RESUMEN
Wernicke's encephalopathy (WE) is a severe brain disorder, first described in 1881, and is caused by a nutritional deficiency of thiamine (vitamin B1) found mostly in patients suffering from chronic alcoholism. In addition, WE can also complicate bariatric surgery if adequate vitamin supplementation is not insured. Without immediate treatment, the prognosis is poor and the mortality rate is high. Most patients present with atypical neurological symptoms, which hampers rapid diagnosis. We present a 40-year-old woman who underwent gastroplasty combined with gastric banding for severe obesity. She experienced repetitive vomiting and her diet was without vitamin supplementation. After three months she developed convergent strabismus, apathy and urinary incontinence, which was diagnosed as WE and treated as such. Six months later her recovery was incomplete, still showing gait difficulties and nystagmus. We aim to show that adequate vitamin supplementation in patients undergoing gastroplasty is necessary, especially considering the risk of permanent neurological deficits.
Asunto(s)
Gastroplastia/efectos adversos , Complicaciones Posoperatorias/tratamiento farmacológico , Náusea y Vómito Posoperatorios/complicaciones , Tiamina/uso terapéutico , Vitaminas/uso terapéutico , Encefalopatía de Wernicke/tratamiento farmacológico , Adulto , Atrofia , Electroencefalografía , Femenino , Trastornos Neurológicos de la Marcha/etiología , Humanos , Imagen por Resonancia Magnética , Examen Neurológico , Nistagmo Patológico/etiología , Obesidad/cirugía , Náusea y Vómito Posoperatorios/etiología , Encefalopatía de Wernicke/etiologíaRESUMEN
A patient with severe vomiting following gastric banding developed Wernicke's encephalopathy. All neurological disorders disappeared with thiamine treatment. This complication may be prevented by keen awareness, early diagnosis and treatment, in patients with persistent vomiting. Vitamin and mineral supplementation must be taken in patients following bariatric surgery.