Encephalopathy responsive to thiamine in severe COVID-19 patients

• Published in: Brain, behavior, & immunity. Health Vol. 14; p. 100252
• Main Authors: Branco de Oliveira, Marcus Vinicius, Irikura, Sergio, Lourenço, Fabiani Honorato de Barros, Shinsato, Monica, Irikura, Tereza Cristina Duarte Batista, Irikura, Rodrigo Batista, Albuquerque, Tales Vieira Cavalvanti, Shinsato, Vilma Neri, Orsatti, Vinicius Nakad, Fontanelli, Antônio Mendes, Samegima, Danyelle Amélia Grecco, Gonçalves, Marcus Vinícius Magno, Bernabé, Daniel Galera
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-07-2021; Elsevier
• Subjects: Acute respiratory distress syndrome (ARDS); COVID-19; Delirium; Encephalopathy; Short Communication; Thiamine; Wernicke encephalopathy; COVID-19; Delirium; Wernicke encephalopathy; Acute respiratory distress syndrome (ARDS); Encephalopathy; Thiamine
• ISSN: 2666-3546; 2666-3546
• DOI: 10.1016/j.bbih.2021.100252

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.