Wernicke encephalopathy post gastrectomy
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At the time the case was submitted for publication Yves Leonard Voss had no recorded disclosures.View Yves Leonard Voss's current disclosures
Ataxia, vertigo, unstable gait, low frequency upbeat nystagmus, vertical gaze palsy. Disorientation to time and space. Sleeve-gastrectomy 2 months ago.
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- 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.
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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.
- 1. Aasheim ET; Wernicke encephalopathy after bariatric surgery: a systematic review. Ann Surg. 2008 Nov;248(5):714-20. Pubmed citation
- 2. 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
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