Post-COVID Wernicke's presenting as bilateral vision loss

Abstract

Purpose: This case report represents poor nutritional intake and vomiting secondary to COVID-19 resulting in Wernicke's syndrome and blindness.

Observations: We report the case of a 36 year old with a post-COVID episode of acute-subacute onset bilateral blindness ultimately diagnosed as Wernicke's syndrome based on MRI findings and clinical response to high dose IV thiamine supplementation.

Conclusions and importance: Given this patient's dramatic presentation of no light perception vision in both eyes and resolution of symptoms with treatment, it is reasonable to consider thiamine deficiency in any individual who presents with acute-subacute onset vision loss, particularly when the history is suggestive of potential nutritional deficiency.

Keywords: COVID-19; Neuro-ophthalmology; Neurology; Nutrition; Optic neuropathy; SARS-CoV-2.

Fig. 1

Clockwise from top left: Coronal MRI post-contrast with mamillary body enhancement (box) (a), sagittal FLAIR with mamillary body (arrow) and periaqueductal gray matter (box) hyperintensity(b), coronal FLAIR with bilateral thalamic (arrows) hyperintensity(c), and axial diffusion restriction of the periaqueductal gray matter (box) (d).

Fig. 2

OCT nerve of patient at presentation and comparison at follow up. At presentation there is fullness to the nerve but no frank edema, consistent with pseudoedema. After treatment with thiamine there is severe temporal thinning noted on the OCT nerves symmetrically in both eyes which can be seen in metabolic optic neuropathy. Global thickness 136 at presentation to 70 at follow up in the right eye, and 131 at presentation to 66 at follow up in the left eye.

Fig. 3

Humphrey visual field of left eye (on the right) and right eye (on the left) after thiamine treatment. The test is poorly reliable in the left eye. There is a possible paracentral scotoma present in the right eye.