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Wernicke's Encephalopathy Following Gastroplasty for Morbid Obesity

Published online by Cambridge University Press:  02 March 2017

Cory Toth  and
Chris Voll
Cory Toth*
Affiliation:
Division of Neurology, Department of Medicine, Royal University Hospital, University of Saskatchewan, Saskatoon, SK, Canada
Chris Voll
Affiliation:
Division of Neurology, Department of Medicine, Royal University Hospital, University of Saskatchewan, Saskatoon, SK, Canada
*
Division of Neurology, Department of Medicine, Royal University Hospital, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK, Canada S7N 0W8
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Abstract:

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Background:

The syndrome of Wernicke's encephalopathy consists of two of four features of (1) dietary deficiency; (2) oculomotor abnormality; (3) cerebellar dysfunction; and (4) confusion or mild memory impairment. Predisposing risk factors include alcoholism, hyperemesis gravidarum and prolonged intravenous feeding.

Methods:

A 35-year-old female developed refractory emesis, severe weight loss, and hypokalemia following banded gastroplasty for morbid obesity. Reversal of gastroplasty was performed four months following initial surgery. Following reversal, the patient developed confusion, ataxia, leg weakness and nystagmus.

Results:

Examination of the patient demonstrated disorientation with confusion, vertical nystagmus worse on downgaze, diffuse weakness of the lower extremities, and bilateral dysmetria. Magnetic resonance imaging of the brain demonstrated symmetrical areas of increased T2 signal present bilaterally in the medial thalamic nuclei. The patient did not demonstrate any initial improvement with intravenous thiamine but improved over two months of follow-up.

Conclusion:

Wernicke's encephalopathy has been reported in the European literature as a complication of gastroplasty, with rare recognition of this clinical entity in the North American literature. This potential complication of gastroplasty may be preventable by nutritional intervention in subjects experiencing severe weight loss and emesis following surgery.

Résumé:

RÉSUMÉ:Introduction:

Le syndrome de l'encéphalopathie de Wernicke est constitué de deux des quatre manifestations suivantes: 1) des carences alimentaires; 2) des anomalies oculomotrices; 3) une dysfonction cérébelleuse; et 4) de la confusion ou une légère atteinte de la mémoire. Les facteurs de risque incluent l'alcoolisme, l'hyperémésis gravidarum et l'alimentation parentérale prolongée.

Méthodes:

Une femme de 35 ans a développé des vomissements incoercibles, une perte de poids importante et de l'hypokaliémie suite à une gastroplastie par cerclage pour une obésité morbide. Le cerclage a été retiré quatre mois après la chirurgie initiale. Suite à cette intervention, la patiente a développé de la confusion, de l'ataxie, de la faiblesse des membres inférieurs et du nystagmus.

Résultats:

À l'examen, la patiente était désorientée et présentait de la confusion, un nystagmus vertical exagéré au regard vers le bas, une faiblesse diffuse des membres inférieurs et une dysmétrie bilatérale. La RMN du cerveau a montré des zones symétriques d'augmentation du signal T2 présentes bilatéralement dans le groupe nucléaire médial du thalamus. Initialement, l'état de la patiente ne s'est pas amélioré lors de l'administration de thiamine intraveineuse, mais il s'est amélioré au cours des deux mois du suivi.

Conclusion:

L'encéphalopathie de Wernicke a été rapportée dans la littérature Européenne comme complication de la gastroplastie et elle est rarement mentionnée dans la littérature nord-américaine. Cette complication possible de la gastroplastie peut être prévenue par une intervention nutritionnelle chez les sujets qui présentent une perte de poids importante et des vomissements suite à la chirurgie.

Type
Case Report
Information
Canadian Journal of Neurological Sciences , Volume 28 , Issue 1 , February 2001 , pp. 89 - 92
Copyright
Copyright © The Canadian Journal of Neurological 2001

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