Wernicke encephalopathy post gastrectomy

Case contributed by Yves Leonard Voss


Ataxia, vertigo, unstable gait, low frequency upbeat nystagmus, vertical gaze palsy. Disorientation to time and space. Sleeve-gastrectomy 2 months ago.

Patient Data

Age: 30 years
Gender: Female

- Periaqueductal T2 hyperintensity involving the quadrigeminal plate.

- T2 hyperintensity of the mammillary bodies.

No restricted diffusion. No contrast enhancement. No signs of infarction or inflammation.

Case Discussion

The patient presented with symptoms of ataxia, nystagmus and vertical gaze palsy. The patient was awake, NIHSS = 0, although disorientated to time and space. The additional neuropsychological testing revealed no hallucinations or delusions, but a mild amnestic syndrome with antegrade and retrograde deficits. Events of the last few 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 encephalopathy.

Laboratory results showed thiamine (vitamin B1) deficiency (13.5 ng/mL, normal: 20-100 ng/mL) and folate deficiency (0.8 ng/mL, normal: 4.6 - 18.7 ng/mL).

The MRI shows some typical signs of Wernicke encephalopathy in this non-alcoholic patient: FLAIR/T2 - hyperintensity periaqueductal involving the quadrigeminal plate and hyperintensity of the mammillary bodies.

The patient was treated with supplementary vitamins and folate and recovered within 2 weeks.

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