A Rare Presentation of Wernicke’s Encephalopathy and Dry Beriberi Secondary to Hyperemesis Gravidarum in Pregnancy

Abstract Hyperemesis gravidarum (HEG) refers to excessive vomiting in pregnancy and may cause severe problems like dehydration, electrolyte imbalances, weight loss, and, in severe cases, nutritional deficiency if not treated appropriately. Wernicke’s encephalopathy (WE) and dry beriberi are severe neuropsychiatric disorders that develop if HEG is not treated. We present a 23-year-old primigravida at 19 weeks + 3 days gestation who was admitted with altered mental status and neurological signs such as disorientation and vomiting that lasted for 3 months. The physical and neurological assessment showed decreased limb tone and hyporeflexia with absent plantar response; magnetic resonance imaging scan demonstrated symmetrical T2/fluid-attenuated inversion recovery hyperintensities in the dorsomedial thalami and periaqueductal gray matter, consistent with WE. Abnormality in nerve conduction studies confirmed dry beriberi. Biochemical investigations showed low potassium level in the blood, raised bilirubin level, and liver enzymes. This patient was managed by receiving high-dose intravenous thiamine, potassium supplementation, and supportive care. She showed progressive improvement over 3 weeks, with partial recovery of motor and cognitive function, though some neurological deficits persisted. This case describes the rare triple presentation of WE, dry beriberi, and HEG to draw awareness to the fact that these diseases can occur together and the importance of early recognition and timely intervention in improved maternal and fetal outcomes. Early thiamine supplementation and appropriate management can prevent long-term neurological deficits and promote favorable maternal and fetal outcomes.