Wernicke encephalopathy after gastrectomy due to thiamine deficiency
Ataxia, Vertigo, unstable gait. Low frequency upbeat nystagmus, Vertical gaze palsy. Mild amnestic syndrome (antegrade and retrograde). Disorientation to time and space. Sleeve-gastrectomy 2 months ago, resulting gastric stenosis. Gastroenterostomy 10 days ago.
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- T2 hyperintensity periaqueductal involving the quadrigeminal plate.
- T2 hyperintensity of the mamillary bodies.
No restricted diffusion. No contrast enhancement. No signs of infarction or inflammation.
1 case question available
The patient presented in the neurologic ambulance with symptoms of ataxia, nystagmus and vertical gaze palsy. The patient was awake, NIHSS = 0. Disorientation to time and space. The additional neuropsychiologigal testing revealed no hallucinations or delusions, but mild amnestic syndrome with antegrade and retrograde deficits. Events of the last days were not correctly remembered.
The patient underwent bariatric surgery 2 months before presentation (sleeve-gastrectomy) which led to the neurological deficits in this case of thiamine deficiency induced Wernicke's encephalopathy.
Laboratory results showed Thiamine (Vitamin B1) deficiency (13,5 ng/ml, ref.: 20-100 ng/ml) and Folate deficiency (0,8 ng/ml, ref.: 4,6 - 18,7 ng/ml).
The MRI shows some typical signs of Wernickes encephalopathy in this nonalcoholic patient: FLAIR / T2 - hyperintensity periaqueductal involving the quadrigeminal plate and hyperintensityof the mamillary bodies.
The patient was treated with supplementary Vitamins and Folate and recovered within 2 weeks.
- Aasheim ET; Wernicke encephalopathy after bariatric surgery: a systematic review. Ann Surg. 2008 Nov;248(5):714-20. Pubmed citation
- G. Zuccoli, M. Gallucci, J. Capellades, L. Regnicolo, B. Tumiati, T. Cabada Giadás, W. Bottari, J. Mandrioli and M. Bertolini; Wernicke Encephalopathy: MR Findings at Clinical Presentation in Twenty-Six Alcoholic and Nonalcoholic Patients. American Journal of Neuroradiology August 2007, 28 (7) 1328-1331 Pubmed citation