Micronutrient-responsive cerebral dysfunction other than Wernicke's encephalopathy after malabsorptive surgery

Abstract

Background Micronutrient-responsive cerebral dysfunction (MRCD) is known to occur after gastric restrictive and malabsorptive weight loss surgery. Wernicke's encephalopathy (WE) is often considered the etiology, but many cases without thiamine deficiency have been reported. It is important to recognize that other micronutrient-responsive cerebral dysfunctions exist in this high-risk group. We evaluated the published data for evidence of MRCD after gastric restrictive and malabsorptive weight loss surgery. Methods A search of PubMed and OVID was conducted to identify all published cases of cerebral dysfunction after gastric restrictive and malabsorptive weight loss surgery. The cases were compared using the presenting clinical signs and symptoms and objective confirmatory findings. The cases were stratified according to the type of surgery and the known or suspected etiology of the cerebral dysfunction. Results A total of 65 cases of cerebral dysfunction after gastric restrictive and/or malabsorptive weight loss surgery were identified. A careful analysis of all cases revealed that 48 (73.8%) could be attributed to WE. The remaining cases represented a subset with a pattern of cerebral dysfunction incompatible with WE. This condition most likely resulted from multiple micronutrient deficiencies (MRCD). Patients with MRCD were more likely to have undergone a malabsorptive surgical procedure ( P = .001), to present with dysarthria ( P <.001), and less likely to have ophthalmoplegia ( P <.001) or nystagmus ( P = .02) compared with those with WE. Conclusion Current evidence supports the identification of MRCD after malabsorptive weight loss surgery that is not compatible with WE. Clinicians should be aware of this clinical entity and be prepared to treat it appropriately.