Introduction: Wernicke’s Encephalopathy is a serious neurological disorder induced by thiamine, Vitamin B1 deficiency. Dr Carl Wernicke, a German neurologist described it in 1881 as a triad of acute mental confusion, ataxia and opthalmoplegia. It may develop in non-alcoholic condition such hyperemesis gravidarum and prolong starvation. We reported a case of Wernicke’s Encephalopathy in our center following hyperemesis gravidarum.

Case Report and Discussion: A 37 years old Indonesian lady who is in her fifth pregnancy was brought in by her husband to screening room after he noticed that his wife was verbally less responsive and keeps on starring at him for a week.  She had thrice admission to hospital for hyperemesis gravidarum for this current pregnancy. On examination, she had nystagmus with conjugate gaze palsies which required her to have frequent head movement instead of her eyes. She had peripheral neuropathy and power assessment were only 3 for each limb. She obeyed simple commands but had slight of agitation, confusion and inattentiveness. Her TFT that was taken during last admission showed hyperthyroidism. No other clinical finding correlated to the thyrotoxicosis except her flapping tremor. Cardio-respiratory and Gastrointestinal system were unremarkable. Diagnosis of Wernicke’s Encephalopathy and gestational thyrotoxicosis were established. Further blood investigation revealed hypokalaemia and folate deficiency. Intravenous Parenterovite and intramuscular thiamine were commenced. She was also given T. Prophylthiouracil as benefit to treat thyrotoxicosis. Serum potassium level was corrected. With the above treatment, her eye gaze improved and she was able to communicate as usual. Her muscle power was 4 over 5 and she started to recall the past. By day 7 of treatment, she was able to ambulate and feed herself. She had neither retrograde nor anterograde amnesia but the care taker claimed she had mild visual hallucination.

Conclusion: Hyperemesis gravidarum constitute 0.3 to 3.6% cases that complicate pregnancy during first trimester. Suboptimal management of hyperemesis gravidarum might lead to Wernicke’s Encepahlopahy. This is the most serious neurological complication that can lead to death. Identifying the unique character of Wernicke’s Encephalopathy and early thiamine initiation are the crucial part of treatment to ensure better prognosis.