P92-T Acute motor and sensory axonal neuropathy followed bariatric surgery: Report of two cases

Abstract

Background Bariatric surgery is an effective treatment for obesity. However, the number of neurological complications including polyneuropathies after bariatric surgery is increasingly reported. Case reports Case1. A 27-year-old female underwent a sleeve gastrectomy (SG) and was discharged on a special diet including parenteral B vitamins. Three months later she developed a weakness in both lower limbs progressively increased. The electro-neuromyography (ENMG) showed a severe amplitude reduction in both motor and sensory nerves. It was thought to be a case of AMSAN. Vitamin B1, B6, B12 levels and metabolic tests were normal. Intravenous immune globulin (IVIG) was started 0.4 g/kg/day for 5 days and 2 g/kg/month for 6 consecutive months. Her condition improved in 6 months. Case2. A 19-year-old male was submitted to a SG, 4 months before. He had numbness and pain in his legs and hands for 2 weeks. Weakness in the lower extremities started gradually ascended over the following days. Biochemical analyses were normal. His ENMG verified the diagnosis of AMSAN. IVIG was started at same dose for 5 days. However, his muscle strength reduced to distal part of the extremities. Plasma exchange (PE) started 5 times on alternate days. Physiotherapy was started after PE for 6 weeks. At his last examination his condition was nearly normal. Discussion Micronutational deficiencies which cannot be monitored can trigger processes of inflammatory neuropathy in SE cases. Our cases showed that IVIG and PE should be kept in mind as a reliable treatment option for subacute polyneuropathies caused by bariatric surgery.