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A difficult case
Beriberi following sleeve gastrectomy
  1. Bernard Liem1,
  2. Xin You Tai1,
  3. Faye Begeti1,
  4. Farheen Fazal Fathima1,
  5. Monika Hofer2,
  6. Lucy Matthews1,
  7. Simon Rinaldi1,3,
  8. David L H Bennett1,3,
  9. Martin R Turner1,3
  1. 1Neurology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  2. 2Neuropathology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  3. 3Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
  1. Correspondence to Professor Martin R Turner; martin.turner{at}ndcn.ox.ac.uk

Abstract

Bariatric surgery is being undertaken more frequently in response to rising levels of obesity but is increasingly also requested as a cosmetic choice. Nutritional deficiencies are a recognised consequence of gastrectomy, with potentially severe and permanent neurological sequelae. We present two cases of acute, severe polyneuropathy following sleeve gastrectomy. Severe thiamine deficiency was considered in both cases but with delayed proof and a significant initial differential diagnosis. Neurologists must have a high index of suspicion for the peripheral as well as central presentations of thiamine deficiency to avoid permanent disability. We also call for explicit information resources warning of the risk and signs of thiamine deficiency to be provided routinely to patients after gastrectomy.

  • PERIPHERAL NEUROPATHOLOGY
  • NEUROPATHY
  • HISTOPATHOLOGY
  • METABOLIC DISEASE
  • NEUROPHYSIOLOGY

Data availability statement

No data are available. Not applicable.

https://doi.org/10.1136/pn-2024-004219

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    Data availability statement

    No data are available. Not applicable.

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    Footnotes

    • Contributors BL: conception, patient involvement and consent, literature search, writing, editing. XYT: conception, patient involvement and consent, literature search, editing. FB: patient involvement and consent, video, consent, editing. FFF: patient involvement, literature search, diagram/figure creation, editing. MH: expert opinion, editing. LM: patient involvement and consent, editing. SR: patient involvement, expert opinion and editing. DLHB: patient involvement, expert opinion and editing. MRT: conception, patient involvement, editing, supervision of project, guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement statement The patients involved in the case reports within this article were provided the opportunity to review this article and provide suggestions prior to submission and publication.

    • Provenance and peer review Provenance and peer review. Not commissioned. Externally peer reviewed by Alex Rossor, London, UK.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.