Encephalopathy responsive to thiamine in severe COVID-19 patients

de Oliveira, Marcus Vinicius Branco; 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

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.