Wernicke's encephalopathy in an adolescent following bariatric surgery

Abstract

Bariatric surgery is a common and effective treatment modality for morbid obesity worldwide. In the pediatric population, the most commonly performed procedure is the sleeve gastrectomy (SG), and it is considered a restrictive operation, limiting the amount of food a person can tolerate. Its popularity in children lies in its efficacy and low-risk profile. However, side-effects and risks still exist and must be monitored for carefully. Here, we present a case of a 16-year-old female who presented with a chief complaint of paraparesis and confused mental state following a gastric sleeve procedure for obesity a few months prior. MRI of the head demonstrated hyperintensities in dorsomedial parts of her bilateral thalami, mamillary bodies, periaqeductal grey matter, and inferior aspect of the tectal plate, thereby confirming the diagnosis of Wernicke's encephalopathy (WE). There have been only two previous reports of WE following SG in a pediatric patient that have been reported in the literature. We suggest that the mechanism for her thiamine deficiency was secondary to a preexisting subclinical deficiency that became clinically significant secondary to the food restriction imposed by her SG procedure. Pediatric patients who receive a SG procedure should be evaluated for preexisting Thiamine deficiency, started on supplementation at adequate doses and observed for the development of overt deficiency that can potentially result in WE. We recommend using MRI to support the clinical diagnosis due to difficulty in obtaining immediate results from laboratory tests for Vitamin B1 levels. Our review suggests that Hispanic ethnicity and female sex increase the risk of Wernicke's encephalopathy after bariatric surgery.

Keywords

• Wernicke's encephalopathy
• Thiamine deficiency
• Bariatric surgery