© FD-Communications Inc. Obesity Surgery, 14, 2004 129 Obesity Surgery, 14, 129-132 Postoperative complications and nutritional deficits resulting from bariatric surgery can lead to severe vitamin-deficiency states, such as Wernicke’s encephalopathy (WE). Patients with acute WE gener- ally present with the classic clinical triad of inatten- tiveness, ataxia, and ophthalmoplegia. We describe a patient who presented with acute WE at 2 months after laparoscopic bariatric surgery. Initial MRI of the brain demonstrated the characteristic injuries of WE, and repeat imaging showed resolution after 4 months of thiamine supplementation, at which time the patient had normal gait but persistent memory deficits. Even with early recognition and aggressive therapy, acute WE commonly results in permanent disability due to the irreversible cytotoxic effects on specific regions of the brain. Since the clinical onset of acute WE follows a predictable time-course in post- bariatric surgery patients with malnutrition, we rec- ommend prevention by administration of parenteral thiamine beginning at 6 weeks postoperatively in mal- nourished patients. Key words: Morbid obesity, bariatric surgery, Wernicke’s encephalopathy, thiamine, hyperemesis, vitamin, malnu- trition Introduction Morbid obesity is increasingly a major public health concern that affects one out of 20 adult Americans. 1,2 Since the National Institutes of Health Consensus Development Conference’s statement in 1992 establishing the superiority of surgical over non-surgical intervention for the treatment of mor- bid obesity, bariatric surgery has become the ther- apy of choice. 3,4 Intractable hyperemesis is a well- documented post-bariatric surgical complication that can result in acute Wernicke’s encephalopathy (WE), a condition secondary to severe thiamine (vitamin B 1 ) deficiency, classically presenting with the clinical triad of ophthalmoplegia, ataxia, and apathetic mental confusion. 5 Acute WE is commonly misdiagnosed at presen- tation, which delays appropriate therapy. Indeed, our recent experience is that patients are initially diagnosed with acute stroke, and generally receive standard parenteral antiemetics for nausea and eme- sis along with intravenous fluid-dextrose resuscita- tion, which can exacerbate ongoing brain cytotoxic- ity when thiamine is not administered before glu- cose. However, even when acute WE is immediately suspected and treated appropriately, permanent dis- ability most commonly consisting of nystagmus and cognitive impairment is the rule rather than the Case Report Acute Wernicke’s Encephalopathy following Bariatric Surgery: Clinical Course and MRI Correlation Yince Loh, MD 1 ; William D. Watson, MD, PhD 1 ; Ajay Verma, MD, PhD 2 ; Suyoung T. Chang, MD 3 ; Derek J. Stocker, MD 3 ; Robert J. Labutta, MD 1 1 Department of Neurology, Walter Reed Army Medical Center, Washington, DC; 2 Uniformed Services University of the Health Sciences, Department of Neurology, Bethesda, MD; 3 Department of Medicine, Walter Reed Army Medical Center, Washington, DC, USA The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Army, the Department of Defense, or the United States Government. Reprint requests to: Yince Loh, MD, Department of Neurology, Walter Reed Army Medical Center, 6900 Georgia Ave. NW, Washington, DC 20307, USA. E-mail:Yince.loh@na.amedd.army.mil