OPTIC NEUROPATHY IN GAYET-WERNICKE ENCEPHALOPATHY: A CASE REPORT

Gayet-Wernicke encephalopathy is a rare neuropathy caused by a thiamine deficiency and characterized by the triad: ophtalmoplegia/ nystagmus, ataxia and confusion. The prognosis for this pathology is poor; it can lead to blindness, coma or feath in the absence of thiamine supplementation.

We report the case of a 30-year-old patient with no history, 19 weeks pregnant, who is vomiting uncontrollable for several weeks in a context of weight loss and asthenia. The patient presented with a decrease in rapidly progressive bilateral visual acuity followed by balenced and walking.

The ophtalmologic examination found a corrected visual acuity of 1/10 in the both eyes, with the presence of a vertical nystagmus. Examination of the anterior segment was normal in the both eyes. Fundus examination revealed symmetrical bilateral papillary edema and sectoral. Flame hemorrhages are present along the inferior temporal branch of the central retinal artery near the papilla. Neurological examination found anterograde amnesia associated with a cerebellar syndrome. Brain magnetic resonnance imaging showed a T2 hypersignal (Flair) involving both thalami and the periacqueductal region.

We started a treatment intravenously by vitamin therapy B1: 500mg 3 times/day for the first five days, followed by 250mg/day for one weekd, associated with a regimen of rehydratation and nutrition by parenteral. The clinical ecolution was marked by the disappearence of the delirium and the decrease in cerebellar ataxia, with a favorable ocular evolution after 6 weeks of treatment. Visual acuity corrected improved to 9/10 in both eyes, nystagmus has significantly regressed.

Pregnancy vomiting is common during pregnancy and may be the cause of Gayet-Wernicke encephalopathy. A early thiamine supplementation prevents neurological and ophtalmic complications, and helps to ensure the normal continuation of pregnancy.