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Acute up-beating nystagmus in a pregnant woman with hyperemesis gravidarum.

ABSTRACT: Purpose:To describe a case of sudden onset of nystagmus in a pregnant patient with hyperemesis gravidarum. Observations:Sixteen days after onset of persistent nausea and uncontrollable vomiting, a 12 week pregnant woman presented up-beating nystagmus, mild memory impairment and reduced sensitivity in the lower limbs. Laboratory tests presented thiamine deficiency and magnetic resonance imaging showed bilateral medial thalami and midbrain lesions. Because of suspected Wernicke's encephalopathy, the patient was treated with thiamine replacement and significant improvement of symptoms took place. Conclusions and importance:Uncontrollable vomiting can lead to malabsorption of vitamin B1 causing acute onset of nystagmus.

SUBMITTER: Hokazono K

PROVIDER: S-EPMC5722145 | biostudies-literature | 2017 Jun

REPOSITORIES: biostudies-literature

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Acute up-beating nystagmus in a pregnant woman with hyperemesis gravidarum.

Hokazono Kenzo K Geminiani Francisco F Bertholdo Debora D

American journal of ophthalmology case reports 20170314

<h4>Purpose</h4>To describe a case of sudden onset of nystagmus in a pregnant patient with hyperemesis gravidarum.<h4>Observations</h4>Sixteen days after onset of persistent nausea and uncontrollable vomiting, a 12 week pregnant woman presented up-beating nystagmus, mild memory impairment and reduced sensitivity in the lower limbs. Laboratory tests presented thiamine deficiency and magnetic resonance imaging showed bilateral medial thalami and midbrain lesions. Because of suspected Wernicke's en ...[more]

PMID: 29260066

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Project description:IntroductionHyperemesis gravidarum (HG) complicates 1% of pregnancies and has a major impact on maternal quality of life and well-being. We know very little about HG's long-term impact after an affected pregnancy, including recurrence rates in future pregnancies, which is essential information for women considering subsequent pregnancies. In this study, we aimed to prospectively measure the recurrence rate of HG and the number of postponed and terminated subsequent pregnancies due to HG. We also aimed to evaluate if there were predictive factors that could identify women at increased risk for HG recurrence, and postponing and terminating subsequent pregnancies.Material and methodsWe conducted a prospective cohort study. A total of 215 women admitted for HG to public hospitals in the Netherlands were enrolled in the original MOTHER randomized controlled trial and associated observational cohort. Seventy-three women were included in this follow-up study. Data were collected through an online questionnaire. Recurrent HG was defined as vomiting symptoms accompanied by any of the following: multiple medication use, weight loss, admission, tube feeding or if nausea and vomiting symptoms were severe enough to affect life and/or work. Outcome measures were recurrence, postponing, and termination rates due to HG. Univariable logistic regression analysis was used to identify predictive factors associated with HG recurrence, and postponing and terminating subsequent pregnancies.ResultsThirty-five women (48%) became pregnant again of whom 40% had postponed their pregnancy due to HG. HG recurred in 89% of pregnancies. One woman terminated and eight women (23%) considered terminating their pregnancy because of recurrent HG. Twenty-four out of 38 women did not get pregnant again because of HG in the past. Univariable logistic regression analysis identifying possible predictive factors found that having a western background was associated with having weight loss due to recurrent HG in subsequent pregnancies (odds ratio 12.9, 95% CI 1.3-130.5, p = 0.03).ConclusionsHigh rates of HG recurrence and a high number of postponed pregnancies due to HG were observed. Women can be informed of a high chance of recurrence to enable informed family planning.

Project description:BACKGROUND:Nausea and vomiting occur 50-90% during the first trimester of pregnancy. However, patients with hyperemesis gravidarum (HG) may be hospitalized at an incidence rate of 0.8-2% before the 20th week of gestational age. The symptoms generally start during the 5-6th gestational weeks, reaching the highest degree during the 9th week, and decline after the 16-20th weeks of gestation. Clinical findings are proportional to the severity of the disease and severe HG is characterized with dehydration, electrolyte imbalance, and nutritional deficiency as a result of vomiting. METHODS:The study population consisted of two groups of pregnant volunteers at 5-12?weeks of gestation: a severe HG group and a control group. The HG severity was scored using the Pregnancy-Unique Quantification of Emesis (and nausea) (PUQE).The serum levels of the maternal Ca, parathyroid hormone (PTH), Na, K, blood urea nitrogen(BUN), creatinine, vitamin D(25OHD3), and the maternal urine NTx levels were compared between the groups. RESULTS:In total, 40 volunteers were enrolled in this study: 20 healthy pregnant volunteers and 20 with severe HG. There were no statistically significant differences between the maternal characteristics. The first trimester weight loss of ?5?kg was significantly higher in the severe HG group (p?<?0.001), while the control group had a significantly higher sunlight exposure ratio than the severe HG group (p?=?0.021). The urine NTx levels were significantly higher in the severe HG group (39.22?±?11.68NTx/Cre) than in the control group(32.89?±?8.33NTx/Cre) (p?=?0.028).The serum Ca, PTH, Na, K, BUN, and creatinine levels were similar between the groups (p?=?0.738, p?=?0.886, p?=?0.841, p?=?0.957, p?=?0.892, and p?=?0.824, respectively). In the severe HG group, the serum 25OHD3 levels were significantly lower than in the control group (p?<?0.001). CONCLUSIONS:The data from this study indicated that severe HG is associated with increased urine NTx levels. However, large-scale studies are required to understand the clinical significance of this finding, as well as the long-term consequences of elevated urine NTx levels and the underlying mechanisms. TRIAL REGISTRATION:NCT02862496 Date of registration: 21/07/2016.

Dataset Information

Acute up-beating nystagmus in a pregnant woman with hyperemesis gravidarum.

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Acute up-beating nystagmus in a pregnant woman with hyperemesis gravidarum.

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