A 25-year-old woman suffered from
hyperemesis gravidarum when she was seven weeks pregnant. Since her
vomiting continued, she received intravenous
dextrose and
electrolytes without
thiamine in a hospital. One month later, she developed gait disturbance, followed by
confusion and
dysarthria. On admission to our department, she was confusional and had ataxic
dysarthria. Spontaneous and gaze evoked nystagmus was present. Limb coordination was bilaterally ataxic. Based on her
clinical course and symptoms, she was diagnosed as having
Wernicke's encephalopathy. From the admission day,
intravenous infusion of
vitamin B1 (600 mg/day) was started. A few days later, her consciousness and
limb ataxia began to improve. However,
truncal ataxia and
polyneuropathy became evident. Eight weeks after onset, she developed Korsakoff's
psychosis such as anterograde and
retrograde amnesia, disorientation and confabulation. We administered large amounts of
corticosteroid (
methylprednisolone 500 mg/day) in order to reduce
brain edema or stabilize the impaired blood-brain barrier. Soon after, her
psychosis began to improve gradually. She recovered remarkably from the
psychosis, but she was left with persistent nystagmus, mild ataxic gait and
polyneuropathy. The present case suggests that
corticosteroid may have the beneficial effect on
Wernicke-Korsakoff syndrome.