tetano
Editor, Senior Moderator
J Neurosurg Case Lessons
. 2022 Sep 19;4(12):CASE22332.
doi: 10.3171/CASE22332. Print 2022 Sep 19.
Bilateral papilledema with vision loss due to post-COVID-19-induced thiamine deficiency: illustrative case
Kern H Guppy[SUP] 1 2 [/SUP], Yekaterina K Axelrod[SUP] 1 [/SUP], Han Kim[SUP] 3 [/SUP]
Affiliations
Abstract
Background: Bilateral papilledema with vision loss is considered a neurosurgical emergency due to high intracranial pressure. However, it may not be the only cause of papilledema. The authors reported an association among coronavirus disease 2019 (COVID-19), bilateral papilledema, blindness, and Wernicke's encephalopathy (WE).
Observations: An 18-year-old woman presented to the neurosurgery service with rapid profound vision loss and bilateral papilledema. She had COVID-19 3 months earlier with subsequent loss of smell (anosmia) and taste (ageusia), which resulted in hyperemesis and a 43-lb weight loss. Examination revealed ataxia, horizontal nystagmus, and blindness. Magnetic resonance imaging and magnetic resonance venography of her brain were normal. Presumptive diagnosis of WE was made, and she was treated with intravenous thiamine with restoration of vision within 48 hours. Patient's thiamine level was less than half the normal value.
Lessons: Neurosurgeons should be aware of this unique correlation between papilledema and vision loss and its association with WE due to post-COVID-19 hyperemesis and weight loss from anosmia and ageusia.
Keywords: COVID-19; Wernicke’s encephalopathy; hyperemesis; papilledema; thiamine deficiency; vision loss.
. 2022 Sep 19;4(12):CASE22332.
doi: 10.3171/CASE22332. Print 2022 Sep 19.
Bilateral papilledema with vision loss due to post-COVID-19-induced thiamine deficiency: illustrative case
Kern H Guppy[SUP] 1 2 [/SUP], Yekaterina K Axelrod[SUP] 1 [/SUP], Han Kim[SUP] 3 [/SUP]
Affiliations
- PMID: 36593680
- DOI: 10.3171/CASE22332
Abstract
Background: Bilateral papilledema with vision loss is considered a neurosurgical emergency due to high intracranial pressure. However, it may not be the only cause of papilledema. The authors reported an association among coronavirus disease 2019 (COVID-19), bilateral papilledema, blindness, and Wernicke's encephalopathy (WE).
Observations: An 18-year-old woman presented to the neurosurgery service with rapid profound vision loss and bilateral papilledema. She had COVID-19 3 months earlier with subsequent loss of smell (anosmia) and taste (ageusia), which resulted in hyperemesis and a 43-lb weight loss. Examination revealed ataxia, horizontal nystagmus, and blindness. Magnetic resonance imaging and magnetic resonance venography of her brain were normal. Presumptive diagnosis of WE was made, and she was treated with intravenous thiamine with restoration of vision within 48 hours. Patient's thiamine level was less than half the normal value.
Lessons: Neurosurgeons should be aware of this unique correlation between papilledema and vision loss and its association with WE due to post-COVID-19 hyperemesis and weight loss from anosmia and ageusia.
Keywords: COVID-19; Wernicke’s encephalopathy; hyperemesis; papilledema; thiamine deficiency; vision loss.