Prevalence and Clinico-Radiologic Spectrum of Intracranial Atherosclerotic Disease-Related Stroke: An Observation from a Single Center in Saudi Arabia.

BACKGROUND: Intracranial atherosclerotic disease (ICAD) is an important etiologic subtype of acute ischemic stroke (AIS). However, little direct evidence is available regarding ICAD-related stroke in Saudi Arabia (SA). This study aimed to identify the prevalence and describe the clinico-radiological spectrum of ICAD-related AIS in a SA cohort. METHODS: This was a hospital-based retrospective study enrolling patients with ICAD-related AIS between 2017 and 2020. The electronic charts were reviewed. The mechanisms of stroke were identified as artery-to-artery embolization (AAE), in situ thrombotic occlusion, hypoperfusion, or perforator branch occlusion. Pearson's χ 2 test was performed to calculate the P values to establish the statistical significance of factors that could correlate with the mechanisms of stroke and functional outcome. RESULTS: ICAD was found in 133 of AIS comprising 26% of total. Data from all patients were reviewed. Left ICA (25%) was the most frequently affected vessel. Territorial pattern (63.9%) was the most common infarct pattern, and AAE (44.3%) was the most common underlying mechanism. Perforator branch occlusion was more prevalent in women than in men. Malignant and hemorrhagic transformation ( P =0.00) were more prevalent in the AAE group. Left-sided vascular involvement was statistically associated with unfavorable outcomes than the right ( P =0.019). CONCLUSIONS: The prevalence of ICAD in our cohort from Western Asia did not differ from that in Southern Asia. ICA involvement was observed more frequently than previously reported. Further research from SA is required to better understand ICAD-related strokes in this region.

Therapeutic Dilemma of Wake-up Stroke: Clinical and Brain Imaging Characteristics and Reperfusion as a Treatment Option.

Objective: Wake-up stroke (WUS) comprises a significant proportion of ischemic strokes. However, due to unclear onset, these patients are often not considered for reperfusion therapy. The objective of this study was to investigate the clinical and imaging differences between WUS patients and those with clear-onset stroke, documenting any sex, age, or risk factor predilection for WUS.Methods: This prospective observational cohort study used an ongoing stroke registry to identify patients with acute ischemic stroke admitted to a hospital in Saudi Arabia within 5 days of symptom onset from April 2018 to March 2020. Patients were classified into 2 groups: WUS and clear-onset stroke.Results: Among 645 patients, 448 met the criteria for acute ischemic stroke and were included in the study. WUS was identified in 112 (25%) patients. There were no differences in sex or median age between the 2 groups. Diabetes mellitus, hypertension, and dyslipidemia were higher in the WUS group, while atrial fibrillation, history of stroke and epilepsy were higher in the clear-onset stroke group. Bihemispheric stroke was higher in the clear-onset stroke group than in the WUS group (6.0% vs 2.7%).Conclusions: Only minor dissimilarities between clinical and radiologic features of WUS and clear-onset stroke were found. Circadian patterns of stroke onset were observed in both groups. Stroke was more likely to occur during waking than during sleep, and a diurnal pattern of common occurrence during the morning was documented. Recognition of the acceptable timeframe for acute reperfusion therapy in unwitnessed strokes is crucial so that thrombolytic treatment can be started for these patients.

Thymectomy in Myasthenia Gravis: A Narrative Review.

Myasthenia gravis (MG) is a rare condition caused by autoantibodies against acetylcholine receptors on postsynaptic membrane that leads to weakness of skeletal muscles. About 7 of 10 patients with MG have thymic hyperplasia and about 1 of 10 patients have thymoma. Thymectomy has increasingly been used as a treatment modality for MG. Several observational studies have shown that thymectomy results in improvement in MG and a randomized trial has established that thymectomy leads to a better outcome in non-thymomatous generalized MG. However, thymectomy is yet controversial in some disease subtypes and there are potential concerns regarding the selection of the ideal surgical approach to achieve complete removal of the thymic tissue to achieve stable remission rates. This review highlights the role of thymectomy in non-thymomatous and thymomatous MG, the effectiveness of various thymectomy methods, postoperative myasthenic crisis, and remission after thymectomy.

Driving Habits Among Patients With Epilepsy in a Tertiary Care Hospital in Saudi Arabia.

Objective: Patients with epilepsy are instructed to avoid high-risk situations such as certain occupations and driving to prevent harm to themselves and others. There is considerable variation in standards to decide if a patient with epilepsy is fit to drive among various countries worldwide, and these patients often continue to drive despite being advised not to. The objective of this study was to determine if patients with epilepsy and uncontrolled epilepsy are driving, the awareness of epilepsy patients regarding driving, and whether physicians are advising the patients to stop driving.Methods: A clinic-based study was conducted in Saudi Arabia from June 2018 through January 2019 with structured interviews of consecutively recruited male patients with established epilepsy diagnosis. Demographic factors, employment status, control of seizures, and awareness of driving restrictions were documented.Results: The response rate was 80.6%. Of the 121 participants (mean age of 35.97 years), 110 (90.9%) were driving, and 39% of those patients were married. Also, 76.9% of participants were employed. Of the participants, 48.8% had 1 seizure in the last 6 months, and 88% of those patients were driving; 51.2% had not had a seizure in the last 6 months, and 93% of those patients were driving. Additionally, 17.4% reported a seizure attack while driving. Only 38% of respondents were aware they should stop driving, whereas 62% were unaware of driving restrictions.Conclusions: There is a definite need to establish a driving policy for patients with epilepsy and to optimize the standards of care of epilepsy patients in Saudi Arabia to ensure minimization of harm to both patients and the public.

Trends in Stroke Presentations before and during the COVID-19 Pandemic: A Meta-Analysis.

BACKGROUND AND PURPOSE: There are reports of decline in the rates of acute emergency presentations during coronavirus disease 2019 (COVID-19) pandemic including stroke. We performed a meta-analysis of the impact of COVID-19 pandemic on rates of stroke presentations and on rates of reperfusion therapy. METHODS: Following the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines, we systematically searched the literature for studies reporting changes in stroke presentations and treatment rates before and during the COVID-19 pandemic. Aggregated data were pooled using meta-analysis with random-effect models. RESULTS: We identified 37 observational studies (n=375,657). Pooled analysis showed decline in rates of all strokes (26.0%; 95% confidence interval [CI], 22.4 to 29.7) and its subtypes; ischemic (25.3%; 95% CI, 21.0 to 30.0), hemorrhagic (27.6%; 95% CI, 20.4 to 35.5), transient ischemic attacks (41.9%; 95% CI, 34.8 to 49.3), and stroke mimics (45.6%; 95% CI, 33.5 to 58.0) during months of pandemic compared with the pre-pandemic period. The decline was most evident for mild symptoms (40% mild vs. 25%-29% moderate/severe). Although rates of intravenous thrombolytic (IVT) and endovascular thrombectomy (EVT) decreased during pandemic, the likelihood of being treated with IVT and EVT did not differ between the two periods, both in primary and in comprehensive stroke centers (odds ratio [OR], 1.08; 95% CI, 0.94 to 1.24 and OR, 0.95; 95% CI, 0.83 to 1.09, respectively). CONCLUSIONS: Rates of all strokes types decreased significantly during pandemic. It is of paramount importance that general population should be educated to seek medical care immediately for stroke-like symptoms during COVID-19 pandemic. Whether delay in initiation of secondary prevention would affect eventual stroke outcomes in the long run needs further study.

Body mass index and its association with various features of migraine: A cross-sectional study from Saudi Arabia.

Introduction: Migraine is a highly prevalent condition, and prevalence of obesity is also increasing. Results of studies addressing association of body mass index (BMI) with migraine and its features are conflicting. In this cross-sectional study, we aim to assess association between BMI and various migraine features. Methods: This study was conducted in the Headache Clinic of King Fahd Hospital of University, Al Khobar, Saudi Arabia. Interviews were conducted by three consultant neurologists. Migraine was defined according to the International Headache Society and BMI was calculated as weight (kilograms)/height (m2). Results: Of total of 121 patients, 79% were female. Almost 87.6% of patients were taking prophylactic medications. Majority of patients had attack for more than 24 h (60.3%), pulsating character (81%), moderate-to-severe intensity (92.6%), associated with nausea and/or vomiting (75.2%), and photophobia/phonophobia (91.7%). About 29.8% of patients were normal weight, 28.1% were overweight, and 39.7% were obese and morbidly obese. There was insignificant association between various categories of BMI and features of migraine, that is, unilateral location (P = 0.385), pulsating character (P = 0.571), moderate-to-severe intensity (P = 0.187), nausea and/or vomiting (P = 0.582), and photophobia and/or phonophobia (P = 0.444). Conclusion: In our study, we did not find an association between BMI and various features of migraine.

RésuméIntroduction: La migraine est une maladie très répandue, et la prévalence de l'obésité est également en augmentation. Résultats des études portant sur l'association de l'indice de masse corporelle (IMC) avec la migraine et ses caractéristiques sont contradictoires. Dans cette étude transversale, nous visons à évaluer l'association entre IMC et diverses caractéristiques de la migraine. Méthodes: Cette étude a été menée à la Headache Clinic de l'hôpital King Fahd de l'Université, Al Khobar, Arabie Saoudite. Les entretiens ont été menés par trois neurologues consultants. La migraine a été définie selon l'International La Headache Society et l'IMC ont été calculés en poids (kilogrammes)/taille (m2). Résultats: Sur un total de 121 patients, 79 % étaient des femmes. Presque 87,6 % des patients prenaient des médicaments prophylactiques. La majorité des patients ont eu une attaque pendant plus de 24h (60,3%), caractère pulsatile (81%), intensité modérée à sévère (92,6 %), associée à des nausées et/ou vomissements (75,2 %) et photophobie/phonophobie (91,7 %). Environ 29,8 % des les patients avaient un poids normal, 28,1 % étaient en surpoids et 39,7 % étaient obèses et obèses morbides. Il y avait une association insignifiante entre diverses catégories d'IMC et caractéristiques de la migraine, c'est-à-dire localisation unilatérale (P = 0,385), caractère pulsatile (P = 0,571), modéré à sévère intensité (P = 0,187), nausées et/ou vomissements (P = 0,582) et photophobie et/ou phonophobie (P = 0,444). Conclusion: Dans notre étude, nous n'ont pas trouvé d'association entre l'IMC et diverses caractéristiques de la migraine. Mots-clés: Indice de masse corporelle, fréquence, migraine, obésité, gravité.

An Observational Study Comparing the Safety and Efficacy of Conventional Anticoagulation Versus New Oral Anticoagulants in the Management of Cerebral Venous Sinus Thrombosis.

Objective: To compare the safety and efficacy of conventional anticoagulants with new oral anticoagulants (NOACs) for management of cerebral venous sinus thrombosis (CVST).Methods: This was a retrospective, prospective cohort study of patients who presented with CVST to a tertiary stroke center in the Middle East from January 2012 to October 2019. Patients with a diagnosis of CVST were identified, and data were analyzed for demographic characteristics. Specific consideration was given to compare the efficacy and safety of different anticoagulation treatments.Results: A total of 36 patients were included in the final analysis, with 15 (41%) men and 21 (59%) women and a male to female ratio of 1:1.4. Most of the patients (n = 22, 61%) were Saudi. Their ages ranged between 15 and 82 years (mean ± SD age of 34.22 ± 13.16 years). Headache was the most common feature, present in 22 (61%) of the patients, followed by unilateral weakness in 15 (41%) and cranial nerve palsies in 11 (30%). The most common etiology was prothrombotic state (both hereditary and acquired thrombophilia: n = 16, 45%). Other etiologies were postpartum state/oral contraceptive pill usage in 7 (19%), infections in 7 (19%), and trauma in 3 (8%). Most of the patients (n = 24, 67%) still received conventional anticoagulation (warfarin/low molecular weight heparin), but 9 (25%) of the patients consented to start NOACs. Efficacy (as measured by clinical improvement plus rate of recanalization of previously thrombosed venous sinuses) showed no statistically significant difference, although it proved to be better tolerated, as none of the patients stopped the treatment due to adverse events and risk of major bleeding was significantly low in the NOAC group. Nine patients in the warfarin group stopped medication, while none in the NOAC group did so (P = .034).Conclusion: NOACs were found to be at least as good as conventional anticoagulation for the management of CVST. However, efficacy was almost similar, a finding that is consistent with most of the published case series and the few recently published prospective studies. Larger prospective and population-based studies are needed to clarify our preliminary results.

Hypertensive Intracerebral Hemorrhage in Young Patients From a Tertiary Care Center in Saudi Arabia: An Observational Study.

Objective: Young patients with intracerebral hemorrhage (ICH) make up a small but important subgroup of patients with ICH. This study investigated the clinical characteristics and outcomes of hypertensive ICH in very young (18-45 years) and young (46-55 years) patients.Methods: This was a retrospective study of patients aged 18-55 years with hypertensive ICH admitted to a hospital from April 2014 to April 2019. Clinical and radiologic features as well as long-term clinical outcomes were compared between 2 age groups: group 1 (18-45 years) and group 2 (46-55 years). Factors affecting the clinical outcome were investigated as well.Results: Of 63 patients with hypertensive ICH, 24 (38.1%) were in group 1 (mean ± SD age of 38 ± 4.6 years), and 39 (61.9%) were in group 2 (50 ± 2.5 years). The risk factor profile was similar except for diabetes, which was more prevalent in group 1 (odds ratio [OR] = 4.65; 95% CI, 1.4-15.2). Patients in group 1 had higher mean ± SD NIH Stroke Scale scores (15.7 ± 4.6, P = .044), had lower Glasgow Coma Scale (GCS) scores (OR = 3.33; 95% CI, 1.0-10.8), were at higher risk of intubation (OR = 2.79; 95% CI, 1.1-9.9), and had higher ICH volume (21 ± 18, P = .034). Worse clinical outcome was higher in group 1 (OR = 5.14; 95% CI, 1.0-26.1). Low GCS score, mean hematoma volume, and intraventricular extension were independently associated with worse outcome.Conclusions: Relatively young patients with hypertensive ICH have higher prevalence of diabetes and worse clinical outcome in comparison to older patients with hypertensive ICH. Such patients should be monitored and treated more aggressively.

Contrast-Induced Transient Neurological Symptoms Following Percutaneous Coronary Intervention: A Case Report.

BACKGROUND Transient neurological symptoms after a percutaneous coronary intervention (PCI) are not uncommon manifestations. In clinical practice, the development of these symptoms might be a warning sign for PCI-related ischemic or hemorrhagic stroke. However, there is a reported risk of contrast-induced neurological injury (CINI) after PCI, which results in a broad spectrum of transient and benign neurological symptoms. Advanced age, renal disease, diabetes, hypertension, and brain parenchymal lesions are risk factors for CINI. CASE REPORT A 78-year-old man with diabetes and impaired renal function developed left-sided hemiparesis and dysarthria within one hour of PCI. Non-contrast CT head showed hyperdense lesions in both frontal lobes, while the susceptibility-weighted sequence of magnetic resonance imaging (SWI-MRI) excludes hemorrhage. Hemodialysis had to be started for fast contrast clearance, and he had recovered completely within 24 hours. CONCLUSIONS This case demonstrates that CINI is an important differential diagnosis that cardiologists and neurologists must be familiar with, especially for high-risk patients. The prognosis is good; whether an appropriate contrast's dose or type for PCI or a need for early hemodialysis to avoid CINI in those patients is unclear.

Paraparetic Variant of Guillain-Barré Syndrome in First 24 Hours of Postpartum Period: A case report.

Guillain-Barré syndrome (GBS) is a heterogeneous disorder with a diverse clinical presentation ranging from weakness of certain body regions to tetraparesis with autonomic dysfunction and respiratory failure. Paraparetic GBS is a variant of GBS which is characterised by weakness limited to the lower limbs only. It is crucial to identify such topographical presentations, as a delay in diagnosis can lead to delayed initiation of specific treatment, which can negatively impact the outcome. We report a 29-year-old female patient who presented to the King Fahd Hospital of the University, Al Khobar, Saudi Arabia, in 2017 with rapid onset asymmetrical weakness of lower extremities associated with bladder dysfunction during the immediate postpartum period. The weakness spared cranial nerves and arms and imaging studies of the spine was unremarkable. Cerebrospinal fluid investigations showed cyto-albuminologic dissociation and nerve conduction studies showed features of demyelination. The patient was diagnosed with a paraparetic variant of GBS and treated with intravenous immunoglobulin. She had almost recovered completely at the two-month follow-up.

Timing to start anticoagulants after acute ischemic stroke with non-valvular atrial fibrillation.

OBJECTIVE: To identify timing for initiation of anticoagulation therapy in acute ischemic stroke (AIS) with non-valvular AF as regards safety and efficacy by detecting the rate of intracranial haemorrhage (ICH) and recurrent ischemic symptoms (RIS) during follow-up. METHODS: This is a prospective observational cohort study conducted at King Fahd Hospital of the University including 120 patients with AIS/TIAs from July 2016 till July 2018. We compared patients who received anticoagulants 1-6 days (Group I (45.83%), 7-14 days, Group II (35%), and > 14 days after the ischemic event (Group III (19.17%). Follow-up was at least 3 months and included identifying ICH or RIS. RESULT: ICH has occurred in 26.67% (n = 32) patients with a highly statistically significant association with time of treatment (P-value = .01) being higher in group I (n = 17) compared to only 1 case in group III. Subgroup analyses on the ICH patients (n = 32) has revealed statistical significant association with higher NIHSS score (P = .001). Also, the type of anticoagulants used between three groups pointed to an association existence (p = .02), however, the direction of this association cannot be determined. There was no statistical significant association between RIS (occurred in 4.16% (n = 5) with time of treatment (P = .754). Functional outcome at 3-6 months measured by mRS did not differ between 3 groups (worst mRS in group I). CONCLUSION: Early initiation of anticoagulation after stroke, especially in cases of large infarction, is associated with significant risk of ICH. This risk is highest with warfarin and lowest with DOAC.

Etiologic and Clinical Features of Cerebral Venous Sinus Thrombosis in Saudi Arabia.

OBJECTIVE: Our study aims to evaluate the etiologic and clinical features of cerebral venous sinus thrombosis (CVST) in Saudi Arabia, and secondarily whether gender plays a role in CVST. MATERIALS AND METHODS: Data were collected retrospectively from the stroke registry during the period from January 2008 to April 2018, and the patients with the diagnosis of CVST were identified, and data were analyzed for any gender-specific differences in clinical presentation and etiology of cerebral venous thrombosis. RESULTS: There were 15 females while 11 males with a female:male ratio of 1.4:1. The mean age was 29.4± standard deviation 8.9 with the age range of 15-49. Headache was the most common and usually the first presenting symptoms present in 65% followed by hemiparesis and cranial nerve palsies. The first neurological examination was normal in 9/26 (34.6%) of the patients, while the common abnormality was cranial nerve palsies. Infections and trauma played an important part in risk factor analysis of our patient after the pregnancy- and hormone-related conditions. Some significant differences between the clinical presentation and risk factors among males and females were noted as age at presentation was higher in females while trauma and infections were common in male patients, although the involvement of the sinuses and response to treatment did not prove to be statistically significant. CONCLUSION: The results of this study were similar to the available literature with few differences. The relatively higher proportion of males in our study can be explained partly with more cases of traumatic CVST. Some important differences were noted between the risk factors and clinical presentation among genders. Large-scale prospective studies are needed to further clarify these differences.

Electrophysiologic severity of carpal tunnel syndrome in diabetic patients of the Saudi population.

OBJECTIVE: To study the frequency of multiple vascular risk factors and electrophysiological severity of carpal tunnel syndrome (CTS) in Saudi diabetic patients. METHODS: This retrospective cross-sectional study was conducted in Neurology Department, King Fahd Hospital of University, Al-Khobar, Kingdom of Saudi Arabia from April 2017 to March 2018 and included 200 patients with CTS. Body parameters, such as blood pressure (BP), weight, height, and body mass index (BMI), along with laboratory and median nerve electrophysiological parameters, of diabetic and non-diabetic patients were compared, and a p-value<0.05 was considered significant. RESULTS: Frequency of hypertension (HTN) and obesity was significantly higher in diabetic patients (p<0.05). Mean median nerve sensory amplitude (MNSA) was lower in diabetic patients (p<0.05).Non-recordable nerves, as well as bilateral and extremely severe CTS (p<0.05), were more frequently seen in diabetic patients. Age, BMI, systolic BP, low serum high density lipoprotein (HDL), high triglycerides, high fasting blood sugar, and high glycated hemoglobin (Hba1c) levels, known to affect the electrophysiological severity of CTS, had a statistically significant association with diabetes. CONCLUSION: Diabetes mellitus (DM) and obesity are the most commonly identified risk factors of CTS. Dyslipidemia, HTN and obesity are more frequently seen in diabetic patients with CTS. These concurrent risk factors are confounding the electrophysiological severity of CTS in these patients. Further larger-scale studies with the control of confounding factors are recommended.

Neurobehcet with cerebral aneurysm.

Neuro-behcets disease (NBD) is an uncommon, serious presentation of behcets disease (BD) causing long-term morbidity and mortality. Cerebral aneurysms are rare in BD, with only a handful of cases reported worldwide. A 39-year-old female experienced slurring of speech, numbness, and reduced sensation in the left face, arm, and leg 90 minutes prior to presentation. She provided a history of recurrent oral and genital ulcers associated with intermittent joints pain and blurring of vision. erythrocyte sedimentation rate was elevated, but all other autoimmune workup was negative. Neuro-behcets disease was diagnosed. Brain magnetic resonance imaging demonstrated acute right periventricular infarction. Magnetic resonance angiogram revealed M1 segment stenosis and right internal carotid artery saccular aneurysm. Catheter angiography confirmed its presence measuring 4.8 mm X 6.1 mm. She was stabilized after coiling of the aneurysm and was started on medical therapy. Brain imaging should be carried out in young patients with BD presenting with an ischemic event, and intervention may be lifesaving.

Epidemiological study of epilepsy from a tertiary care hospital in kingdom of Saudi Arabia.

OBJECTIVE: To identify the types of seizures and describe the clinical features, EEG and radiological findings among patients with epilepsy. METHODS: In this retrospective epidemiological study, we analyzed the medical records of the patients with the diagnosis of epilepsy during the study period (January 1st 2016- December 2016) RESULTS: The study included 184 patients, 91 (49.5%) were males and 93 (50.5%) females. Age ranged between 12 and 85 years (mean 35.4+/-19.5 SD years). Most of the patients 150 (82%) had Generalized tonic clonic seizures followed by focal onset in 27 (14%) of the patients. Main EEG abnormality was focal to bilateral was recorded in 53 (41%), idiopathic/ cryptogenic epilepsy was diagnosed in 61% of the patients. The most common abnormalities on brain imaging were temporal/hippocampal atrophy/stroke. The most common cause of symptomatic epilepsy was stroke found in 20(11%) followed by post infectious epilepsy and head trauma. CONCLUSION: Seizure types, EEG characteristics and etiologies of symptomatic epilepsy in our cohort of patients are in accordance with the current literature. Slight discrepancy observed in gender distribution and etiologies for symptomatic epilepsy compared with other studies from Saudi Arabia need to be studied further by prospective and population base studies.

Bilateral Moyamoya Disease in a 2-Year-Old Pakistani Male Treated with Bilateral Encephaloduroarteriosynangiosis: A Positive Outcome.

Background. We present a rare case of bilateral moyamoya disease presenting as multiple strokes and neurological deficits, treated with the neurosurgical procedure, encephaloduroarteriosynangiosis (EDAS), in a 2-year-old male Pakistani minor. A positive outcome was achieved and the patient recovered fully. Case Summary. Our patient presented with a history of seizures and multiple episodes of hemiparesis (on and off weakness) at the age of 2 years. He had a delayed speech development and could not speak more than a few words. He had a slight slurring of speech too. He was diagnosed with bilateral moyamoya disease on Computed Tomography Angiography (CTA). Bilateral EDAS was done in the same year, after which his symptoms improved and patient had moderate functional recovery. Conclusion. A rare disease, moyamoya has been left unexplored in Pakistan; physicians and surgeons when dealing with cases in the pediatric population presenting with symptoms of stroke, signs of generalized weakness, and seizures should consider moyamoya disease as a possibility. Furthermore, this case demonstrates the effectiveness of EDAS procedure for the treatment of moyamoya disease.

Guillain-Barré syndrome (demyelinating) six weeks after bariatric surgery: A case report and literature review.

Obesity is a major health problem worldwide. Bariatric surgery has been increasingly used to manage obesity. Many acute as well as chronic neurological complications have been reported after bariatric surgery including Guillain-Barré syndrome (GBS). An autoimmune process has been postulated as the underlying pathophysiology. Most of the reported cases of GBS after bariatric surgery are of the axonal variety. Here, we report a case of a demyelinating variety of GBS in a young woman who presented with acute onset of progressive weakness and paresthesia of all limbs within six weeks after bariatric surgery. She was treated with intravenous immunoglobulin (IVIG) and rehabilitation. She had complete recovery on follow-up. We believe that onset of acute inflammatory demyelinating polyradiculoneuropathy (AIDP), which is demyelinating variety of GBS, is associated with changes in immune system after bariatric surgery.