Wernicke Encephalopathy a Risk After Obesity Surgery

Prospective studies of thiamine supplementation urgently needed

MONDAY, March 12 (HealthDay News) -- Bariatric surgery patients and the physicians treating them should be alert for symptoms of vomiting, confusion and other neurological problems as Wernicke encephalopathy can develop relatively soon after the procedure, according to a review in the March 13 issue of Neurology. Most cases occur 4 to 12 weeks after the procedure, often in young women with vomiting.

Sonal Singh, M.D., of Wake Forest University in Winston-Salem, N.C. and Johns Hopkins University in Baltimore, and a colleague conducted a systematic review of medical databases to identify clinical studies aimed at characterizing the clinical features, risk factors, radiographic findings and prognosis of Wernicke encephalopathy after bariatric surgery.

The investigators identified 32 cases of Wernicke encephalopathy, mostly in women, that occurred anywhere from two weeks to 18 months after surgery. Vomiting as well as the Wernicke encephalopathy triad (confusion, ataxia and nystagmus) was common in the majority cases. Radiographic studies identified hyperintense signals in the thalamus in some patients but in 15 cases radiographs were unremarkable.

"The diagnosis [of Wernicke encephalopathy] is mainly clinical, because radiographic findings are normal in some patients," the authors conclude. "Prospective studies to determine the prevalence of this problem and protocols for preventive thiamine supplementation need evaluation."

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