RESUMO
BACKGROUND: The number of bariatric procedures is rapidly growing as the prevalence of obesity in the USA is increasing. Such procedures are not without complications, and those affecting the nervous system are often disabling and irreversible. We now describe our experience with these complications and review the pertinent literature. METHODS: We describe 26 patients with major neurologic conditions that seemed causally related to bariatric surgery encountered in the neurology service of a tertiary referral university medical center over a decade. RESULTS: The neurologic complications affected most regions of the nervous system: encephalopathy, optic neuropathy, myelopathy, polyradiculoneuropathy, and polyneuropathy. Myelopathy was the most frequent and disabling problem; symptoms began about a decade after surgery. Encephalopathy and polyradiculoneuropathy were acute and early complications. Except for vitamin B(12) and copper deficiencies in patients with myelopathy, we could not correlate specific nutritional deficiencies to the neurologic complications. All patients had multiple nutritional deficiencies, but their correction did not often yield dramatic results. The best result was achieved in one patient after surgical revision to reduce the bypassed jejunum. CONCLUSIONS: A wide spectrum of serious neurologic conditions may follow bariatric surgery. These complications may occur acutely or decades later.
Assuntos
Deficiência de Vitaminas/complicações , Encefalopatias Metabólicas/etiologia , Derivação Gástrica/efeitos adversos , Doenças Neurodegenerativas/etiologia , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/etiologia , Adulto , Deficiência de Vitaminas/patologia , Deficiência de Vitaminas/fisiopatologia , Encéfalo/metabolismo , Encéfalo/patologia , Encéfalo/fisiopatologia , Encefalopatias Metabólicas/patologia , Encefalopatias Metabólicas/fisiopatologia , Cobre/deficiência , Suplementos Nutricionais/normas , Feminino , Derivação Gástrica/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Neurodegenerativas/patologia , Doenças Neurodegenerativas/fisiopatologia , Obesidade Mórbida/fisiopatologia , Nervos Periféricos/metabolismo , Nervos Periféricos/patologia , Nervos Periféricos/fisiopatologia , Doenças do Sistema Nervoso Periférico/etiologia , Doenças do Sistema Nervoso Periférico/patologia , Doenças do Sistema Nervoso Periférico/fisiopatologia , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/fisiopatologia , Reoperação , Medula Espinal/metabolismo , Medula Espinal/patologia , Medula Espinal/fisiopatologia , Doenças da Medula Espinal/etiologia , Doenças da Medula Espinal/patologia , Doenças da Medula Espinal/fisiopatologia , Deficiência de Tiamina/etiologia , Deficiência de Tiamina/fisiopatologia , Deficiência de Vitamina B 12/etiologia , Deficiência de Vitamina B 12/fisiopatologia , Encefalopatia de Wernicke/etiologia , Encefalopatia de Wernicke/patologia , Encefalopatia de Wernicke/fisiopatologiaRESUMO
A 23-year-old patient developed diffuse paresthesias and sensory loss. He had mildly reduced serum vitamin B12 (B12) concentration with unusually high levels of methylmalonic acid (MMA) and homocysteine and no evidence of B12 malabsorption. Following parenteral B12 administration, his neurological deficit promptly resolved and B12 and MMA levels normalized, but elevated levels of homocysteine persisted. One year later, he admitted to inhaling nitrous oxide (N2O). After halting N2O abuse his homocysteine level normalized. This case demonstrates the importance of serum homocysteine level measurements in cases of suspected N2O toxicity [corrected].