A Case Report of Wernicke's Encephalopathy During a Pregnancy Complicated by Preeclampsia: A Diagnosis Not to Be Overlooked

Wernicke's encephalopathy (WE) is a potentially life-threatening neurological complication of thiamine deficiency.Although classically associated with chronic alcohol use, it may occur during pregnancy, particularly in the setting of prolonged vomiting and hyperemesis gravidarum.Its clinical presentation may overlap with neurological complications of preeclampsia, making diagnosis challenging.We report the case of a 19-year-old primigravida at 24 weeks of gestation who was admitted to the intensive care unit with prolonged vomiting, altered consciousness, cerebellar ataxia, and oculomotor abnormalities.She presented with severe hypertension, proteinuria, tachycardia, and significant metabolic disturbances, in the context of severe preeclampsia.Initial brain computed tomography was unremarkable.Due to persistent neurological manifestations, brain magnetic resonance imaging was performed and revealed symmetrical lesions involving the mammillary bodies, periaqueductal region, thalami, and periventricular areas, consistent with WE.Thiamine was promptly administered, along with correction of metabolic abnormalities and nutritional support.Neurological status improved progressively, with complete clinical recovery and normalization of laboratory abnormalities.WE should be considered in pregnant women presenting with neurological symptoms and prolonged vomiting, even when preeclampsia is present.The overlap with neurological complications of preeclampsia may delay diagnosis.Early recognition and prompt administration of thiamine are essential to prevent irreversible neurological sequelae.