Nervous System Involvement After Bariatric Surgery: A Case Report

Abstract

Aim: Neuropathies are one of the common neurological problems after bariatric surgery. Neuropathies often appear as axonal polyneuropathy secondary to nutritional deficiencies. However, inflammatory processes may also be triggered secondary to weight loss and nutritional deficiencies, resulting in neuropathies. In this article, we aimed to discuss a case with neurological involvement responsive to immunomodulatory treatment after bariatric surgery. Case: A 27-year-old female patient presented with nystagmus, ataxia and paraparesis, 1.5 months after bariatric surgery. Despite nutritional support, recovery was not observed. Clinical remission was achieved after immunomodulatory treatment. Result: In patients where neurological complaints persist despite nutritional supplements after bariatric surgery, processes triggered by immune mechanisms should be considered and treated.

Keywords

• Bariatric surgery
• Polyradiculoneuropathy
• Inflammation
• Vitamin deficiency

Bariyatrik Cerrahi Sonrası Gelişen Nörolojik Sistem Tutulumu: Olgu Sunumu

Abstract

Amaç: Nöropatiler, bariyatrik cerrahi sonrası sık karşılaşılan nörolojik problemler arasındadır. Nöropatiler, sıklıkla nütrisyonel eksikliklere sekonder aksonal polinöropati şeklinde karşımıza çıkmaktadır. Ancak inflamatuar süreçlerin de kilo kaybı ve nütrisyonel eksikliklere sekonder tetiklenebileceği, buna bağlı nöropatiler yaratabileceği bildirilmiştir. Bu yazıda bariyatrik cerrahi sonrası gelişen immünmodülatör tedaviye yanıtlı nörolojik tutulumu olan olguyu sunmayı amaçladık. Olgu: Yirmi yedi yaşında kadın hasta bariyatrik cerrahiden 1,5 ay sonra nistagmus, ataksi ve paraparezi kliniği ile başvurdu. Nütrisyonel desteğe rağmen şikayetlerde tam düzelme sağlanamadı. Takiplerinde kas gücünde tekrardan kötüleşme gözlenmesi üzerine uygulanan immünmodülatör tedavi ile klinik remisyon elde edildi. Sonuç: Bariyatrik cerrahi sonrası nütrisyonel takviyelerinin yapılmasına rağmen nörolojik yakınmaların ısrarcı olduğu durumlarda immün mekanizmaların tetiklediği süreçler akla gelmeli ve tedavi edilmedir.

Keywords

• Bariyatrik cerrahi
• poliradikülonöropati
• inflamasyon
• vitamin eksikliği

References

1. 1. Berger JR. The neurological complications of bariatric surgery. Arch Neurol. 2004;61(8):1185-1189.
2. 2. Juhasz-Pocsine K, Rudnicki SA, Archer RL, Harik SI. Neurologic complications of gastric bypass surgery for morbid obesity. Neurology. 2007;68(21):1843-1850.
3. 3. Ba F, Siddiqi ZA. Neurologic complications of bariatric surgery. Rev Neurol Dis. 2010;7(4): 119-124.
4. 4. Thaisetthawatkul P, Collazo-Clavell ML, Sarr MG, et al. A controlled study of peripheral neuropathy after bariatric surgery. Neurology. 2004;63(8):1462-1470.
5. 5. ] Koffman BM, Greenfield J, Ali II, Pirzada NA. Neurologic complications after surgery for obesity. Muscle Nerve. 2006;33:166–176.
6. 6. Kumar N. Neurologic complications of bariatric surgery. Continuum (Minneap Minn). 2014;20(3):580-597.
7. 7. Juhasz-Pocsine K, Rudnicki SA, Archer RL, Harik SI. Neurologic complications of gastric bypass surgery for morbid obesity. Neurology. 2007;68:1843–1850.
8. 8. Lindboe CF, Løberg EM. Wernicke's encephalopathy in non-alcoholics. An autopsy study. J Neurol Sci. 1989;90(2):125-129.

9. 9. Ishibashi S ve Ark. Reversible Acute Axonal Polyneuropathy Associated with Wernicke-Korsakoff Syndrome: Impaired Physiological Nerve Conduction Due to Thiamine Deficiency? J Neurol Neurosurg Psychiatry. 2003; 74: 674-676.
10. 10. Mechanick JI, Apovian C, Brethauer S, et al. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures—2019 update: cosponsored by American Association of Clinical Endocrinologists/- American College of Endocrinology, the Obesity Society, American Society for Metabolic & bariatric surgery, obesity medicine association, and American Society of Anesthesiologists. Surg Obes Relat Dis. 2020;16(2):175-247.
11. 11. Gwathmey, Kelly G., and James Grogan. "Reply to the letter to the editor regarding “nutritional neuropathies”. Muscle Nerve. 2020;62(6):89-90.
12. 12. Kumar N. Neurologic presentations of nutritional deficiencies. Neurol Clin. 2010; 28(1):107-170.
13. 13. Sunbol AH, Almaghrabi S, Al Aslany SJ, et al. Delayed Guillain-Barré Syndrome after Bariatric Surgery: A Report of Three Cases. Case Rep Surg. 2018; 8413206.
14. 14. Dias JC, Vidal CM, Freitas MRG. Inflammatory polyneuropathy after bariatric surgery: report of two cases. J Neurol Disord. 2016;4:278.