You are here

Article Text

Article menu
Download PDFPDF
Neurology
Atypical presentation of Wernicke encephalopathy due to thiamine deficiency in a patient post sleeve gastrectomy
  1. Keith Scharf1,
  2. Janet Tang2,
  3. Selene Jamall3 and
  4. Nancy Baker4
  1. 1 Surgery, Loma Linda University School of Medicine, Loma Linda, California, USA
  2. 2 School of Medicine, Loma Linda University School of Medicine, Loma Linda, California, USA
  3. 3 Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
  4. 4 Neurology, Loma Linda University School of Medicine, Loma Linda, California, USA
  1. Correspondence to Dr Nancy Baker; NANBaker{at}llu.edu

Abstract

We present a case of a woman in her 20s who presented to the emergency department with a 1-month history of blurry vision, lower extremity weakness in both legs and progressive numbness involving the feet and anterior chest. On admission, the patient was unable to ambulate. She was 3 months status post laparoscopic vertical sleeve gastrectomy for weight loss and using transdermal vitamin patches for nutritional supplementation. Laboratory values revealed low levels of vitamin B1, vitamin A, vitamin D, folic acid and copper levels. The patient was diagnosed with Wernicke encephalopathy and possible peripheral neuropathy secondary to thiamine deficiency. She was started on intravenous thiamine 500 mg three times a day and folate 1 mg one time a day for 3 days and then transitioned to oral thiamine 500 mg along with a multivitamin tablet. Improvement in ophthalmoplegia, weakness, sensation and cognition was noticed after initiating treatment.

  • General surgery
  • Neuroimaging
  • Vitamins and supplements
  • General practice / family medicine

https://doi.org/10.1136/bcr-2024-261292

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Contributors The following authors were responsible for drafting the text, sourcing and editing clinical images, investigating results, drawing original diagrams and algorithms and critical revision for important intellectual content: KS, JT, SJ and NB. KS and JT contributed equally to this paper (joint first authorship). KS, JT and NB contributed to conception and design and drafting and revising the article. SJ contributed to drafting and revising the manuscript. The following authors gave final approval of the manuscript: JT, KS, SJ and NB.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.