Oculomotor and gait disturbance during pregnancy

摘要

MRI showed bilateral lesions in the paraventricular regions of the thalamus and the periaqueductal grey matter (see Images in Neurascience: Question Figs. 1 and 2), which are highly suggestive of Wernicke's encephalopathy. Thrombosis of the deep venous system, particularly the internal cerebral veins, was ruled out because brain venography with magnetic resonance was normal (see Images in Neuwscience: Question Fig. 3). Blood thiamine concentration was particularly low (43 ng/mL, normal range >70 ng/mL). Other laboratory studies were noteworthy only for elevated aspartate aminotransferase and alanine ami-notransferase. Foetal echography was normal. Wernicke's encephalopathy was confirmed and the patient was placed on 1000 mg parenteral thiamine daily for two weeks, followed by a daily oral dose of 750 mg. After two days of treatment, her mental status had improved, as had the dysarthria, ageusia and anosmia. After three weeks, her gait and the laboratory studies had returned to normal. At the conclusion of the follow-up, after two months, her ocular abnormalities had resolved gradually and the MRI was normal (Fig. 1).