Disability After Weight Loss Surgery

Dec. 28, 2005 - After gastric-bypass surgery, a 35-year-old woman lost a lot more than weight.

She ended up back in the hospital, barely conscious and with weakness of all four limbs. A vitamin deficiency had affected her brain and nervous system.

Because of appetite loss, nausea, and vomiting after surgery, the woman got too little vitamin B-1, or thiamine. That led to a severe deficiency and a hard-to-recognize syndrome called Wernicke encephalopathy. It's the same kind of condition that can be seen in long-time alcoholics, and it can lead to permanent disability.

"A high index of suspicion for Wernicke encephalopathy is required in surgically treated obese patients," warn Raul Mandler, MD, and colleagues at George Washington University School of Medicine.

The case, reported in the Dec. 27 issue of Neurology, stands as a warning for doctors -- and patients -- to be on the lookout for signs of nervous system complications after weight loss surgery. This is particularly common in patients who can't stop vomiting after surgery, notes University of Rochester neurologist Heidi Schwarz, MD, in an editorial accompanying the report.

Vitamin B-1 is found in foods such as pork, legumes, grains, breads, and cereals. It is absorbed through the small intestine.

Difficult to Diagnose

Wernicke encephalopathy has three classic symptoms: abnormal eye movement, mental confusion, and inability to coordinate muscle movements. But only one in five patients actually has all three symptoms.

In the case of the bariatric surgery patient, there was the unusual symptom of progressive hearing loss. Twelve weeks after surgery, she was confused, had difficulty walking, and was very weak. She suffered further decline by the time doctors figured out the problem and gave her intravenous doses of B-1.