WERNICKE ENCEHALOPATHY AND PERIPHERAL NEUROPATHY AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY

Introduction A few cases about micronutrient deficiencies determining neurologic manifestations after bariatric surgery are reported1. Thiamine deficiency isthought to be responsible for most of the micronutrient-responsive cerebraldysfunction. Although malabsorption following some bariatric procedures is potentially considered as an evident cause to determine these complications, mostof them appeared after restrictive procedures. To date only one case of Wernickeencephalopathy following sleeve gastrectomy (LSG) has been reported2Patient and Method A 27 years-old woman presenting with generalized weakness, nausea, vomiting and dehydration was admitted at the EmergencyDepartment 2 months following a LSG. A barium gastrointestinal swallowand gastroscopy showed a good sleeve caliber, no obstruction or pathologicalfindings and no delayed gastric emptying. The patients refused further examand was discharged against physician suggestions. One month later, shedeveloped generalized fatigue, vision and hearing impairment, forgetfulness,balance disturbance, distal muscles weakness and lower limbs paresthesias.Brain MRI showed typical features consistent with thiamine deficiency. Lumbar puncture showed no abnormalities.Results The evolution of symptoms, laboratory and MRI findings confirmed vitamin B1 deficiency with acute presentation of Wernicke’s encephalopathy. Therapeutic implementation of vitamine B12, folate and B1 was immediately started,and clinical conditions improved. Six months later the patient was able to walk withminimal assistance and was autonomous in all activities of daily living.Discussion Because LSG is a restrictive procedure and therefore lacks themalabsorptive component, the risk for developing micronutrients deficienciesafter surgery is considered low and, therefore, often not tested. However,because of the resection of the fundus, a number of micronutrients like ironand vitamin B12 are less likely to be absorbed, and the low risk status fordeveloping deficiencies can be questioned. Moreover, the development ofintense and persistent vomiting can quickly lead to vitamin, mineral andprotein deficiencies. Of interest, our patient did not show any stenosis. Moreover, in our case MRI changes consistent with thiamine deficiency were found,while in the former case reported2 brain MRI resulted normal.Conclusions All patients undergoing restrictive procedures, especially LSG,and presenting frequent vomiting in lack of mechanical or functional stenosis,should be considered for intense thiamine supplementation.