Postbariatric surgery neuropathic pain (PBSNP): case report, literature review, and treatment options.

OBJECTIVE: This study is aimed at facilitating clinician understanding of factors associated with postbariatric surgery neuropathic pain (PBSNP) and discussing the evidence base for management options. DESIGN: A case report and systematic literature review. METHODS: A search was conducted of PubMed, MEDLINE, Google Scholar, EMBASE, Psych Info, and Cochrane Database of Reviews for articles published between 1985 and 2013 on neuropathy, pain, and pharmacokinetics associated with postbariatric surgery. RESULTS: The epidemiology of PBSNP has not been well established, and current therapeutic options are not evidence based. Available data indicate up to 33% incidence of pain in patients with neuropathy after bariatric surgery, resulting in significant decreases in quality of life and increases in health care costs. Pathophysiologic mechanisms underlying PBSNP are unclear, and the natural course is variable, with some patients experiencing spontaneous improvement when nutritional deficiency is identified and corrected. Early identification of nutritional deficiency along with glycemic and lipid control may prevent or partially reverse postsurgical neuropathy and modulate PBSNP. CONCLUSIONS: A better understanding of the peripheral and central mechanisms resulting in PBSNP is likely to promote the development of targeted and effective treatments.

Limbic encephalitis and psychosis.

OBJECTIVE: To report a case of limbic encephalitis (LE) presenting with psychosis. METHOD: Case report. RESULTS: A woman with LE initially presented with acute psychotic symptoms. Magnetic resonance imaging (MRI) showed hyperintensity in bilateral temporal lobes. Paraneoplastic and autoimmune antibodies were negative, but symptoms resolved after starting methylprednisolone. CONCLUSION: A greater awareness for and knowledge of LE among all disciplines could help early recognition and management of LE and avoid permanent behavioral deficits.