2023 American Academy of Neurology Abstract Website

Objective:

Background:

Wernicke’s Encephalopathy (WE) is classically a triad of encephalopathy, ophthalmoplegia and gait ataxia resulting from thiamine (B1) deficiency. MRI shows symmetric white matter hyperintensities in the mammillary bodies, bilateral thalami, tectal plate and periaqueductal gray matter. WE is commonly associated with chronic alcohol use; however it can develop in any condition that limits intake or absorption of thiamine, including pancreatitis. Although rare, a number of cases of hyperemesis gravidarum in pregnancy leading to WE have been reported, however comorbid pancreatitis and progression to Korsakoff in this population have not.

Design/Methods:

Results:

A 29-year-old woman of 11-weeks gestation, with multiple prior admissions for hyperemesis gravidarum and pancreatitis, was admitted for management of acute pancreatitis with a serum lipase over one-thousand. Her family initially noted symptoms of apathy, abulia, and cognitive changes which they ascribed to possession by a djinn (demon or spirit), according to an ethnomedical belief system. She also developed ataxia, identified by her family as a biomedical symptom, for which they sought medical care. Patient and her family speak Soninke, a Gambian dialect initially unavailable on hospital translation services. These factors delayed recognition of the patient's clinical picture. Neurology was consulted on hospital day three for altered mentation, exam was notable for direction changing nystagmus, abulia, and somnolence. MRI showed a pattern typical in WE as well as cortical hyperintensities in the perirolandic cortex. Intravenous high dose thiamine improved patient’s abulia, but she continues to have residual retrograde and anterograde amnesia consistent with Korsakoff psychosis.

Conclusions:

Pregnant women are uniquely vulnerable to thiamine deficiency. Prompt IV thiamine repletion should be considered in hyperemesis or acute pancreatitis. Language barriers and ethnomedical beliefs can be concurrent with biomedical beliefs and limit communication and delay clinical diagnosis resulting in poor patient outcomes.