Case Report Open Access Acute Confusion and Double Vision Post-Bariatric Surgery Prince Mohammed Bin AbdulAziz Hospital Afair National Guard, Saudi Arabia Ahmed Mohamed Mnofala*, Abdulhadi Tashkandi, Mohammad Parvez Sheikh, A Akhtar and Marwa Salman Alluqmani *Corresponding author Ahmed Mohamed Mnofala, Prince Mohammed Bin AbdulAziz Hospital Afair National Guard, Saudi Arabia. Tel: +966590770474; E-mail: dr.ahmedmnofala@gmail.com Received: April 22, 2022; Accepted: April 25, 2022; Published: May 02, 2022 Journal of Critical Care & Emergency Medicine Keywords: Wernicke Encephalopathy, Thiamine Defciency, Bariatric Surgery, Acute Confusion, Case Report Introduction Bariatric surgeries are one of the most commonly performed procedures for the treatment of morbidly obese people. They have been shown to be the most benefcial in achieving signifcant and long-lasting weight reduction. In spite of all the well-known benefts of these surgeries, as with almost any major surgery, post-operative complications are not uncommon. These potential health risks can be both, short-term or long-term and it falls into two categories: Surgery-related or Nutritional defciencies- related. Emergency physicians should keep an open eye in order to prevent, recognize and treat, as early as possible, those serious post-operative complications. Below is a case of young male patient, presenting with multiple neurological signs and symptoms, following a bariatric surgery. Clinical Case 18 years old male presented to emergency department with acute confusion and fve days history of memory impairment. He also reported gait unsteadiness and double vision. Symptoms were worsening over time associated with occasional feeling of numbness of extremities. There was no history of fever, diarrhea or vomiting. He had no history of any chronic disease and denied ingestion of any substance of abuse. No history of recent travel or similar symptoms in the family.Two months ago, he underwent gastric sleeve procedure and lost 31 kgs as a result of that. Patient was not compliant to the prescribed multivitamins. On examination vital signs were within normal limits. Patient was conscious and oriented with GCS 15/15. Neurology examination revealed; vertical nystagmus along with bilateral lateral gaze palsy (abducent nerve involvement) with no other cranial nerve affection. Power bilaterally was 5/5. Sensations and refexes were intact bilaterally. Patient had diffculty to stand due to weakness and was noted to have ataxic gait. Rest of examination was normal Laboratory blood investigations were requested and all were reported within normal range except for positive serum ketones. CT scan of the brain also requested which was reported normal. In view of patient condition and reassessment of investigations ordered, suspicion of a metabolic cause was raised. Thiamine level was requested (knowing test result will not be available during patient stay in the emergency department). Meanwhile an empiric administration of intra venous Thiamine in the emergency department was ordered for suspicion of Wernicke Encephalopathy. Interestingly patient started to show signs of improvement, mainly in the level of confusion, double vision and nystagmus. Patient was admitted to hospital for further management. A thorough assessment by Neurologist affrmed the examination fndings J Critical Care & Emerg Med, 2022 ABSTRACT Background: Bariatric surgeries are one of the most commonly performed procedures for the treatment of morbidly obese people. Post-operative complications are not uncommon. Tese potential health risks can be both, short-term or long-term and it falls into two categories: Surgery-related or Nutritional defciencies- related. Case Presentation: We report 18 years old male patient with Wernicke’s encephalopathy presenting as acute confusion and double visison.Pateint underwent gastric sleeve procedure two months prior. Te patient’s vital signs were unremarkable and he had no past history signifcant. Neurological exam revealed nystagmus, gaze palsy and ataxic gait. CT scan brain was unremarkable. Tiamine was administered and patient was admitted. MRI was performed which showed signs, highly suggestive of Wernicke encephalopathy likely due to Tiamine defciency. Conclusion: While dealing with presentation of neurological features such as memory impairment, gait abnormalities, diplopia or other neurological symptoms, in a postgastric sleeve patient, nutritional defciency syndrome such as Wernicke’s encephalopathy should be borne in mind in line with evaluating the patient for other organic causes. Volume 1(2): 1-3 ISSN: 2754-6667