Wernicke Korsakoff syndrome in a teenage female as a complication of COVID‐19

Skok, Hannah; Jabour, Joseph; Betcher, Joseph

doi:10.1002/emp2.12735

Cited by 5 publications

(7 citation statements)

References 18 publications

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“…In 86% of cases (24/28), clinical investigations revealed pathological findings and only in 14% (4/28), no abnormalities were found neither in sera, nor CSF, brain MRI, or EEG [ 6 , 24 , 26 ]. Brain MRI results were abnormal in 53% (16/30) [ 6 , 20 – 22 , 25 , 27 , 31 , 32 ] and showed cerebellar signal alterations in 31% (5/16), and white matter changes in 31% (5/16), of which three MRI met criteria of acute demyelinating encephalomyelitis (ADEM) (Supplementary table 1). One patient (6%) was diagnosed with Guillain-Barré syndrome and correspondingly presented with thickening of nerve roots.…”

Section: Resultsmentioning

confidence: 99%

“…In 14% (4/28) of patients, the symptoms resolved spontaneously, and treatment was not necessary [ 6 , 20 , 28 , 29 ]. One patient with thiamine deficiency and cerebellitis was supplemented with thiamine [ 32 ] and another patient received carbamazepine to reduce choreatic movements of a suspected Sydenham’s chorea relapse [ 34 ]. The other 79% (22/28) of children were treated with immunotherapy.…”

Section: Resultsmentioning

confidence: 99%

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Pediatric de novo movement disorders and ataxia in the context of SARS-CoV-2

et al. 2023

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Objective In the fourth year of the COVID-19 pandemic, mortality rates decreased, but the risk of neuropsychiatric disorders remained the same, with a prevalence of 3.8% of pediatric cases, including movement disorders (MD) and ataxia. Methods In this study, we report on a 10-year-old girl with hemichorea after SARS-CoV-2 infection and immunostained murine brain with patient CSF to identify intrathecal antibodies. Additionally, we conducted a scoping review of children with MD and ataxia after SARS-CoV-2 infection. Results We detected antibodies in the patient's CSF binding unknown antigens in murine basal ganglia. The child received immunosuppression and recovered completely. In a scoping review, we identified further 32 children with de novo MD or ataxia after COVID-19. While in a minority of cases, MD or ataxia were a symptom of known clinical entities (e.g. ADEM, Sydenham's chorea), in most children, the etiology was suspected to be of autoimmune origin without further assigned diagnosis. (i) Children either presented with ataxia (79%), but different from the well-known postinfectious acute cerebellar ataxia (older age, less favorable outcome, or (ii) had hypo-/hyperkinetic MD (21%), which were choreatic in most cases. Besides 14% of spontaneous recovery, immunosuppression was necessary in 79%. Approximately one third of children only partially recovered. Conclusions Infection with SARS-CoV-2 can trigger de novo MD in children. Most patients showed COVID-19-associated-ataxia and fewer-chorea. Our data suggest that patients benefit from immunosuppression, especially steroids. Despite treatment, one third of patients recovered only partially, which makes up an increasing cohort with neurological sequelae.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Pediatric de novo movement disorders and ataxia in the context of SARS-CoV-2

et al. 2023

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“…The present case developed COVID-19, increasing the risk of thiamine depletion and WE. Recently, a number of papers focused on the increased likelihood of developing WE following COVID-19 infections [46][47][48]. A shortage in thiamine is a relatively common complication of COVID-19 infections.…”

Section: Discussionmentioning

confidence: 99%

Young Nonalcoholic Wernicke Encephalopathy Patient Achieves Remission Following Prolonged Thiamine Treatment and Cognitive Rehabilitation

Oudman

Wijnia

Bidesie

et al. 2023

JCM

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Wernicke encephalopathy (WE), a neurological emergency commonly associated with alcohol use disorder, results from a severe deficiency of vitamin B1. If left untreated, patients either succumb to the illness or develop chronic Korsakoff’s syndrome (KS). Recently, an increasing number of nonalcoholic WE case studies have been published, highlighting a lack of understanding of malnutrition-related disorders among high-functioning patients. We present the case of a 26 year old female who developed life-threatening WE after COVID-19-complicated obesity surgery. She experienced the full triad of WE symptoms, including eye-movement disorders, delirium, and ataxia, and suffered for over 70 days before receiving her initial WE diagnosis. Late treatment resulted in progression of WE symptoms. Despite the severity, the patient achieved remission of some of the symptoms in the post-acute phase due to prolonged parenteral thiamine injections and intensive specialized rehabilitation designed for young traumatic brain injury (TBI) patients. The rehabilitation resulted in gradual remission of amnesia symptomatology, mainly increasing her autonomy. The late recognition of this case highlights the importance of early diagnosis and prompt, targeted intervention in the management of nonalcoholic WE, as well as underscores the potential for positive outcomes after delayed treatment through intensive cognitive rehabilitation in specialized treatment centers.

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“…However, these encephalopathies are non-specific and usually have a good prognosis, and only very rarely has COVID been associated with ataxia [ 81 , 82 ]. Moreover, in the typical cases of WE after COVID-19, this infection apparently provided only the context in which thiamine depletion could develop, i.e., through malnutrition after persistent nausea and vomiting or after dysgeusia [ 83 , 84 , 85 , 86 ]. Furthermore, patients on an ICU with sepsis or in catabolic states are always at risk of thiamine depletion, with or without COVID-19, but they usually respond with immediate neurologic improvement when treated with intravenous thiamine [ 87 , 88 ].…”

Section: Discussionmentioning

confidence: 99%

Coordination and Cognition in Pure Nutritional Wernicke’s Encephalopathy with Cerebellar Degeneration after COVID-19 Infection: A Unique Case Report

Arts

Dorst

Vos

et al. 2023

JCM

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Background: Alcoholic cerebellar degeneration is a restricted form of cerebellar degeneration, clinically leading to an ataxia of stance and gait and occurring in the context of alcohol misuse in combination with malnutrition and thiamine depletion. However, a similar degeneration may also develop after non-alcoholic malnutrition, but evidence for a lasting ataxia of stance and gait and lasting abnormalities in the cerebellum is lacking in the few patients described with purely nutritional cerebellar degeneration (NCD). Methods: We present a case of a 46-year-old woman who developed NCD and Wernicke’s encephalopathy (WE) due to COVID-19 and protracted vomiting, resulting in thiamine depletion. We present her clinical course over the first 6 months after the diagnosis of NCD and WE, with thorough neuropsychological and neurological examinations, standardized clinical observations, laboratory investigations, and repeated MRIs. Results: We found a persistent ataxia of stance and gait and evidence for an irreversible restricted cerebellar degeneration. However, the initial cognitive impairments resolved. Conclusions: Our study shows that NCD without involvement of alcohol neurotoxicity and with a characteristic ataxia of stance and gait exists and may be irreversible. We did not find any evidence for lasting cognitive abnormalities or a cerebellar cognitive-affective syndrome (CCAS) in this patient.

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Wernicke Korsakoff syndrome in a teenage female as a complication of COVID‐19

Cited by 5 publications

References 18 publications

Pediatric de novo movement disorders and ataxia in the context of SARS-CoV-2

Pediatric de novo movement disorders and ataxia in the context of SARS-CoV-2

Young Nonalcoholic Wernicke Encephalopathy Patient Achieves Remission Following Prolonged Thiamine Treatment and Cognitive Rehabilitation

Coordination and Cognition in Pure Nutritional Wernicke’s Encephalopathy with Cerebellar Degeneration after COVID-19 Infection: A Unique Case Report

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