(Kiosk 6) Wernicke-korsakoff Syndrome Following Sleeve Gastrectomy

Case Diagnosis: A 16-year old girl with a history of asthma, diagnosed with Wernicke-Korsakoff Syndrome following a sleeve gastrectomy.

Case Description or Program Description: The patient presented to the emergency department with acute onset generalized weakness 3 months after a cosmetic sleeve gastrectomy in Mexico. She did not undergo pre-operative screening or education. Post-operatively, she reported vomiting and poor oral intake. She took Biotin, B12, and iron supplements but received no follow up. Neurologic exam revealed nystagmus, and labs showed thiamine deficiency. MRI demonstrated hyperintensities involving bilateral medial thalami, the periaqueductal grey, and bilateral mammillary bodies, consistent with Wernicke’s Encephalopathy. She completed a course of intravenous thiamine and was transferred to acute inpatient rehabilitation on oral supplementation.

Setting: Acute Inpatient Rehabilitation

Assessment/Results: The patient showed inattention, poor motivation, and short-term memory deficits during therapy. She was diagnosed with Wernicke-Korsakoff Syndrome on neuropsychological assessment. During her rehabilitation course, she made significant improvements in strength and activities of daily living. However, she had persistent cognitive deficits that limited her progress.

Discussion (relevance): Wernicke’s encephalopathy is an uncommon complication of gastric sleeve procedures, developing within 6 months due to thiamine deficiency. Although B12 absorption in the small intestine is preserved, patients may develop thiamine deficiency through vomiting and poor oral intake. Typical symptoms include ataxia, nystagmus, and diplopia. Many patients make a full recovery following thiamine supplementation. Here, we describe a progression from Wernicke’s Encephalopathy to Wernicke Korsakoff syndrome in the setting of poor follow up. Therapy interventions were beneficial for the patient. However, she suffered long term impairment.

Conclusions: Wernicke Korsakoff Syndrome is a permanent neurological condition that can significantly impair quality of life and functional status. With new guidelines recommending bariatric surgeries at an earlier age, it is important to ensure adequate follow up and education on nutritional supplementation and to recognize the symptoms of thiamine deficiency post-operatively.