Gayet – Wernicke encephalopathy in pregnant women: modern approaches to diagnosis and treatment

Objective. To develop a clinical management algorithm for pregnant women with Wernicke encephalopathy based on a comprehensive literature review and the authors’ own clinical experience.
Materials and methods. This article presents data from both international and domestic sources, as well as the authors’ personal clinical observations on the subject.
Results. Both clinical cases of Wernicke encephalopathy in pregnant women occurred in the context of severe hyperemesis gravidarum, accompanied by thiamine deficiency and characteristic neurological manifestations, including elements of the classic triad: oculomotor dysfunction, ataxia, and mental status changes. Timely administration of high-dose thiamine combined with comprehensive intensive care led to stabilization and complete resolution of symptoms. In both cases, pregnancy was successfully prolonged to full term, resulting in favorable outcomes. These observations underscore the importance of early diagnosis and immediate initiation of therapy when Wernicke's encephalopathy is suspected in pregnant patients, most commonly in the setting of excessive vomiting.
Conclusion. The proposed clinical management algorithm for Wernicke encephalopathy in pregnancy may improve maternal and perinatal outcomes and help prevent long-term neurological sequelae.

1. Grigor'eva V.N., Guzanova E.V., Muhin V.V. Wernicke's encephalopathy, central pontine myelinolysis and polyneuropathy in patients with indomitable vomiting of pregnant (hyperemesis gravidarum). Nevrologicheskij zhurnal. 2016; (3): 131–141. (in Russian)

2. Lonsdale D., Marrs C. Thiamine deficiency disease, dysautonomia, and high calorie malnutrition. London: Academic Press. 2017; 356.

3. Sinha S., Kataria A., Kolla B.P., et al. Wernicke encephalopathy – clinical pearls. Mayo Clin Proc. 2019; 94(6): 1065–1072.

4. Scalzo S.J., Bowden S.C., Ambrose M.L., et al. Wernicke-Korsakoff syndrome not related to alcohol use. J Neurol Neurosurg Psychiatry. 2015; 86(12): 1362–1368.

5. Galvin R., Brathen G., Ivashynka A., et al. EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy. Eur J Neurol. 2010; 17(12): 1408–1418.

6. Ota Y., Capizzano A.A., Moritani T., et al. Comprehensive review of Wernicke encephalopathy: pathophysiology, clinical symptoms and imaging findings. Jpn J Radiol. 2020; 38(9): 809–820.

7. Thomson A.D., Cook C.C.H., Touquet R., Henry J. A. The Royal College of physicians report on alcohol: guidelines for managing Wernicke's encephalopathy in the accident and emergency department. Alcohol Alcohol. 2002; 37(6): 513–521.

8. Vasan S., Kumar A. Wernicke encephalopathy. StatPearls. Available at: https://www.ncbi.nlm.nih.gov/books/NBK470344/ (accessed: 31.10.2025).

9. Smertina L.P., Kasparova A.E. Rare clinical case of Wernicke encephalopathy in pregnant: diagnosis and management. Vestnik SurGU. Meditsina. 2020; (2): 92–97. (in Russian)

10. MacGibbon K.W., Fejzo M.S., Mullin P.M. Mortality secondary to hyperemesis gravidarum. Womens Health Gynecol. 2015; 1(2): 1–7. Available at: https://www.hyperemesis.org/HER-Research/downloads/2015_MacGibbon_HG_Case_Study.pdf (accessed: 30.10.2025).

11. Ashraf V.V., Prijesh J., Praveenkumar R., Saifudheen K. Wernicke's encephalopathy due to hyperemesis gravidarum: clinical and magnetic resonance imaging characteristics. J Postgrad Med. 2016; 62(4): 260–263.

12. Schabelman E., Kuo D. Glucose before thiamine for Wernicke encephalopathy. J Emerg Med. 2012; 42(4): 488–494.