Cranial Ultrasonography in Infantile Encephalitic Beriberi: A Useful First-Line Imaging Tool for Screening and Diagnosis in Suspected Cases

Wani, Nisar Ahmad; Qureshi, Umar Amin; Ahmad, Kaisar; Choh, Naseer A.

doi:10.3174/ajnr.a4756

Cited by 15 publications

(22 citation statements)

References 21 publications

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“…Some children with beriberi and adults with Wernicke's encephalopathy display similar brain changes on magnetic resonance imaging, specifically, bilateral, symmetric hyperintensity signals in the mammillary bodies, thalamic, and periaqueductal areas; however, pediatric brain neuroimaging may also show lesions in the basal ganglia and the frontal lobes. In a recent study of infants with thiamine deficiency encephalopathies, cranial ultrasound revealed hyperechoic lesions of the basal ganglia …”

Section: Thiamine Deficiency and Its Consequencesmentioning

confidence: 98%

“…Beriberi in older infants and children may present with predominant neurological symptoms, including loss of appetite, nystagmus, ophthalmoplegia, bulging fontanelle, and loss of consciousness . In areas with low awareness of thiamine deficiency, symptoms are easily mistaken for meningitis.…”

Section: Thiamine Deficiency and Its Consequencesmentioning

confidence: 99%

“…A number of reports of infantile beriberi have emerged from the northern region of India, where the diet consists largely of polished, unfortified rice . Cases all occurred in infants who were exclusively breastfed, and the majority of mothers followed a customary dietary restriction.…”

Section: Prevalence Of Thiamine Deficiency and Burden Of Tddsmentioning

confidence: 99%

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Thiamine deficiency disorders: diagnosis, prevalence, and a roadmap for global control programs

Whitfield

Bourassa

Adamolekun

et al. 2018

Annals of the New York Academy of Sciences

241

335

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Thiamine is an essential micronutrient that plays a key role in energy metabolism. Many populations worldwide may be at risk of clinical or subclinical thiamine deficiencies, due to famine, reliance on staple crops with low thiamine content, or food preparation practices, such as milling grains and washing milled rice. Clinical manifestations of thiamine deficiency are variable; this, along with the lack of a readily accessible and widely agreed upon biomarker of thiamine status, complicates efforts to diagnose thiamine deficiency and assess its global prevalence. Strategies to identify regions at risk of thiamine deficiency through proxy measures, such as analysis of food balance sheet data and month-specific infant mortality rates, may be valuable for understanding the scope of thiamine deficiency. Urgent public health responses are warranted in high-risk regions, considering the contribution of thiamine deficiency to infant mortality and research suggesting that even subclinical thiamine deficiency in childhood may have lifelong neurodevelopmental consequences. Food fortification and maternal and/or infant thiamine supplementation have proven effective in raising thiamine status and reducing the incidence of infantile beriberi in regions where thiamine deficiency is prevalent, but trial data are limited. Efforts to determine culturally and environmentally appropriate food vehicles for thiamine fortification are ongoing.

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Section: Thiamine Deficiency and Its Consequencesmentioning

confidence: 98%

Section: Thiamine Deficiency and Its Consequencesmentioning

confidence: 99%

See 1 more Smart Citation

Thiamine deficiency disorders: diagnosis, prevalence, and a roadmap for global control programs

Whitfield

Bourassa

Adamolekun

et al. 2018

Annals of the New York Academy of Sciences

241

335

View full text Add to dashboard Cite

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“…The echocardiogram will be completed at baseline (ie, prior to or soon after the first thiamine administration) and repeated at 24 and 48 hours. Since normalisation of encephalitic beriberi occurs slowly,12 the cranial ultrasound will be performed once during the hospital stay, typically within the first 12 hours.…”

Section: Methods and Analysismentioning

confidence: 99%

“…During later infancy, the cry may sound hoarse or change to a soundless cry (4–6 months of age) and neurological symptoms may present, including nystagmus, convulsions and unconsciousness (7–9 months of age). Infants with encephalitic beriberi were found to have abnormal cranial ultrasonography, with normalisation within 8 weeks of thiamine administration 12. In the second year of life and later in childhood, TDD more typically presents with a broad range of neurological symptoms, such as anorexia, irritability, agitation, muscle pain, reduced deep tendon reflexes, ataxia, paralysis and altered levels of consciousness 11 13–15.…”

Section: Introductionmentioning

confidence: 99%

Establishing a case definition of thiamine responsive disorders among infants and young children in Lao PDR: protocol for a prospective cohort study

et al. 2020

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IntroductionDiagnosis of infantile thiamine deficiency disorders (TDD) is challenging due to the non-specific, highly variable clinical presentation, often leading to misdiagnosis. Our primary objective is to develop a case definition for thiamine responsive disorders (TRD) to determine among hospitalised infants and young children, which clinical features and risk factors identify those who respond positively to thiamine administration.Methods and analysisThis prospective study will enrol 662 children (aged 21 days to <18 months) seeking treatment for TDD symptoms. Children will be treated with intravenous or intramuscular thiamine (100 mg daily for a minimum of 3 days) alongside other interventions deemed appropriate. Baseline assessments, prior to thiamine administration, include a physical examination, echocardiogram and venous blood draw for the determination of thiamine biomarkers. Follow-up assessments include physical examinations (after 4, 8, 12, 24, 36, 48 and 72 hours), echocardiogram (after 24 and 48 hours) and one cranial ultrasound. During the hospital stay, maternal blood and breast-milk samples and diet, health, anthropometric and socio-demographic information will be collected for mother–child pairs. Using these data, a panel of expert paediatricians will determine TRD status for use as the dependent variable in logistic regression models. Models identifying predictors of TRD will be developed and validated for various scenarios. Clinical prediction model performance will be quantified by empirical area under the receiver operating characteristic curve, using resampling cross validation. A frequency-matched community-based cohort of mother–child pairs (n=265) will serve as comparison group for evaluation of potential risk factors for TRD.Ethics and disseminationEthical approval has been obtained from The National Ethics Committee for Health Research, Ministry of Health, Lao PDR and the Institutional Review Board of the University of California Davis. The results will be disseminated via scientific articles, presentations and workshops with representatives of the Ministry of Health.Trial registration numberNCT03626337.

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Descriptive spectrum of thiamine deficiency in pregnancy: A potentially preventable condition

Nisar

Kareem

Muzaffer

et al. 2023

Intl J Gynecology & Obste

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ObjectivePregnancy, a nutritionally demanding situation in terms of macro‐ and micronutrient supply owing to heightened maternal, placental, and fetal needs, significantly affects thiamine reserves. Thiamine deficiency during pregnancy and the postpartum period, presenting with varied manifestations and outcomes, is a relatively common condition in our population. The study aimed to understand the various manifestations and outcomes of acute thiamine deficiency in pregnant and postpartum women, emphasizing the significance of early recognition and thiamine therapy to prevent serious complications during pregnancy and after childbirth.MethodsThis prospective study conducted in a tertiary care center in North India enrolled consecutive pregnant and postpartum women presenting with clinical features consistent with thiamine deficiency disorders, such as thiamine deficiency‐related neuropathy, high‐output heart failure, heart failure with reduced ejection fraction, Wernicke's encephalopathy, gastric beriberi, and thiamine‐responsive acute pulmonary hypertension. In addition to capturing medical history including drug intake, dietary consumption, and comorbidities, women underwent brief relevant clinical examinations and laboratory assessments, including whole‐blood thiamine levels. Response to intravenous thiamine supplementation was also monitored.ResultsData of 31 women (12 pregnant, 19 postpartum) with a diagnosis of acute thiamine deficiency and a mean age of 28.88 ± 2.69 years were analyzed. The mean thiamine level was 1.28 ± 0.44 μg/dL with mean blood lactate of 3.46 ± 3.33. The most common presentation was gastric beriberi (n = 10), followed by paraparesis (n = 6), high‐output heart failure (n = 6), acute pulmonary hypertension, heart failure with reduced ejection fraction (n = 3 each), and an acute confusional state (n = 2). All patients responded to thiamine challenge.ConclusionIn the context of borderline thiamine status, particularly in our population with endemic thiamine deficiency and heightened demand for thiamine during pregnancy and the peripartum period, the deficiency can have varied and serious manifestations of dry and wet beriberi. Early recognition of the clinical features and thiamine therapy can be life‐saving. There is a need for validated clinical criteria owing to the non‐availability of thiamine testing in resource‐limited settings.

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Cranial Ultrasonography in Infantile Encephalitic Beriberi: A Useful First-Line Imaging Tool for Screening and Diagnosis in Suspected Cases

Abstract: BACKGROUND AND PURPOSE:Brain imaging is central to the diagnosis of infantile encephalitic beriberi. Because cranial sonography findings have not been described in infantile encephalitic beriberi, our aim was to investigate its role in the diagnosis of this condition.

Cited by 15 publications

References 21 publications

Thiamine deficiency disorders: diagnosis, prevalence, and a roadmap for global control programs

Thiamine deficiency disorders: diagnosis, prevalence, and a roadmap for global control programs

Establishing a case definition of thiamine responsive disorders among infants and young children in Lao PDR: protocol for a prospective cohort study

Descriptive spectrum of thiamine deficiency in pregnancy: A potentially preventable condition

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