Acute flaccid paralysis: Do not forget beriberi neuropathy

Area of Science:

• Neurology
• Nutritional Neuroscience

Background:

• Beriberi neuropathy (BB) is a severe condition often associated with thiamine deficiency.
• Its presentation in a general hospital setting, especially differentiating it from Guillain-Barré syndrome (GBS), requires clear characterization.

Purpose of the Study:

• To elucidate the clinical characteristics of beriberi neuropathy (BB) in a general hospital (GH) setting.
• To identify key features that distinguish BB from GBS.

Main Methods:

• Retrospective review of nerve conduction studies (NCS) and clinical records of 13 patients diagnosed with BB between May 2011 and July 2017.
• Analysis of patient demographics, clinical presentations, neurological examination findings, cerebrospinal fluid analysis, NCS results, and treatment outcomes.

Main Results:

• The study identified 13 BB patients (23-64 years), predominantly incarcerated (11/13) and with prior severe anorexia (11/13).
• Common symptoms included weakness (12/13), numbness/paresthesiae (10/13), and dysautonomia (6/13), with 11/13 unable to walk independently at nadir.
• NCS revealed a predominantly sensorimotor axonal polyneuropathy, rarely asymmetric, with only one patient showing a sural-sparing pattern. All patients received high-dose thiamine, and 11/13 improved to independent ambulation.

Conclusions:

• Beriberi neuropathy (BB) is an important cause of acute to subacute flaccid paralysis, particularly in incarcerated patients and those with significant dietary deprivation.
• Key features favoring BB over GBS include symptom duration of ≥3 weeks, nystagmus, confusion, vocal cord dysfunction, volume overload, normal spinal fluid, elevated lactate, and absence of a sural-sparing pattern on NCS.
• While thiamine treatment leads to significant recovery, residual neurocognitive effects can occur, especially in those with a history of alcohol misuse.