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Long-term consequences of severe thiamine deficiency are manifested by the appearance of hemorrhagic and/or necrotic lesions with neuronal and dendritic spine loss in the thalamus, hypothalamus, and cerebellum (109–111), as well as polyneuritis, peripheral edema, cardiac enlargement, and ophthalmoplegia ( When early, generalized thiamine deficiency is suspected, prompt administration of thiamine is advised and typically an effective treatment