Study to Assess Thiamine Deficiency in Stroke Patients

Vartgez Mansourian, MD

A new study is looking into the association between vitamin B₁ (thiamine) levels and the prevalence of symptoms linked to stroke.

An early review of data by Vartgez Mansourian, MD, medical director of the Stroke Rehabilitation Program at Vanderbilt Stallworth Rehabilitation Hospital, shows that about 10% of all stroke patients are thiamine deficient; another 50% are borderline deficient.

The initial findings, which come at a time when a thiamine-rich diet is common among most Americans, could lead to a greater embrace of thiamine testing in emergency and neurological specialty settings.

Thiamine is often abundant in foods with whole grains and legumes, as well as some seeds, vegetables, meats, and cooked fish. Its role in nervous system function is defined by the metabolism of amino acid, fat, and carbohydrates.

People who suffer from alcoholism, gastrointestinal absorption disorders, HIV/AIDS, or a genetic deficiency commonly have thiamine deficiency. Eventually, patients can develop symptoms of confusion, peripheral neuropathy, ataxia, numbness, or others. As such, Mansourian noted, it’s a difficult diagnosis.

“The biggest danger is when someone with a thiamine deficiency is admitted to the ED with confusion, and the deficiency isn’t picked up,” he said in a statement. “They may be given a glucose load, which in the presence of thiamine deficiency can result in metabolic encephalopathy.”

Patients could also be subjected to unnecessary antipsychotic therapy, Mansourian added. As it currently stands, the symptoms of deficiency don’t warrant a test in most emergency department (ED) settings—where results take 3 days to come back. Unless a patient is offered an infusion of some kind—and this case is only frequent for those suffering from alcoholism, gastric bypass, or malnourishment—not much is done at the ED level for a stroke-susceptible patient.

Mansourian’s team is leading a year-long retrospective assessment of 200 stroke patients to understand the association between thiamine levels, cognitive function, patient length of stay, balance, and other symptoms. Investigators will look to understand the effect of probable causes for thiamine deficiency and how they each associate with stroke prevalence.

Investigators hope to understand whether some patients have been previously misdiagnosed with stroke, and if comorbid thiamine deficiency harms a patient’s recovery from stroke. Ultimately, though, Mansourian vies to make thiamine testing standard practice in both hospital and physician office settings.

What that improvement of practice would mean for stroke patients, though, is not yet fully understood.

“The benefits of correcting a deficiency are evident fairly quickly,” he said. “The long-term benefits to continuing on thiamine supplements over and above correcting the acute issue remain to be seen.”

Following the study’s completion, Mansourian intends to follow patients for a prospective analysis, which could include a comparison of functional independence measures, patient energy levels, and other metrics over a period of time.