RESUMEN
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.
RESUMEN
Encephalopathy has been frequently reported in patients with acute respiratory distress syndrome (ARDS) related to COVID-19, and its etiology remains undetermined. These patients display hypercatabolic state, weight loss, use of diuretics, and dialytic therapy, which represent risk factors for thiamine depletion. The diagnosis of Wernicke encephalopathy (WE) is challenging and based on risk factors for the depletion of thiamine. We reported three cases of patients with COVID-19-related WE treated with intravenous thiamine. All patients responded with immediate neurologic improvement, and two of them had accelerated ventilatory weaning. The cases reported suggest that thiamine deficiency could represent relevant etiology of COVID-19-related encephalopathy.