A 25 year old female with 16 weeks of gestation presents with excess vomiting, apathy, ataxia, nystagmus and ophthalmoplegia. The diagnosis is

(A) Wernicke's encephalopathy# Features of WERNICKE'S DISEASE:> Wernicke's disease is a common and preventable disorder due to a deficiency of thiamine> Characteristic clinical Triad is that of Ophthalmoplegia, Ataxia, & Global confusion. Only 1/3rd of patients with acute Wernicke's disease present with the classic clinical triad.> Most patients are profoundly disoriented, indifferent, and inattentive, although rarely they have an agitated delirium related to ethanol withdrawal.> If the disease is not treated, stupor, coma, and death may ensue.> Ocular motor abnormalities include horizontal nystagmus on lateral gaze, lateral rectus palsy (usually bilateral), conjugate gaze palsies, and rarely ptosis.> Gait ataxia probably results from a combination of polyneuropathy, cerebellar involvement, and vestibular paresis.> Pupils are usually spared, but they may become miotic with advanced disease.> Tachycardia & postural hypotension may be related to impaired function of the autonomic nervous system or to the coexisterce of cardiovascular beriberi.> Most common cause of Wernike's disease is noise-induced hearing loss.> Other causes include: Neurological damage - Multiple sclerosis, Ear infections, Oxidative stress, Emotional stress.