Wernicke encephalopathy after obesity surgery

A systematic review

Sonal Singh, Abhay Kumar

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: To characterize the clinical features, risk factors, radiographic findings, and prognosis of Wernicke encephalopathy after bariatric surgery. METHODS: We performed a systematic review of MEDLINE, Embase, Ovid, ISI (Science Citation Index), and Google Scholar for case reports, case series, or cohort studies of Wernicke encephalopathy after bariatric surgery. RESULTS: We found 32 cases (27 of whom were women) reported, from 2 weeks to 18 months after the procedure. Most patients had vomiting as a risk factor (n = 25) and presented with the triad of Wernicke encephalopathy (confusion, ataxia, and nystagmus; n = 21). Optic neuropathy, papilledema, deafness, seizures, asterixis, weakness, and sensory and motor neuropathy were also reported. Characteristic radiographic findings were hyperintense signals in the periaqueductal gray area and dorsal medial nucleus of the thalamus; radiographs were normal in 15 patients. One series from Brazil reported 4 patients (among 50 patients) with Wernicke encephalopathy; all presented with vomiting and concomitant peripheral neuropathy at a median of 2.5 months (1.5 to 3 months) after bariatric surgery. Another series identified 2 of 23 patients (both women) with Wernicke encephalopathy after bariatric surgery. CONCLUSION: Wernicke encephalopathy after bariatric surgery usually occurs between 4 and 12 weeks postoperatively, especially in young women with vomiting. Atypical neurologic features are common. The diagnosis is mainly clinical, because radiographic findings are normal in some patients. Prospective studies to determine the prevalence of this problem and protocols for preventive thiamine supplementation need evaluation.

Original languageEnglish (US)
Pages (from-to)807-811
Number of pages5
JournalNeurology
Volume68
Issue number11
DOIs
StatePublished - Mar 2007

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Wernicke Encephalopathy
Bariatric Surgery
Obesity
Vomiting
Mediodorsal Thalamic Nucleus
Confusion
Periaqueductal Gray
Optic Nerve Diseases
Papilledema
Thiamine
Dyskinesias
Peripheral Nervous System Diseases
Deafness
Ataxia
Thalamus
MEDLINE
Nervous System
Brazil
Seizures
Cohort Studies

ASJC Scopus subject areas

  • Neuroscience(all)

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Wernicke encephalopathy after obesity surgery : A systematic review. / Singh, Sonal; Kumar, Abhay.

In: Neurology, Vol. 68, No. 11, 03.2007, p. 807-811.

Research output: Contribution to journalArticle

Singh, Sonal ; Kumar, Abhay. / Wernicke encephalopathy after obesity surgery : A systematic review. In: Neurology. 2007 ; Vol. 68, No. 11. pp. 807-811.
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