Login Register Cart 0
Generic placeholder image

Endocrine, Metabolic & Immune Disorders - Drug Targets

Editor-in-Chief

ISSN (Print): 1871-5303
ISSN (Online): 2212-3873

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Case Report

A Case of Wernicke’s Encephalopathy After Sleeve Gastrectomy

Author(s): Elena Sani*, Giuliana Da Prato, Veronica Gremes, Francesco Valletta, Matilde Bariani and Maria Grazia Zenti

Volume 23, Issue 12, 2023

Published on: 19 July, 2023

Page: [1548 - 1551] Pages: 4

DOI: 10.2174/1871530323666230508152340

Price: $65

Abstract

Background: Wernicke's encephalopathy, resulting from thiamine deficiency, is a rare but serious neurological complication of bariatric procedures. A clinical and radiologic diagnosis is often difficult, and thiamine blood tests are not broadly available. Only a few cases of Wernicke’s encephalopathy after sleeve gastrectomy have been reported in the literature, nonetheless, subjects can be underdiagnosed, and their cases can be underreported.

Case Presentation: We present the case of a 20-year-old female patient who developed Wernicke’s encephalopathy after sleeve gastrectomy for grade II obesity with metabolic complications. She was presented to the Emergency Department showing confusion, gait ataxia and horizontal nystagmus two months after surgery. Persistent vomiting and lack of compliance with vitamin intake were reported. Cerebral MRI showed acute bilateral lesions in the periaqueductal and periventricular regions. Parenteral thiamine supplementation was administered, obtaining a progressive resolution of altered mental status, motor ataxia, and nystagmus. She was discharged on oral thiamine supplementation and underwent a multidisciplinary rehabilitation program, since anterograde, retrograde, and working memory impairment persisted. After a 2-year follow-up, she was compliant with a balanced fractionated diet and vitamin supplementation. A new cerebral MRI showed regression of the neuroradiological findings, but minimal memory impairment remained.

Conclusion: Wernicke’s encephalopathy is a concrete possibility after sleeve gastrectomy and should always be suspected in patients with recurrent vomiting, poor nutritional intake, and non-compliance to vitamin supplementation. Immediate and aggressive thiamine supplementation is mandatory to prevent patients from irreversible neurological impairment, even though full recovery is not always achieved.

« Previous Next »
Graphical Abstract

[1]
Tabbara, M.; Carandina, S.; Bossi, M.; Polliand, C.; Genser, L.; Barrat, C. Rare neurological complications after Sleeve Gastrectomy. Obes. Surg., 2016, 26(12), 2843-2848.
[http://dx.doi.org/10.1007/s11695-016-2227-8] [PMID: 27173817]
[2]
Sechi, G.; Serra, A. Wernicke’s encephalopathy: New clinical settings and recent advances in diagnosis and management. Lancet Neurol., 2007, 6(5), 442-455.
[http://dx.doi.org/10.1016/S1474-4422(07)70104-7] [PMID: 17434099]
[3]
Ota, Y.; Capizzano, A.A.; Moritani, T.; Naganawa, S.; Kurokawa, R.; Srinivasan, A. Comprehensive review of Wernicke encephalopathy: Pathophysiology, clinical symptoms and imaging findings. Jpn. J. Radiol., 2020, 38(9), 809-820.
[http://dx.doi.org/10.1007/s11604-020-00989-3] [PMID: 32390125]
[4]
Mechanick, J.I.; Apovian, C.; Brethauer, S.; Garvey, W.T.; Joffe, A.M.; Kim, J.; Kushner, R.F.; Lindquist, R.; Pessah-Pollack, R.; Seger, J.; Urman, R.D.; Adams, S.; Cleek, J.B.; Correa, R.; Figaro, M.K.; Flanders, K.; Grams, J.; Hurley, D.L.; Kothari, S.; Seger, M.V.; Still, C.D. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures - 2019 update: cosponsored by american association of clinical endocrinologists/american college of endocrinology, the obesity society, american society for metabolic & bariatric surgery, obesity medicine association, and american society of anesthesiologists - executive summary. Endocr. Pract., 2019, 25(12), 1346-1359.
[PMID: 31682518]
[5]
Saif, T.; Strain, G.W.; Dakin, G.; Gagner, M.; Costa, R.; Pomp, A. Evaluation of nutrient status after laparoscopic sleeve gastrectomy 1, 3, and 5 years after surgery. Surg. Obes. Relat. Dis., 2012, 8(5), 542-547.
[http://dx.doi.org/10.1016/j.soard.2012.01.013] [PMID: 22398110]
[6]
Makarewicz, W.; Kaska, L.; Kobiela, J.; Stefaniak, T.; Krajewski, J.; Stankiewicz, M.; Wujtewicz, M.A.; Lachinski, A.J.; Sledzinski, Z. Wernicke’s syndrome after sleeve gastrectomy. Obes. Surg., 2007, 17(5), 704-706.
[http://dx.doi.org/10.1007/s11695-007-9114-2] [PMID: 17658035]
[7]
Saab, R.; El Khoury, M.; Farhat, S. Wernicke’s encephalopathy three weeks after sleeve gastrectomy. Surg. Obes. Relat. Dis., 2014, 10(5), 992-994.
[http://dx.doi.org/10.1016/j.soard.2013.11.016] [PMID: 24582417]
[8]
Truong, J.; Shalchian, S.; Myressiotis, S.; Maertens de Noordhout, A.; Fumal, A. About a case of Wernicke’s encephalopathy after sleeve gastrectomy. Eat. Weight Disord., 2016, 21(4), 721-723.
[http://dx.doi.org/10.1007/s40519-016-0318-0] [PMID: 27722872]
[9]
Hamilton, L.A.; Darby, S.H.; Hamilton, A.J.; Wilkerson, M.H.; Morgan, K.A. Case report of Wernicke’s encephalopathy after sleeve gastrectomy. Nutr. Clin. Pract., 2018, 33(4), 510-514.
[http://dx.doi.org/10.1177/0884533617722758] [PMID: 29730896]
[10]
Casalnuovo, C.A.; Vera Cedeño, C.A.; Refi, C.A.; Suarez García, M.A. Wernicke encephalopathy after sleeve gastrectomy. Obes. Surg., 2020, 30(12), 5129-5130.
[http://dx.doi.org/10.1007/s11695-020-04778-9] [PMID: 32594467]
[11]
Lee, C.W.J.; Tuck, L.; Kumar, S.; Nye, E. Acute Wernicke’s encephalopathy in a young female after sleeve gastrectomy. ANZ J. Surg., 2021, 91(11), 2549.
[http://dx.doi.org/10.1111/ans.17214] [PMID: 34766690]
[12]
Oudman, E.; Wijnia, J.W.; van Dam, M.; Biter, L.U.; Postma, A. Preventing Wernicke encephalopathy after bariatric surgery. Obes. Surg., 2018, 28(7), 2060-2068.
[http://dx.doi.org/10.1007/s11695-018-3262-4] [PMID: 29693218]
[13]
Pardo-Aranda, F.; Perez-Romero, N.; Osorio, J.; Rodriguez-Santiago, J.; Muñoz, E.; Puértolas, N.; Veloso, E. Wernicke’s encephalopathy after sleeve gastrectomy: Literature review. Int. J. Surg. Case Rep., 2016, 20, 92-95.
[http://dx.doi.org/10.1016/j.ijscr.2016.01.016] [PMID: 26826934]
[14]
Kröll, D.; Laimer, M.; Borbély, Y.M.; Laederach, K.; Candinas, D.; Nett, P.C. Wernicke encephalopathy: A future problem even after sleeve gastrectomy? A systematic literature review. Obes. Surg., 2016, 26(1), 205-212.
[http://dx.doi.org/10.1007/s11695-015-1927-9] [PMID: 26476834]
[15]
Dirani, M.; Chahine, E.; Dirani, M.; Kassir, R.; Chouillard, E. More than a case report? Should Wernicke encephalopathy after sleeve gastrectomy be a concern? Obes. Surg., 2017, 27(10), 2684-2687.
[http://dx.doi.org/10.1007/s11695-017-2823-2] [PMID: 28733807]
[16]
Arts, N.; Walvoort, S.; Kessels, R. Korsakoff’s syndrome: A critical review. Neuropsychiatr. Dis. Treat., 2017, 13, 2875-2890.
[http://dx.doi.org/10.2147/NDT.S130078] [PMID: 29225466]
[17]
Kerns, J.C.; Arundel, C.; Chawla, L.S. Thiamin deficiency in people with obesity. Adv. Nutr., 2015, 6(2), 147-153.
[http://dx.doi.org/10.3945/an.114.007526] [PMID: 25770253]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy