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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

References

REFERENCES

1. Gudden, H. Klinische und anatomische beitraege zur kenntniss der multiplen alkoholneuritis nebst bemerkungen ueber die regenerationsvorgaenge im peripheren nervensystem. Arch Psychiatr Nervenkr 1896; 28:643–741.Google Scholar
2. Caine, D, Halliday, GM, Kril, JJ, Harper, CG. Operational criteria for the classification of chronic alcoholics: identification of Wernicke’s encephalopathy. J Neurol Neurosurg Psychiatry 1997; 62:51–60.Google Scholar
3. Victor, M, Adams, RD, Collins, GH. The Wernicke-Korsakoff syndrome and related neurological disorders due to alcoholism and malnutrition. 2nd ed. Philadelphia: FA Davis, 1989.Google Scholar
4. Suzuki, S, Ichijo, M, Fujii, H, Matsuoka, Y, Ogawa, Y. Acute Wernicke’s encephalopathy: comparison of magnetic resonance images and autopsy findings. Intern Med 1996; 35(10):831–834.Google Scholar
5. Gallucci, M, Bozzao, A, Splendiani, A, Masciocchi, C, Passariello, R. Wernicke encephalopathy: MR findings in five patients. AJR Am J Roentgenol 1990; 155(6):1309–1314.CrossRefGoogle ScholarPubMed
6. Omer, SM, al Kawi, MZ, al Watban, J, et al. Acute Wernicke’s encephalopathy associated with hyperemesis gravidarum: magnetic resonance imaging findings. J Neuroimaging 1995; 5(4):251–253.Google Scholar
7. Ohkoshi, N, Ishii, A, Shoji, S. Wernicke’s encephalopathy induced by hyperemesis gravidarum, associated with bilateral caudate lesions on computed tomography and magnetic resonance imaging. Eur Neurol 1994;34(3):177–180.Google Scholar
8. Shogry, ME, Curnes, JT. Mamillary body enhancement on MR as the only sign of acute Wernicke encephalopathy. AJNR Am J Neuroradiol 1994;15(1):172–174.Google ScholarPubMed
9. Langlais, PJ. Pathogenesis of diencephalic lesions in an experimental model of Wernicke’s encephalopathy. Metab Brain Dis 1995;10:31–44.Google Scholar
10. Gilroy, J. Basic Neurology. New York: Pergamon Press, 1990.Google Scholar
11. Kolanowski, J. Surgical treatment for morbid obesity. Br Med Bull 1997;53(2):433–444.Google Scholar
12. Mason, EE. Starvation injury after gastric reduction for obesity. World J Surg 1998; 22(9):1002–1007.CrossRefGoogle ScholarPubMed
13. Oczkowski, WJ, Kertesz, A. Wernicke’s encephalopathy after gastroplasty for morbid obesity. Neurology 1985; 35(1):99–101.Google Scholar
14. Seehra, H, MacDermott, N, Lascelles, RG, Taylor, TV. Wernicke’s encephalopathy after vertical banded gastroplasty for morbid obesity. BMJ 1996; 312(7028):434.CrossRefGoogle ScholarPubMed
15. Christodoulakis, M, Maris, T, Plaitakis, A, Melissas, J. Wernicke’s encephalopathy after vertical banded gastroplasty for morbid obesity. Eur J Surg 1997; 163(6):473–474.Google Scholar
16. Abarbanel, JM, Berginer, VM, Osimani, A, Solomon, H, Charuzi, I. Neurologic complications after gastric restriction surgery for morbid obesity. Neurology 1987;37(2):196–200.CrossRefGoogle ScholarPubMed
17. Shimomura, T, Mori, E, Hirano, N, Imamura, T, Yamashita, H. Development of Wernicke-Korsakoff syndrome after long intervals following gastrectomy. Arch Neurol 1998;55(9):1242–1245.CrossRefGoogle ScholarPubMed
18. Albina, JE, Stone, WM, Bates, M, Felder, ME. Catastrophic weight loss after vertical banded gastroplasty:malnutrition and neurologic alterations. JPEN 1988;12(6):619–620.Google Scholar
19. Morinville, V, Jeannet-Peter, N, Hauser, C. Anaphylaxis to parenteral thiamine (vitamin B1). Schweiz Med Wochenschr 1998;128(44):1743–1744.Google Scholar
20. Rowland, LP(ed.). Merritt’s Textbook of Neurology. Ninth Ed. Philadelphia: Williams and Wilkins, 1995.Google Scholar