Wernicke encephalopathy after subtotal gastrectomy for morbid obesity

• Published in: Revue neurologique 2008-05, Vol.164 (5), p.463
• Main Authors: Gabaudan, C, La-Folie, T, Sagui, E, Soulier, B, Dion, A-M, Richez, P, Brosset, C
• Format: Article
• Language: fre
• Subjects: Adult; Brain - pathology; Gastrectomy - adverse effects; Humans; Korsakoff Syndrome - complications; Korsakoff Syndrome - psychology; Magnetic Resonance Imaging; Male; Obesity, Morbid - complications; Obesity, Morbid - surgery; Thiamine - therapeutic use; Vitamins - therapeutic use; Vomiting - etiology; Wernicke Encephalopathy - etiology; Wernicke Encephalopathy - pathology
• ISSN: 0035-3787
• DOI: 10.1016/j.neurol.2008.01.006

Wernicke's encephalopathy (WE) is one of the potential complications of obesity surgery. It is an acute neuropsychiatric syndrome resulting from thiamine deficiency often associated with repeated vomiting. The classic triad is frequently reported in these patients (optic neuropathy, ataxia and confusion), associated with uncommon features. Cerebral impairment affects the dorsal medial nucleus of the thalamus and the periaqueductal grey area, appearing on MRI, as hyperintense signals on T2, Flair and Diffusion weighted imaging. Early diagnosis and parenteral thiamine are required to decrease morbidity and mortality. We report a case of WE and Korsakoff's syndrome in a young obese patient after subtotal gastrectomy, who still has substantial sequelae. The contribution of MRI with diffusion-weighted imaging is illustrated. The interest of nutritional supervision in the first weeks and preventive thiamine supplementation in case of repeated vomiting are of particular importance in these risky situations.