tetano
Editor, Senior Moderator
Brain Behav Immun Health
. 2021 Mar 31;100252.
doi: 10.1016/j.bbih.2021.100252. Online ahead of print.
Encephalopathy responsive to thiamine in severe COVID-19 patients
Marcus Vinicius Branco de Oliveira[SUP] 1 2 3 4 [/SUP], Sergio Irikura[SUP] 1 2 3 4 [/SUP], Fabiani Honorato de Barros Louren?o[SUP] 1 2 3 4 [/SUP], Monica Shinsato[SUP] 1 2 3 4 [/SUP], Tereza Cristina Duarte Batista Irikura[SUP] 1 2 3 4 [/SUP], Rodrigo Batista Irikura[SUP] 1 2 3 4 [/SUP], Tales Vieira Cavalvanti Albuquerque[SUP] 1 2 3 4 [/SUP], Vilma Neri Shinsato[SUP] 1 2 3 4 [/SUP], Vinicius Nakad Orsatti[SUP] 1 2 3 4 [/SUP], Ant?nio Mendes Fontanelli[SUP] 1 2 3 4 [/SUP], Danyelle Am?lia Grecco Samegima[SUP] 1 2 3 4 [/SUP], Marcus Vin?cius Magno Gon?alves[SUP] 5 [/SUP], Daniel Galera Bernab?[SUP] 6 [/SUP]
Affiliations
Abstract
Encephalopathy is one of the most frequent neurological complications of severe Coronavirus Disease 2019 (COVID-19) patients. Cytokine storm and sepsis, hypercatabolic states, the use of furosemide and dialytic therapy represent risk factors for thiamine deficiency and are also found in patients with severe COVID-19. In this retrospective case series, we report clinical and neurological findings of fifteen patients with COVID-19-associated Wernicke Encephalopathy (WE) and their response to treatment with intravenous thiamine. All patients had encephalopathy, with 67% displaying at least one additional sign of classic WE triad (ophthalmoparesis and ataxia). Two patients (13%) had the classic triad. All COVID-19 patients had significant improvement of the neurological manifestations between two to five days after intravenous thiamine administration. Eleven patients (73%) had good neurological outcome at hospital discharge and only two patients (13%) died. This case series suggests that thiamine deficiency may be an etiology of encephalopathy in severe COVID-19 patients and its treatment may represent a safety and low-cost response to reduce the neurological burden.
Keywords: Acute Respiratory Distress Syndrome (ARDS); COVID-19; Delirium; Encephalopathy; Thiamine; Wernicke encephalopathy.
. 2021 Mar 31;100252.
doi: 10.1016/j.bbih.2021.100252. Online ahead of print.
Encephalopathy responsive to thiamine in severe COVID-19 patients
Marcus Vinicius Branco de Oliveira[SUP] 1 2 3 4 [/SUP], Sergio Irikura[SUP] 1 2 3 4 [/SUP], Fabiani Honorato de Barros Louren?o[SUP] 1 2 3 4 [/SUP], Monica Shinsato[SUP] 1 2 3 4 [/SUP], Tereza Cristina Duarte Batista Irikura[SUP] 1 2 3 4 [/SUP], Rodrigo Batista Irikura[SUP] 1 2 3 4 [/SUP], Tales Vieira Cavalvanti Albuquerque[SUP] 1 2 3 4 [/SUP], Vilma Neri Shinsato[SUP] 1 2 3 4 [/SUP], Vinicius Nakad Orsatti[SUP] 1 2 3 4 [/SUP], Ant?nio Mendes Fontanelli[SUP] 1 2 3 4 [/SUP], Danyelle Am?lia Grecco Samegima[SUP] 1 2 3 4 [/SUP], Marcus Vin?cius Magno Gon?alves[SUP] 5 [/SUP], Daniel Galera Bernab?[SUP] 6 [/SUP]
Affiliations
- PMID: 33817670
- PMCID: PMC8011322
- DOI: 10.1016/j.bbih.2021.100252
Abstract
Encephalopathy is one of the most frequent neurological complications of severe Coronavirus Disease 2019 (COVID-19) patients. Cytokine storm and sepsis, hypercatabolic states, the use of furosemide and dialytic therapy represent risk factors for thiamine deficiency and are also found in patients with severe COVID-19. In this retrospective case series, we report clinical and neurological findings of fifteen patients with COVID-19-associated Wernicke Encephalopathy (WE) and their response to treatment with intravenous thiamine. All patients had encephalopathy, with 67% displaying at least one additional sign of classic WE triad (ophthalmoparesis and ataxia). Two patients (13%) had the classic triad. All COVID-19 patients had significant improvement of the neurological manifestations between two to five days after intravenous thiamine administration. Eleven patients (73%) had good neurological outcome at hospital discharge and only two patients (13%) died. This case series suggests that thiamine deficiency may be an etiology of encephalopathy in severe COVID-19 patients and its treatment may represent a safety and low-cost response to reduce the neurological burden.
Keywords: Acute Respiratory Distress Syndrome (ARDS); COVID-19; Delirium; Encephalopathy; Thiamine; Wernicke encephalopathy.