Vitamin B1 in the treatment of Wernicke's encephalopathy due to hyperemesis after gastroplasty.
Wernicke's encephalopathy (WE) is a severe brain disorder, first described in 1881, and is caused by a nutritional deficiency of thiamine (vitamin B1) found mostly in patients suffering from chronic alcoholism. In addition, WE can also complicate bariatric surgery if adequate vitamin supplementation is not insured. Without immediate treatment, the prognosis is poor and the mortality rate is high. Most patients present with atypical neurological symptoms, which hampers rapid diagnosis. We present a 40-year-old woman who underwent gastroplasty combined with gastric banding for severe obesity. She experienced repetitive vomiting and her diet was without vitamin supplementation. After three months she developed convergent strabismus, apathy and urinary incontinence, which was diagnosed as WE and treated as such. Six months later her recovery was incomplete, still showing gait difficulties and nystagmus. We aim to show that adequate vitamin supplementation in patients undergoing gastroplasty is necessary, especially considering the risk of permanent neurological deficits.
New England Center for Stroke Research (NECStR), Department of Radiology, University of Massachusetts Medical School, Worcester, MA 01655, USA. anna.kuhn@umassmed.edu
A L
AL
Kühn
F
F
Hertel
T
T
Boulanger
N J
NJ
Diederich
D000328:Adult; D001284:Atrophy; D004569:Electroencephalography; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology; D015391:Gastroplasty / Q000009:adverse effects*; D006801:Humans; D008279:Magnetic Resonance Imaging; D009460:Neurologic Examination; D009759:Nystagmus, Pathologic / Q000209:etiology; D009765:Obesity / Q000601:surgery; D011183:Postoperative Complications / Q000188:drug therapy*; D020250:Postoperative Nausea and Vomiting / Q000150:complications* / Q000209:etiology; D013831:Thiamine / Q000627:therapeutic use*; D014815:Vitamins / Q000627:therapeutic use*; D014899:Wernicke Encephalopathy / Q000188:drug therapy* / Q000209:etiology
D014815:Vitamins; D013831:Thiamine