Introduction : Wernicke’s encephalopathy (WE) is a rare but potentially fatal neuropsychiatric syndrome resulting from thiamine (vitamin B1) deficiency. Although most frequently associated with chronic alcoholism, it has also been reported in patients with hyperemesis gravidarum. The true incidence of WE is likely underestimated due to under diagnosis. The condition is primarily diagnosed clinically, based on the classical triad of confusion, ocular motor abnormalities, and ataxia, which is observed in approximately 60% of cases. Neurological damage is potentially reversible, but only if thiamine supplementation is initiated promptly

Clinical Case : A 30-year-old woman, G2P2 with one living child and no significant medical history, was admitted at 24 weeks of gestation due to intractable vomiting persisting for two months, which had resulted in severe malnutrition. On examination, she was conscious, well-oriented, and hemodynamically stable, but exhibited signs of dehydration. Obstetric ultrasound confirmed a viable singleton pregnancy. Laboratory evaluation was unremarkable except for hypokalemia, which was corrected. During hospitalization, the patient developed ataxia, multidirectional nystagmus, and visual and tactile hallucinations, while maintaining a Glasgow Coma Scale score of 15. Brain MRI findings were consistent with Wernicke’s encephalopathy. She was treated with high-dose parenteral thiamine (1.5 g/day), resulting in significant clinical improvement. At follow-up, the patient continued to experience mild headaches and residual visual and tactile hallucinations.

Conclusion : Wernicke’s encephalopathy should be suspected in any pregnant patient with hyperemesis gravidarum presenting with neurological manifestations, as early recognition and prompt thiamine supplementation are essential to prevent irreversible neurological damage.

Gynecology 2026 Dr. Rania Chihaoui is a resident in Obstetrics and Gynecology at the Ministry of Public Health in Tunisia. She completed complementary certificates in Maternal Health. Her residency training includes rotations in Obstetrics and Gynecology at Ibn El Jazzar Hospital in Kairouan, Taher Sfar Hospital in Mahdia, and Kasserine Hospital. She has participated in national and international gynecology and obstetrics conferences, including AGOB and STGO.