Posters
Presenting Author Academic/Professional Position
Hugo Zamarron
Academic Level (Author 1)
Medical Student
Discipline/Specialty (Author 1)
Neurology
Academic Level (Author 2)
Medical Student
Discipline/Specialty (Author 2)
Neurology
Academic Level (Author 3)
Fellow
Discipline/Specialty (Author 3)
Neurology
Discipline Track
Clinical Science
Abstract Type
Case Report
Abstract
Background: Wernicke’s encephalopathy is a life-threatening neurological disorder caused by thiamine deficiency, most commonly associated with alcoholism. However, postoperative nutritional deficiencies in young patients undergoing bariatric procedures are increasingly recognized. This case is unique due to the rapid succession of bariatric and cholecystectomy surgeries, development of classic Wernicke’s symptoms with a normal MRI, and diagnostic delay due to overlapping differential diagnoses including intracranial hypotension and myelopathy.
Case Presentation: A 22-year-old woman with class III obesity underwent sleeve gastrectomy in July 2022, followed by significant weight loss and persistent intractable vomiting. Due to suspected gallbladder disease, she underwent a cholecystectomy in early September. Shortly thereafter, she developed progressive neurological symptoms including diplopia, bilateral sixth nerve palsy, ataxia, paresthesia in both legs, and memory impairment. Physical examination revealed nystagmus, central ataxia, and decreased vibration in the lower extremities. MRI of the brain and spine was unremarkable. Lumbar puncture showed a low opening pressure (5 cmH₂O) with otherwise normal cerebrospinal fluid. Initial differentials included intracranial hypotension, demyelinating disease, and spinal pathology. However, given the clinical presentation and recent gastrointestinal surgeries, thiamine deficiency was suspected. Empiric intravenous thiamine therapy was initiated. Laboratory studies later confirmed severe vitamin A deficiency (7nmol/L), further supporting a diagnosis of post-surgical malnutrition. The patient showed marked improvement of diplopia and ataxia within 58 hours. She was transitioned to oral thiamine and folic acid, then discharged with outpatient rehabilitation and nutritional support.
Conclusion: This case highlights a rare but important cause of Wernicke’s encephalopathy following dual surgeries that impair nutrient intake and absorption. Despite exhibiting the full clinical triad of ophthalmoplegia, ataxia, and confusion, the patient’s brain imaging was normal, illustrating the need for early clinical recognition and treatment. The case also underscores the diagnostic challenge posed by overlapping neurological syndromes and the importance of nutritional surveillance in post-bariatric surgery patients. Clinicians should maintain a high index of suspicion for Wernicke’s in young individuals with gastrointestinal surgical histories, regardless of imaging findings.
Presentation Type
Poster
Recommended Citation
Zamarron, Hugo; Mourao, Nina; and Cruz Saldana, Roberto A., "Wernicke’s Encephalopathy with Classic Triad and Normal MRI in a Young Woman Following Rapid-Sequence Bariatric and Biliary Surgery" (2025). Research Colloquium. 49.
https://scholarworks.utrgv.edu/colloquium/2025/posters/49
Included in
Diagnosis Commons, Digestive System Commons, Medical Biochemistry Commons, Medical Nutrition Commons, Nervous System Diseases Commons, Neurology Commons, Neurosciences Commons, Surgical Procedures, Operative Commons
Wernicke’s Encephalopathy with Classic Triad and Normal MRI in a Young Woman Following Rapid-Sequence Bariatric and Biliary Surgery
Background: Wernicke’s encephalopathy is a life-threatening neurological disorder caused by thiamine deficiency, most commonly associated with alcoholism. However, postoperative nutritional deficiencies in young patients undergoing bariatric procedures are increasingly recognized. This case is unique due to the rapid succession of bariatric and cholecystectomy surgeries, development of classic Wernicke’s symptoms with a normal MRI, and diagnostic delay due to overlapping differential diagnoses including intracranial hypotension and myelopathy.
Case Presentation: A 22-year-old woman with class III obesity underwent sleeve gastrectomy in July 2022, followed by significant weight loss and persistent intractable vomiting. Due to suspected gallbladder disease, she underwent a cholecystectomy in early September. Shortly thereafter, she developed progressive neurological symptoms including diplopia, bilateral sixth nerve palsy, ataxia, paresthesia in both legs, and memory impairment. Physical examination revealed nystagmus, central ataxia, and decreased vibration in the lower extremities. MRI of the brain and spine was unremarkable. Lumbar puncture showed a low opening pressure (5 cmH₂O) with otherwise normal cerebrospinal fluid. Initial differentials included intracranial hypotension, demyelinating disease, and spinal pathology. However, given the clinical presentation and recent gastrointestinal surgeries, thiamine deficiency was suspected. Empiric intravenous thiamine therapy was initiated. Laboratory studies later confirmed severe vitamin A deficiency (7nmol/L), further supporting a diagnosis of post-surgical malnutrition. The patient showed marked improvement of diplopia and ataxia within 58 hours. She was transitioned to oral thiamine and folic acid, then discharged with outpatient rehabilitation and nutritional support.
Conclusion: This case highlights a rare but important cause of Wernicke’s encephalopathy following dual surgeries that impair nutrient intake and absorption. Despite exhibiting the full clinical triad of ophthalmoplegia, ataxia, and confusion, the patient’s brain imaging was normal, illustrating the need for early clinical recognition and treatment. The case also underscores the diagnostic challenge posed by overlapping neurological syndromes and the importance of nutritional surveillance in post-bariatric surgery patients. Clinicians should maintain a high index of suspicion for Wernicke’s in young individuals with gastrointestinal surgical histories, regardless of imaging findings.
