背景:已知吸收不良综合征是减肥手术的慢性并发症。因此,建议口服补充多种维生素。Wernicke脑病代表与酒精中毒或严重营养不良相关的急性神经精神综合征;文献中描述了与减肥手术相关的这种潜在并发症的散发性病例。我们介绍了一例减肥手术后严重缺乏维生素B1引起的韦尼克脑病。
方法:一名31岁女性,从3岁开始患有聋哑症,手术前3个月,用小型胃旁路术治疗严重肥胖,进入急诊室后被转移到我们单位.在近期的病史中,视力突然迅速下降,导致视力完全丧失,明显的虚弱,和四肢的感觉异常。考虑到以前的减肥手术,非酒精性Wernicke综合征的诊断被怀疑,其中维生素B1的IV治疗开始时剂量为5瓶200毫克在100毫升的盐水溶液中(在最初的72小时内每天三次,随后1次/天)。12小时后,视力有了改善,症状在48小时内完全缓解。1个月后,所有症状完全缓解,出院。
结论:无意识错乱或脑病的初始视力丧失是Wernicke综合征的一种不典型表现。在酒精中毒或减肥后手术的情况下,临床怀疑必须很高。早期识别非典型症状,包括视力丧失,及时给予治疗可改善这种潜在可逆但时间依赖性神经系统急症的预后.
BACKGROUND: Malabsorption syndromes are known chronic complications of bariatric surgery. Therefore, it is recommended to take oral supplementation with multivitamins. Wernicke\'s encephalopathy represents an acute neuropsychiatric syndrome associated with alcoholism or severe malnutrition; sporadic cases of this potential complication related to bariatric surgery are described in the literature. We present a case of Wernicke\'s encephalopathy due to severe vitamin B1 deficiency after bariatric surgery.
METHODS: A 31-year-old woman with deaf-mutism from the age of 3 years old, operated 3 months before with a mini-gastric bypass for severe obesity, was transferred to our unit after accessing the emergency room. In the immediate medical history, there was the sudden and rapid decline in vision, leading to complete loss of vision, marked asthenia, and paresthesia in the four limbs. Considering the previous bariatric surgery, the diagnosis of non-alcoholic Wernicke\'s syndrome was suspected, for which IV therapy with Vitamin B1 was started at a dosage of 5 vials of 200 mg in 100 cc of saline solution (three times a day for the first 72 hours, subsequently 1 once/day). After 12 hours, there was an improvement in visual acuity, and the symptoms completely resolved within 48 hours. She was discharged with complete resolution of all symptoms after 1 month.
CONCLUSIONS: Initial vision loss without confusion or encephalopathy is one atypical presentation of Wernicke syndrome. Clinical suspicion must be high in case of alcoholism or post-bariatric surgery. Early recognition of atypical symptoms, including vision loss, and timely administration of therapy improves the prognosis of this potentially reversible but time-dependent neurological emergency.