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A 33-year-old Japanese woman, 13 weeks pregnant, developed progressive nausea and vomiting. The vomiting episodes were accompanied by headache, occasional low-grade fever and excessive sleepiness with subsequent diplopia. She had developed hyperemesis gravidarum in a previous pregnancy but had been otherwise well. The neurological examination showed confusion, sleepiness and involuntary non-rhythmic eye movements, suggesting opsoclonus. There was no ophthalmoparesis, ataxia, myoclonus or meningism.
Blood tests showed hypokalaemia, evidence of renal failure, leucocytosis and abnormal liver function tests. CT scan of head was normal and cerebrospinal fluid examination was normal with negative microbiology, including common viruses and flaviviruses. HIV and hepatotropic viruses were negative.
We gave her intravenous fluids and antiemetics along with intravenous thiamine and corticosteroids to treat hyperemesis gravidarum. MR scan of brain (figure 1) showed fluid-attenuated inversion …
Contributors All authors contributed to this work.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned. Externally peer reviewed by Stefan Schwartz, Cardiff, UK.