Wernicke encephalopathy post gastrectomy
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.
1 case question available
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