Bariatrik cerrahi sonrası gelişen papil ödeminin eşlik ettiği Wernicke ensefalopatisi: bir olgu sunumu

Öz

Wernicke ensefalopatisi konfüzyon, oftalmopleji ve ataksi üçlüsü ile karakterize bir akut ensefalopati tablosudur. Etiyolojide tiaminin yetersiz alımı veya emilim bozukluğu ile ilişkili olabilecek birçok neden bildirilmiştir. Burada, erken muayenede papil ödemi ve obezite dışında bir özellik olmadığı için tanısı geciken, gastrik bypass ameliyatı sonrası gelişmiş bir Wernicke ensefalopatisi olgusunu sunuyoruz. Takip sırasında hastada oftalmopleji ve tetraparezi gelişti ve tabloya bilinç değişikliği de eklendi. Ayırıcı tanıda Wernicke ensefalopatisi düşünülür düşünülmez yüksek doz intravenöz tiamin tedavisi başlandı ve hastanın kliniği progresif olarak düzeldi. Bu vakada papil ödemi, obezite ve tablonun karakteristik bulgularının başlangıçta silik olması tanıda gecikmeye yol açmıştır. Bu vakanın Wernicke ensefalopatisinin sık karşılaşılmayan bulguları hakkında farkındalığı artıracağı için önemli olduğu düşünülmüştür.

Anahtar Kelimeler

• bariatrik cerrahi
• papil ödemi
• tiamin
• Wernicke ensefalopatisi

Wernicke Encephalopathy with papilledema after bariatric surgery: a case report

Öz

Wernicke encephalopathy is an acute encephalopathy, characterized by the triad of mental confusion, ophthalmoplegia, and gait ataxia. Many reasons have been reported in the etiology that may be related to insufficient intake or malabsorption of thiamine. Here, we present a case of Wernicke's encephalopathy that developed after gastric bypass surgery, whose diagnosis was delayed because there was no feature other than papillary edema and obesity at early examination. During follow-up, the patient developed ophthalmoplegia and tetraparesis, and a change in consciousness was added. When Wernicke's encephalopathy was considered in the diagnosis, her clinic improved progressively under high dose intravenous thiamine treatment. The fact that this case had papillary edema, being obese, and the characteristic findings of the picture were obscure at the beginning caused a delay in diagnosis. This case was thought to be important as it would increase awareness of the uncommon findings of Wernicke's encephalopathy.

Anahtar Kelimeler

• bariatric surgery
• papilledema
• thiamine
• Wernicke encephalopathy

Kaynakça

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