A case of ascending paralysis in pregnancy: Thiamine deficiency mimicking Guillain–Barré syndrome
Thiamine (vitamin B1) deficiency may present with diverse symptoms and is often triggered by chronic alcoholism, severe malnutrition or hyperemesis gravidarum. While typically diagnosed clinically, atypical presentations may delay recognition and treatment.We report a 26-year-old pregnant woman in h...
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Elsevier
2025-03-01
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| Series: | Clinical Medicine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1470211825000120 |
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| author | De Yee Gan Chin Meng Lee Shakirin Pairan Raja Ahmad Reza Raja Lope Ahmad Hamdi Najman Achok |
| author_facet | De Yee Gan Chin Meng Lee Shakirin Pairan Raja Ahmad Reza Raja Lope Ahmad Hamdi Najman Achok |
| author_sort | De Yee Gan |
| collection | DOAJ |
| description | Thiamine (vitamin B1) deficiency may present with diverse symptoms and is often triggered by chronic alcoholism, severe malnutrition or hyperemesis gravidarum. While typically diagnosed clinically, atypical presentations may delay recognition and treatment.We report a 26-year-old pregnant woman in her second trimester with prolonged nausea and vomiting since early pregnancy. She developed ascending lower limb paralysis, dysarthria, horizontal nystagmus, and lagophthalmos. Initially managed as hypokalaemia periodic paralysis with thyrotoxicosis and later Guillain–Barré syndrome (GBS), her symptoms worsened despite treatment.Subsequent MRI brain imaging revealed findings indicative of Wernicke encephalopathy, prompting high-dose thiamine therapy. This resulted in significant neurological improvement.This case underscores the importance of considering thiamine deficiency in atypical neurological presentations, particularly in pregnancy. Early recognition and prompt treatment can mitigate irreversible neurological damage, emphasising the necessity of maintaining a high index of suspicion in clinical practice. |
| format | Article |
| id | doaj-art-c41f4736c2414bcfb5ce26b9f2ad5dd9 |
| institution | OA Journals |
| issn | 1470-2118 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Clinical Medicine |
| spelling | doaj-art-c41f4736c2414bcfb5ce26b9f2ad5dd92025-08-20T02:09:59ZengElsevierClinical Medicine1470-21182025-03-0125210029410.1016/j.clinme.2025.100294A case of ascending paralysis in pregnancy: Thiamine deficiency mimicking Guillain–Barré syndromeDe Yee Gan0Chin Meng Lee1Shakirin Pairan2Raja Ahmad Reza Raja Lope Ahmad3Hamdi Najman Achok4Department of Internal Medicine, Hospital Segamat, Ministry of Health, 6, Jalan Genuang, Bandar Putra, 85000 Segamat, Johor Darul Ta'zim, Malaysia; Corresponding author: De Yee Gan, 6, Jalan Genuang, Bandar Putra, 85000 Segamat, Johor Darul Ta'zim, Malaysia.Department of Internal Medicine, Hospital Segamat, Ministry of Health, 6, Jalan Genuang, Bandar Putra, 85000 Segamat, Johor Darul Ta'zim, MalaysiaDepartment of Internal Medicine, Hospital Segamat, Ministry of Health, 6, Jalan Genuang, Bandar Putra, 85000 Segamat, Johor Darul Ta'zim, MalaysiaDepartment of Neurology, Hospital Sultanah Aminah Johor Bahru, Ministry of Health, Jalan, Persiaran Abu Bakar Sultan, 80100 Johor Bahru, MalaysiaDepartment of Neurology, Hospital Sultanah Aminah Johor Bahru, Ministry of Health, Jalan, Persiaran Abu Bakar Sultan, 80100 Johor Bahru, MalaysiaThiamine (vitamin B1) deficiency may present with diverse symptoms and is often triggered by chronic alcoholism, severe malnutrition or hyperemesis gravidarum. While typically diagnosed clinically, atypical presentations may delay recognition and treatment.We report a 26-year-old pregnant woman in her second trimester with prolonged nausea and vomiting since early pregnancy. She developed ascending lower limb paralysis, dysarthria, horizontal nystagmus, and lagophthalmos. Initially managed as hypokalaemia periodic paralysis with thyrotoxicosis and later Guillain–Barré syndrome (GBS), her symptoms worsened despite treatment.Subsequent MRI brain imaging revealed findings indicative of Wernicke encephalopathy, prompting high-dose thiamine therapy. This resulted in significant neurological improvement.This case underscores the importance of considering thiamine deficiency in atypical neurological presentations, particularly in pregnancy. Early recognition and prompt treatment can mitigate irreversible neurological damage, emphasising the necessity of maintaining a high index of suspicion in clinical practice.http://www.sciencedirect.com/science/article/pii/S1470211825000120Ascending paralysisHyperemesis gravidarumThiamine deficiencyDiagnostic challengeAtypical |
| spellingShingle | De Yee Gan Chin Meng Lee Shakirin Pairan Raja Ahmad Reza Raja Lope Ahmad Hamdi Najman Achok A case of ascending paralysis in pregnancy: Thiamine deficiency mimicking Guillain–Barré syndrome Clinical Medicine Ascending paralysis Hyperemesis gravidarum Thiamine deficiency Diagnostic challenge Atypical |
| title | A case of ascending paralysis in pregnancy: Thiamine deficiency mimicking Guillain–Barré syndrome |
| title_full | A case of ascending paralysis in pregnancy: Thiamine deficiency mimicking Guillain–Barré syndrome |
| title_fullStr | A case of ascending paralysis in pregnancy: Thiamine deficiency mimicking Guillain–Barré syndrome |
| title_full_unstemmed | A case of ascending paralysis in pregnancy: Thiamine deficiency mimicking Guillain–Barré syndrome |
| title_short | A case of ascending paralysis in pregnancy: Thiamine deficiency mimicking Guillain–Barré syndrome |
| title_sort | case of ascending paralysis in pregnancy thiamine deficiency mimicking guillain barre syndrome |
| topic | Ascending paralysis Hyperemesis gravidarum Thiamine deficiency Diagnostic challenge Atypical |
| url | http://www.sciencedirect.com/science/article/pii/S1470211825000120 |
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