Alborz University

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Introduction: Wernicke-Korsakoff syndrome is a serious brain condition which can occurs due to long term vitamin B-1, or thiamin deficiency and cause damage to hypothalamus and thalamus. The main symptoms are such as: Nystagmus, abducens nerve palsy, eye movement, ataxia and confusion. The risk factors which included are: Anorexia nervosa, hyperemesis gravidarum, Alcohol consumption and fasting. This syndrome must be diagnosed as soon as possible otherwise it can lead to serious liver and heart defects or even patients death.
Case Presentation: Patient was a 30 years old  G2P1L1 mother , she had her first delivery 13 years ago. Through her current pregnancy, she has lost 20 kg weight due to anorexia and hyperemesis.
She has got admitted two times during her current pregnancy to two different referral centers duo to hyperemesis gravidarum. On 6th Sep 2017 , during 16 weeks of her pregnancy she got admitted in hospital with chief complaints of abdominal and sides pain and blurred vision. With fractional blood pressure between 140/80 to 160/100, ketonuria 1+, proteinuria 1+ and glycosuria 3+.During her hospital stay there were symptoms such as blurred vision, oculomotor nerve palsy, nerve IV paralysis, staring eyes and distraction. Laboratory investigations demonstrated elevated liver enzymes, increased ESR level. There was oliguria too. She went under medication such as  magnesium sulfate therapy , Atenolol and methylprednisolone. EKG revealed mild ST segment depression on anteroseptal leads. There was also hypokalemia (K=2/7). According to internal specialist consultation, in attention to increased ESR, severe oliguria, elevated liver enzymes and and CNS involvement, prednisolone was prescribed. After two weeks on 22th Sep, according to three primatologist consultation with uncertainty to preeclampsia termination of pregnancy was decided. Misoprostol suppositories was inserted. After eight hours eventually Fetus and placenta expulsion occurred completely. After delivery according to neurologist consultation with possibility to thromboembolism heparin therapy has been started. Thyroid investigations revealed hyperthyroidism state as normal T3 and T4 but TSH<0/1 level. Methimazole was prescribed. According to ophthalmologist there was central. After 4 days of delivery there were decreased level of consciousness CVP Line was inserted through the internal jugular vein. Duo to inadequate condition of airway protective reflexes and throat discharge she was intubated. WBC level was 20000, PLT was normal, broad-spectrum antibiotics was prescribed. And 18 days postdelivery with brain death patient became bradycardia. Unfortunately CRP failed and patient died.