Wernicke encephalopathy after sleeve gastrectomy

Rationale

Wernicke encephalopathy (WE) is a recognized complication of bariatric surgery. WE is characterized by the classic triad of ataxia, ophthalmoplegia, and acute confusion due to thiamine deficiency. Bariatric surgery has complications in the form of vitamin deficiencies, and thiamine deficiency following bariatric surgery can present as WE. However, WE after sleeve gastrectomy is rarely observed in clinical practice.

Patient concerns

A 24-year-old man presented to our hospital with a 3-week history of vomiting, diplopia, and unsteady gait. He also noticed problems in his memory and loss of concentration. He had undergone sleeve gastrectomy 3 months prior to presentation.

Diagnoses

The patient was diagnosed with bilateral abducent nerve palsy, horizontal nystagmus, and ataxic gait. Based on the typical clinical manifestations and history of sleeve gastrectomy, the patient was diagnosed with WE. In addition, the magnetic resonance imaging of brain was consistent with WE.

Intervention

The patient received a 7-day course of intravenous thiamine and other vitamin supplements.

Outcome

Significant improvement in neurological manifestations after parenteral thiamine administration.

Lessons

Clinicians should be aware that WE is a complication of bariatric surgery. Prompt administration of parenteral thiamine is effective in treating such conditions.

Other Information

Published in: Medicine: Case Reports and Study Protocols
License: http://creativecommons.org/licenses/by/4.0/
See article on publisher's website: https://dx.doi.org/10.1097/md9.0000000000000245