Visual Loss Due to Wernicke Syndrome Following Gastric Bypass

Purpose: To report a case of Wernicke encephalopathy after gastric bypass surgery resulting in vision loss, ophthalmoplegia, and ataxia, all of which reversed with a single dose of IV thiamine. Methods: Observational case report. Results: A 34-year-old woman presented with decreased vision and inter...

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Bibliographic Details
Published in:Seminars in ophthalmology 2007, Vol.22 (1), p.13-19
Main Authors: Longmuir, Reid, Lee, Andrew G., Rouleau, Jacinthe
Format: Article
Language:English
Subjects:
Adult
Blindness - diagnosis
Blindness - etiology
Blindness - physiopathology
Diagnosis, Differential
Female
Gastric Bypass - adverse effects
Humans
Magnetic Resonance Imaging
Obesity, Morbid - complications
Obesity, Morbid - surgery
Postoperative Complications
thiamine
Visual Acuity
Visual Fields
visual loss
Wernicke encephalopathy
Wernicke Encephalopathy - complications
Wernicke Encephalopathy - diagnosis
Wernicke Encephalopathy - etiology
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Summary:Purpose: To report a case of Wernicke encephalopathy after gastric bypass surgery resulting in vision loss, ophthalmoplegia, and ataxia, all of which reversed with a single dose of IV thiamine. Methods: Observational case report. Results: A 34-year-old woman presented with decreased vision and intermittent diplopia after gastric bypass surgery. She was found to have bilateral limitation of horizontal gaze, decreased vision with bilateral central scotoma and mild disc edema OU. Her cranial magnetic resonance imaging (MRI) was normal. A presumptive diagnosis of Wernicke encephalopathy was made. The patient was admitted, and a single dose of IV thiamine reversed the ophthalmoplegia and vision loss within 24 hours. Conclusion: Wernicke encephalopathy should be considered in patients with vision loss after gastric bypass surgery. The classic triad of confusion, ataxia, and ophthalmoplegia may not be present and, although uncommon, the findings of optic disc edema and vision loss should not deter the clinician from making the diagnosis. Replacement thiamine if given promptly may rapidly reverse the findings.
ISSN:0882-0538
1744-5205
DOI:10.1080/08820530601182733