A cluster of polyneuropathy and Wernicke-Korsakoff syndrome in a bariatric unit

Background: Wernicke-Korsakoff syndrome and peripheral neuropathy are very uncommon in bariatric surgical practice. The literature indicates that these complications tend to strike patients receiving unbalanced diets or undergoing rapid weight-loss. Methods: In a retrospective analysis of the initial experience of a bariatric team in the city of Belem, Pari, in northern Brazil, 5 cases were diagnosed in the first year, 4 of them following gastric bypass and the last one after therapy with an intragastric balloon. Results: All episodes followed periods of severe vomiting, which certainly interfered with intake of food as well as of routine vitamin supplements, resulting in severe polyneuropathy and other neurologic manifestions, mostly damaging motility of lower limbs. Therapy consisted of pharmacologic doses of vitamin B-1 along with restoration of adequate diet and multivitamin prescriptions. Physical therapy was employed to prevent atrophy and accelerate normalization of muscle strength. All patients responded to this program after variable intervals without significant sequelae. Conclusions: Thiamine-related neurologic derangements were a cause for much concern and prolonged morbidity in this series, but responded to vitamin B, replenishment. A high degree of clinical suspicion in bariatric patients and urgent therapeutic intervention whenever postoperative vomiting persists for several days, especially during the first 2-3 months after operation, are the safest approach to these uncommon episodes. It is speculated whether peculiarities in the regional diet of this area in Brazil could have influenced the high incidence of the neurologic aberrations.