Wernicke's syndrome after bariatric surgery

Two young females with severe morbid obesity presented with Wernicke's synd rome after Roux-en-Y gastro-jejunum bypass had been performed. The first pa tient had recurrent vomiting and dyplopia two months post-surgery. Physical examination indicated bilateral ophthalmoparesia with conserved convergenc e and ataxia. The second patient had frequent vomiting episodes over the pr evious three months together with lower limb hypotonia, myoclonia and gener alised tonicoclonic seizures on two occasions within one year of surgery. I n both cases routine blood test, ion levels (sodium, potassium, calcium, ph osphates), electroencephalogram and CT scan were normal. Thiamine therapy w as instigated on the basis of clinical intuition and the first patient achi eved complete remission within 24 hours while the second improved gradually in that two years later only mild lower limb hypotonia and a slight cognit ive deficit remains. Erythrocyte transketolase activity determinations were abnormal on two separate occasions for this second patient. Vitamin B1 det erminations were not available for the first patient. In conclusion, the re striction in energy intake and the persistent vomiting together with malabs orption induced by the surgical intervention could explain the vitamin defi ciency causing Wernicke's encephalopathy. This indicates a need for close m onitoring and systematic vitamin supplementation in those patients who unde rgo bariatric surgery. (C) 2000 Harcourt Publishers Ltd.