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

Overview

Journal J Clin Med

Specialty General Medicine

Date 2023 Apr 13

PMID 37048595

Authors

Nicolaas J M Arts

Maud E G van Dorst

Sandra H Vos

Roy P C Kessels

Affiliations

Soon will be listed here.

Abstract

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.

References

Yap K, Kessels R, Azmin S, van de Warrenburg B, Mohamed Ibrahim N . Neurocognitive Changes in Spinocerebellar Ataxia Type 3: A Systematic Review with a Narrative Design. Cerebellum. 2021; 21(2):314-327. DOI: 10.1007/s12311-021-01282-3. View

Fitzpatrick L, Crowe S . Cognitive and emotional deficits in chronic alcoholics: a role for the cerebellum?. Cerebellum. 2013; 12(4):520-33. DOI: 10.1007/s12311-013-0461-3. View

MANCALL E, MCENTEE W . ALTERATIONS OF THE CEREBELLAR CORTEX IN NUTRITIONAL ENCEPHALOPATHY. Neurology. 1965; 15:303-13. View

Maury A, Lyoubi A, Peiffer-Smadja N, De Broucker T, Meppiel E . Neurological manifestations associated with SARS-CoV-2 and other coronaviruses: A narrative review for clinicians. Rev Neurol (Paris). 2021; 177(1-2):51-64. PMC: 7832485. DOI: 10.1016/j.neurol.2020.10.001. View

Branco de Oliveira M, Bernabe D, Irikura S, Irikura R, Fontanelli A, Goncalves M . Wernicke Encephalopathy in COVID-19 Patients: Report of Three Cases. Front Neurol. 2021; 12:629273. PMC: 7952637. DOI: 10.3389/fneur.2021.629273. View

Kho J, Mandal A, Geraldes R, Tuzlali H, Boyd E, Nortley R . COVID-19 encephalitis and Wernicke's encephalopathy. J Med Virol. 2021; 93(9):5248-5251. PMC: 8242851. DOI: 10.1002/jmv.27088. View

Bodranghien F, Bastian A, Casali C, Hallett M, Louis E, Manto M . Consensus Paper: Revisiting the Symptoms and Signs of Cerebellar Syndrome. Cerebellum. 2015; 15(3):369-91. PMC: 5565264. DOI: 10.1007/s12311-015-0687-3. View

Guilmette T, Sweet J, Hebben N, Koltai D, Mahone E, Spiegler B . American Academy of Clinical Neuropsychology consensus conference statement on uniform labeling of performance test scores. Clin Neuropsychol. 2020; 34(3):437-453. DOI: 10.1080/13854046.2020.1722244. View

Argyropoulos G, van Dun K, Adamaszek M, Leggio M, Manto M, Masciullo M . The Cerebellar Cognitive Affective/Schmahmann Syndrome: a Task Force Paper. Cerebellum. 2019; 19(1):102-125. PMC: 6978293. DOI: 10.1007/s12311-019-01068-8. View

10.

Maas R, Killaars S, van de Warrenburg B, Schutter D . The cerebellar cognitive affective syndrome scale reveals early neuropsychological deficits in SCA3 patients. J Neurol. 2021; 268(9):3456-3466. PMC: 8357713. DOI: 10.1007/s00415-021-10516-7. View

11.

Harding A, Halliday G, Caine D, Kril J . Degeneration of anterior thalamic nuclei differentiates alcoholics with amnesia. Brain. 1999; 123 ( Pt 1):141-54. DOI: 10.1093/brain/123.1.141. View

12.

Chirino-Perez A, Marrufo-Melendez O, Munoz-Lopez J, Hernandez-Castillo C, Ramirez-Garcia G, Diaz R . Mapping the Cerebellar Cognitive Affective Syndrome in Patients with Chronic Cerebellar Strokes. Cerebellum. 2021; 21(2):208-218. DOI: 10.1007/s12311-021-01290-3. View

13.

Jaatinen P, Rintala J . Mechanisms of ethanol-induced degeneration in the developing, mature, and aging cerebellum. Cerebellum. 2008; 7(3):332-47. DOI: 10.1007/s12311-008-0034-z. View

14.

Alexandri M, Reynolds B, Smith H, Golden B, Gross H, Switzer J . Wernicke's encephalopathy and cranial nerve VII palsy in a 24-year-old patient with COVID-19. Int J Emerg Med. 2022; 15(1):6. PMC: 8796183. DOI: 10.1186/s12245-022-00409-5. View

15.

Rensen Y, Oudman E, Oosterman J, Kessels R . Confabulations in Alcoholic Korsakoff's Syndrome: A Factor Analysis of the Nijmegen-Venray Confabulation List. Assessment. 2020; 28(6):1545-1555. PMC: 8392856. DOI: 10.1177/1073191119899476. View

16.

Pavel B, Moroti R, Spataru A, Popescu M, Panaitescu A, Zagrean A . Neurological Manifestations of SARS-CoV2 Infection: A Narrative Review. Brain Sci. 2022; 12(11). PMC: 9688734. DOI: 10.3390/brainsci12111531. View

17.

Sullivan E, Pfefferbaum A . Neuroimaging of the Wernicke-Korsakoff syndrome. Alcohol Alcohol. 2008; 44(2):155-65. PMC: 2724861. DOI: 10.1093/alcalc/agn103. View

18.

Zahr N, Pitel A, Chanraud S, Sullivan E . Contributions of studies on alcohol use disorders to understanding cerebellar function. Neuropsychol Rev. 2010; 20(3):280-9. PMC: 2998898. DOI: 10.1007/s11065-010-9141-y. View

19.

Manto M . The underpinnings of cerebellar ataxias. Clin Neurophysiol Pract. 2022; 7:372-387. PMC: 9731828. DOI: 10.1016/j.cnp.2022.11.002. View

20.

Yokota O, Tsuchiya K, Terada S, Oshima K, Ishizu H, Matsushita M . Frequency and clinicopathological characteristics of alcoholic cerebellar degeneration in Japan: a cross-sectional study of 1,509 postmortems. Acta Neuropathol. 2006; 112(1):43-51. DOI: 10.1007/s00401-006-0059-7. View