Empiric Thiamine Administration in Severe Traumatic Brain Injury: A Case Report

Thiamine deficiency is increasingly recognized as a contributing factor to poor outcomes in critically ill patients. This case describes a 24-year-old male with severe traumatic brain injury (TBI) characterized by multiple hemorrhagic cerebral contusions, minimal subarachnoid hemorrhage, and admission Glasgow Coma Scale (GCS) score of 7-8, loss of consciousness lasting more than 24 hours, and post-traumatic amnesia exceeding 7 days. Despite standard intensive care, the patient developed persistent tachycardia and delayed neurological recovery. Empiric intravenous thiamine was initiated at a dose of 100 mg every 8 hours after transfer from the intensive care unit to the intermediate care unit, when the patient remained tachycardic and demonstrated limited neurological recovery despite ongoing supportive care. Within 48 hours, the patient’s heart rate improved to below 100 beats per minute, and his GCS score improved from 10–11 to 15. However, this clinical course was also consistent with the expected recovery trajectory following severe TBI after discontinuation of sedation, and several concurrent factors may have contributed to the observed improvement. Previous clinical and experimental studies have suggested that thiamine may support mitochondrial function and modulate inflammatory pathways in critical illness and TBI. This case describes the clinical course following empiric thiamine administration in a patient with severe TBI. The specific contribution of thiamine cannot be determined from this single case, and prospective studies are needed to investigate whether thiamine provides clinical benefit in TBI.