RESUMEN
Bariatric surgical procedures are increasingly common. In this review, we characterize the neurologic complications of such procedures, including their mechanisms, frequency, and prognosis. Literature review yielded 50 case reports of 96 patients with neurologic symptoms after bariatric procedures. The most common presentations were peripheral neuropathy in 60 (62%) and encephalopathy in 30 (31%). Among the 60 patients with peripheral neuropathy, 40 (67%) had a polyneuropathy and 18 (30%) had mononeuropathies, which included 17 (94%) with meralgia paresthetica and 1 with foot drop. Neurologic emergencies including Wernicke's encephalopathy, rhabdomyolysis, and Guillain-Barré syndrome were also reported. In 18 surgical series reported between 1976 and 2004, 133 of 9996 patients (1.3%) were recognized to have neurologic complications (range: 0.08-16%). The only prospective study reported a neurologic complication rate of 4.6%, and a controlled retrospective study identified 16% of patients with peripheral neuropathy. There is evidence to suggest a role for inflammation or an immunologic mechanism in neuropathy after gastric bypass. Micronutrient deficiencies following gastric bypass were evaluated in 957 patients in 8 reports. A total of 236 (25%) had vitamin B(12) deficiency and 11 (1%) had thiamine deficiency. Routine monitoring of micronutrient levels and prompt recognition of neurological complications can reduce morbidity associated with these procedures.
Asunto(s)
Cirugía Bariátrica/efectos adversos , Síndromes de Malabsorción/complicaciones , Enfermedades del Sistema Nervioso/etiología , Obesidad/cirugía , Encefalopatías Metabólicas/epidemiología , Encefalopatías Metabólicas/etiología , Encefalopatías Metabólicas/fisiopatología , Femenino , Humanos , Absorción Intestinal , Síndrome de Korsakoff/epidemiología , Síndrome de Korsakoff/etiología , Síndrome de Korsakoff/fisiopatología , Síndromes de Malabsorción/tratamiento farmacológico , Síndromes de Malabsorción/fisiopatología , Masculino , Micronutrientes/deficiencia , Micronutrientes/farmacología , Micronutrientes/uso terapéutico , Enfermedades del Sistema Nervioso/fisiopatología , Obesidad/fisiopatología , Enfermedades del Nervio Óptico/epidemiología , Enfermedades del Nervio Óptico/etiología , Enfermedades del Nervio Óptico/fisiopatología , Enfermedades del Sistema Nervioso Periférico/epidemiología , Enfermedades del Sistema Nervioso Periférico/etiología , Enfermedades del Sistema Nervioso Periférico/fisiopatología , Deficiencia de Vitamina B/complicaciones , Deficiencia de Vitamina B/tratamiento farmacológico , Deficiencia de Vitamina B/fisiopatologíaRESUMEN
Vagus nerve stimulation (VNS) is an important therapeutic option for individuals with refractory epilepsy who have failed multiple antiepileptic drugs (AEDs). The intricate relationship of the vagus nerve to cardiac function raises concern that vagal stimulation may affect cardiac rhythm and function. Previous pre- and postmarketing studies have not shown this to be a significant problem, with the incidence of bradyarrhythmias reported to be about 0.1%. We review three cases of ventricular asystole with complete heart block that occurred during intraoperative lead tests. The purpose of these case reports is to identify the specific type of cardiac abnormality associated with vagus nerve stimulation and to identify individuals at risk.