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TitreWernicke’s encephalopathy after sleeve gastrectomy : a matter of life ophthalmological diagnosis
Abstract Nr.3018
ButTo present a clinical case of Wernicke’s encephalopathy (WE) after sleeve gastrectomy with ocular manifestation as initial symptoms.
MéthodesWe report a case of a 19-year-old woman who had a sleeve gastrectomy 2 months before and came with complaints of acute bilateral vision loss, diplopia, photophobia, walking difficulty and vomiting. The ophthalmological examination showed vertical nystagmus in all gaze position, impaired abduction on the left eye and best-corrected Snellen distance visual acuity < 1/20 on both eyes. Fundus showed papillary and retinal hemorrhages.
RésultatsWE is a severe neurological disorder due to thiamine deficiency mainly secondary to chronic alcohol consumption and is characterized by the triad ophthalmoplegia, motor ataxia and confusion. The cases of WE after bariatric surgery are fortunately infrequent (0.05% in the United States in 2007²). Most were seen within 6 months after surgery. Although ophthalmoplegia in WE is well documented, fundus abnormalities are less so and can present as optic neuritis, retinal flame hemorrhage, telangiectasia or may be normal.
Serological examinations and brain magnetic resonance (MRI) may be very useful for the diagnosis.
ConclusionWernicke’s encephalopathy is a medical emergency due to thiamine deficiency and any therapeutic delay may result in permanent neurological damage or death.
It should be born in mind especially after bariatric surgery. In case of WE suspicion, glucose perfusion should be avoided and treatment with thiamine should begin as soon as possible without waiting for any imaging or laboratory confirmation results.
Conflit d'intérêtNon
Auteur 1
NomPREUD'HOMME
InitialesB
InstitutHôpital Erasme
VilleBruxelles
Auteur 2
NomDEPASSE
InitialesF
InstitutHôpital Marie Curie
VilleCharleroi
Auteur 3
NomVAUTHIER
InitialesL
InstitutHôpital Marie Curie
VilleCharleroi
Auteur 4
NomCORDONNIER
InitialesM
InstitutHôpital Erasme
VilleBruxelles
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