Wernicke's Encephalopathy Presenting as Acute Psychosis after Gastric Bypass

Bariatric Endoscopy

“…As is the case for physical comorbidities, morbidly obese patients present a higher rate of psychological comorbidities than the average population, including depression, eating disorders, and impaired quality of life [ 66 ] . Approximately 25-30% of patients report symptoms of depression at the time of evaluation for surgery [ 67 ] .…”

“…A typical history entails a patient who is a few weeks status post-gastric bypass and develops persistent nausea, vomiting, and dehydration. Neurological exam may reveal a wide range of cognitive impairment, paresthesias and h yperesthesias, dysarthria, nystagmus and other opthalmoplegias, weakness, or even ataxia [62][63][64][65][66][67] . The neuropathy associated with this de fi ciency is symmetrical, sensory motor and is most prominent distally [ 62 ] .…”

“…The neuropathy associated with this de fi ciency is symmetrical, sensory motor and is most prominent distally [ 62 ] . The pathophysiology is thought to be due to abnormal carbohydrate metabolism in the central nervous system leading to axonal degeneration involving the thalamus, ocular motor nuclei, vestibular nuclei, cerebellum, and around the third and forth ventricles [ 66,68 ] . Interestingly, there are con fl icting MRI fi ndings in patients with thiamine de fi ciency.…”

“…Treatment consists of intravenous thiamine supplementation, which may produce variable degrees of symptomatic improvement. However, some patients may continue to have chronic neurological impairment after therapy [ 66 ] . Care should be taken to initiate thiamine supplementation prior to administration of any intravenous fl uids containing dextrose.…”

Micronutrient-Related Neurologic Complications Following Bariatric Surgery

“…More than 30 case reports (>100 cases) and two reviews have been published regarding WE occurring after bariatric surgery [18,[26][27][28][29][30]. Cases have occurred as soon as 2 weeks and as long as 13 years after surgery and fatalities have been reported.…”