Unusual Late-onset Wernicke's Encephalopathy Following Vertical Banded Gastroplasty

Overview

Journal Obes Surg

Date 2009 May 6

PMID 19415403

Citations 4

Authors

Maria Victoria Velasco

Ignacio Casanova

Andres Sanchez-Pernaute

Elia Perez-Aguirre

Antonio Torres

Jesus Puerta

Lucio Cabrerizo

Miguel A Rubio

Affiliations

Soon will be listed here.

Abstract

Wernicke's encephalopathy (WE) related to bariatric surgery is the consequence of thiamine depletion occurring usually after restrictive surgical procedures with gastric outlet impairment causing frequent vomiting. We present a 35-year-old man with body mass index of 47.2 who developed a WE 7 years after a vertical banded gastroplasty. Late stenosis of the outlet due to gastric band inclusion was the precipitating mechanism. Poor compliance of dietary pattern and vitamin supplementation along with episodic vomiting both contributed to progressive symptoms of instable gait and mental changes. Magnetic resonance imaging confirmed the diagnosis of WE by showing hyperintense T2 signals at the mammillary bodies. Recovery of symptoms was possible after early thiamine therapy. Unusual late-onset symptoms and contributing factors to WE are discussed.

Citing Articles

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Manigrasso M, Velotti N, De Palma G, Musella M J Clin Med. 2023; 12(19).

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A Late Onset of Wernicke-Korsakoff Encephalopathy After Biliopancreatic Diversion: a Case Report.

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Preventing Wernicke Encephalopathy After Bariatric Surgery.

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MR imaging findings in alcoholic and nonalcoholic acute Wernicke's encephalopathy: a review.

Manzo G, De Gennaro A, Cozzolino A, Serino A, Fenza G, Manto A Biomed Res Int. 2014; 2014:503596.

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References

Grace D, Alfieri M, Leung F . Alcohol and poor compliance as factors in Wernicke's encephalopathy diagnosed 13 years after gastric bypass. Can J Surg. 1998; 41(5):389-92. PMC: 3949779. View

Sechi G, Serra A . Wernicke's encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol. 2007; 6(5):442-55. DOI: 10.1016/S1474-4422(07)70104-7. View

Handler C, Perkin G . Anorexia nervosa and Wernicke's encephalopathy: an underdiagnosed association. Lancet. 1982; 2(8301):771-2. DOI: 10.1016/s0140-6736(82)90955-2. View

Loh Y, Watson W, Verma A, Chang S, Stocker D, Labutta R . Acute Wernicke's encephalopathy following bariatric surgery: clinical course and MRI correlation. Obes Surg. 2004; 14(1):129-32. DOI: 10.1381/096089204772787437. View

Al-Fahad T, Ismael A, Soliman M, Khoursheed M . Very early onset of Wernicke's encephalopathy after gastric bypass. Obes Surg. 2006; 16(5):671-2. DOI: 10.1381/096089206776945075. View

Aasheim E . Wernicke encephalopathy after bariatric surgery: a systematic review. Ann Surg. 2008; 248(5):714-20. DOI: 10.1097/SLA.0b013e3181884308. View

Fandino J, Benchimol A, Fandino L, Barroso F, Coutinho W, Appolinario J . Eating avoidance disorder and Wernicke-Korsakoff syndrome following gastric bypass: an under-diagnosed association. Obes Surg. 2005; 15(8):1207-10. DOI: 10.1381/0960892055002266. View

Escalona A, Perez G, Leon F, Volaric C, Mellado P, Ibanez L . Wernicke's encephalopathy after Roux-en-Y gastric bypass. Obes Surg. 2004; 14(8):1135-7. DOI: 10.1381/0960892041975523. View

Seehra H, Macdermott N, LASCELLES R, Taylor T . Wernicke's encephalopathy after vertical banded gastroplasty for morbid obesity. BMJ. 1996; 312(7028):434. PMC: 2350056. DOI: 10.1136/bmj.312.7028.434. View

10.

Pagnan L, Berlot G . Magnetic resonance imaging in a case of Wernicke's encephalopathy. Eur Radiol. 1998; 8(6):977-80. DOI: 10.1007/s003300050499. View

11.

Sola E, Morillas C, Garzon S, Ferrer J, Martin J, Hernandez-Mijares A . Rapid onset of Wernicke's encephalopathy following gastric restrictive surgery. Obes Surg. 2003; 13(4):661-2. DOI: 10.1381/096089203322190934. View

12.

Worden R, Allen H . Wernicke's encephalopathy after gastric bypass that masqueraded as acute psychosis: a case report. Curr Surg. 2006; 63(2):114-6. DOI: 10.1016/j.cursur.2005.06.004. View

13.

Bozbora A, Coskun H, Ozarmagan S, Erbil Y, Ozbey N, Orham Y . A rare complication of adjustable gastric banding: Wernicke's encephalopathy. Obes Surg. 2000; 10(3):274-5. DOI: 10.1381/096089200321643610. View

14.

Makarewicz W, Kaska L, Kobiela J, Stefaniak T, Krajewski J, Stankiewicz M . Wernicke's syndrome after sleeve gastrectomy. Obes Surg. 2007; 17(5):704-6. DOI: 10.1007/s11695-007-9114-2. View

15.

Chaves L, Faintuch J, Kahwage S, Alencar F . A cluster of polyneuropathy and Wernicke-Korsakoff syndrome in a bariatric unit. Obes Surg. 2002; 12(3):328-34. DOI: 10.1381/096089202321088093. View

16.

Cirignotta F, Manconi M, Mondini S, Buzzi G, Ambrosetto P . Wernicke-korsakoff encephalopathy and polyneuropathy after gastroplasty for morbid obesity: report of a case. Arch Neurol. 2000; 57(9):1356-9. DOI: 10.1001/archneur.57.9.1356. View

17.

Antunez E, Estruch R, CARDENAL C, Nicolas J, Fernandez-Sola J, Urbano-Marquez A . Usefulness of CT and MR imaging in the diagnosis of acute Wernicke's encephalopathy. AJR Am J Roentgenol. 1998; 171(4):1131-7. DOI: 10.2214/ajr.171.4.9763009. View

18.

Oczkowski W, Kertesz A . Wernicke's encephalopathy after gastroplasty for morbid obesity. Neurology. 1985; 35(1):99-101. DOI: 10.1212/wnl.35.1.99. View

19.

Shimomura T, Mori E, Hirono N, Imamura T, Yamashita H . Development of Wernicke-Korsakoff syndrome after long intervals following gastrectomy. Arch Neurol. 1998; 55(9):1242-5. DOI: 10.1001/archneur.55.9.1242. View

20.

Salas-Salvado J, Garcia-Lorda P, Cuatrecasas G, Bonada A, Formiguera X, Del Castillo D . Wernicke's syndrome after bariatric surgery. Clin Nutr. 2000; 19(5):371-3. DOI: 10.1054/clnu.2000.0138. View