leading to early treatment can potentially reverse its grave clinical symptoms and complications.

  • Neurology (drugs and medicines)
  • Vitamins and supplements
  • Pregnancy
  • Visual pathway
  • Materno-fetal medicine

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  • Contributors PS, AdityaG, AnirbanG and STP were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content. PS, AdityaG, AnirbanG and STP gave final approval of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.