Functional neurological symptoms masquerading as Wernicke encephalopathy following bariatric surgery

ObjectivesTo explore the opinion of todays neurologist and psychiatrist in the kingdom of Saudi Arabia regarding pathogenesis, diagnosis, treatment and outcome. It is a replication for Dutch experience with Functional Neurological symptoms Disorder (FND).MethodsA multi-centres Cross-sectional study was conducted in Saudi Arabia started from November 2019 and still ongoing. The target populations were a qualified psychiatrists or neurologists. Data were collected through an electronic questionnaire.ResultsThere were 70 respondents, 37.1% were female and 62.9% males. A 15.5% were Neurologists and 72.4% psychiatrists. Three questionnaires were taken out due to incompletion error. Most neurologists and psychiatrists believed that FND is a disorder of functioning of the nervous system together with psychogenic factors. However, 100% of psychiatrist believed that a prior psychological stress is a cause of the disorder (among other causes) while 86.84% of neurologists. Also found that, a 71% of patients who referred to neurologist were evaluated initially by a general practitioner, while 85% of the patients who referred to psychiatrist; were evaluated by neurologists. Eventually, most of the neurologists and the psychiatrists diagnosed patients by conversion disorder (13/38 of neurologist and 13/20 of psychiatrists).ConclusionOur preliminary conclusion is comparable for Dutch experience that is not considered purely a psychiatric disorder and counted disordered brain functioning together with psychogenic factors responsible for FNS. However, the majority of the psychiatrists in our study diagnose FND as conversion disorder.

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Treatment of Functional Neurological Symptoms with Transcranial Magnetic Stimulation: A Novel Approach

Psychiatric Annals ◽

10.3928/00485713-20211103-01 ◽

2021 ◽

Vol 51 (12) ◽

pp. 579-581

Author(s):

Marshall Steele ◽

Alan Mayfield ◽

Joanna Galati ◽

Steven Galati

Keyword(s):

Transcranial Magnetic Stimulation ◽

Magnetic Stimulation ◽

Neurological Symptoms ◽

Novel Approach ◽

Functional Neurological Symptoms

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292 Mapping patient pathways for acute functional neurological symptoms

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2018-abn.156 ◽

2018 ◽

Vol 89 (10) ◽

pp. A45.3-A46

Author(s):

Southall Clea ◽

Haley Samantha ◽

Williams Stefan ◽

Graham Christopher D ◽

Alty Jane ◽

...

Keyword(s):

Care Pathway ◽

Healthcare Utilisation ◽

Real Data ◽

Neurological Symptoms ◽

Teaching Hospitals ◽

Service Improvement ◽

Healthcare Burden ◽

Mapping Software ◽

Patient Pathways ◽

Functional Neurological Symptoms

IntroductionPatients with Functional Neurological Symptoms (FNS) can present acutely, but many hospitals lack specific pathways or services for them. Outpatient FNS cohorts have been studied, but there is little data regarding acute FNS to inform service improvement.MethodOver an 8 month period at Leeds Teaching Hospitals NHS Trust (UK), the on-call neurology and stroke teams were telephoned regularly. Acute referrals with possible FNS were recorded. Electronic documentation was searched for the following events: symptoms, first presentation, diagnosis, A and E, outpatient clinic, inpatient admission, investigation, and psychological/psychiatric referral. This data was analysed with process mapping software (Fluxicon disco).ResultsWe present a dynamic care pathway map using real data, showing 205 patients with possible FNS moving through hospital services over time. Our map visualises the temporal relationships between healthcare utilisation, first presentation, diagnosis and therapy. The picture shows high healthcare burden, with incomplete and slow movement towards appropriate therapy (e.g. clear diagnosis documented in only 66%; referral to psychological therapy in 26%).ConclusionPatients with FNS are regularly referred to acute neurological services in Leeds. Our dynamic map shows a high healthcare burden, and slow or incomplete movement to appropriate care, which suggests potential targets for service improvement.

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Wernicke encephalopathy concurrent with polyradiculoneuropathy in a young man after bariatric surgery

Medicine ◽

10.1097/md.0000000000014808 ◽

2019 ◽

Vol 98 (10) ◽

pp. e14808 ◽

Cited By ~ 2

Author(s):

Heng-Wei Chang ◽

Pei-Yu Yang ◽

Ting-I Han ◽

Nai-Hsin Meng

Keyword(s):

Bariatric Surgery ◽

Wernicke Encephalopathy

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SUN-596 A Rare Presentation of Early Onset Wernicke Encephalopathy Following Sleeve Gastrectomy

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.1509 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Nathan Gilreath ◽

Ravi Kant ◽

Mc Anto Antony ◽

Vipin Verma

Keyword(s):

Bariatric Surgery ◽

Sleeve Gastrectomy ◽

Pseudotumor Cerebri ◽

Wernicke Encephalopathy ◽

Mri Findings ◽

Rare Presentation ◽

Number Of Patients ◽

Patient Reported ◽

Blurry Vision ◽

Thiamine Level

Abstract Background: Wernicke encephalopathy (WE) has been reported after malabsorptive bariatric surgeries but is an uncommon complication of sleeve gastrectomy. Since 2011, the number of patients receiving a sleeve gastrectomy has tripled, with almost 60% of patients undergoing bariatric surgery receiving a sleeve gastrectomy in 2017 (1). We present a case of WE in a young woman as a rare and early complication of sleeve gastrectomy. Clinical Case: A 32-year old female with a past medical history significant for hypertension, pseudotumor cerebri, and morbid obesity status post sleeve gastrectomy two months prior presented to the emergency department with complaints of blurry vision and lower extremity numbness. Physical examination showed sluggish light reflex and decreased extraocular movements. Given history of pseudotumor cerebri, patient underwent a therapeutic lumbar puncture with removal of 13 ml of CSF. Opening pressure was 20 cm of water and patient experienced no relief of her symptoms. Ophthalmology consult did not offer an explanation for the blurry vision. MRI-brain with and without contrast showed findings highly suggestive of WE. It showed faint linear symmetric hyperintensities along the bilateral mesial thalamus, dorsal midbrain and periaqueductal gray matter, which were determined to be acute in nature in comparison with a MRI performed three weeks prior. Upon further investigation, thiamine level was low at 43.6 nmol/L [66.5 – 200] confirming the diagnosis of WE. Thiamine supplementation was started immediately and patient reported improvement of her vision the next day with return to baseline in 3 days. Conclusion: There have been a handful of cases of WE reported in literature as a complication of sleeve gastrectomy. Zheng, L also reported a case of WE 7 weeks after sleeve gastrectomy (2). Although sleeve gastrectomy does not directly affect the primary absorptive pathway of thiamine in the gastrointestinal tract, it is imperative to consider WE in patients presenting with suspicious neurologic symptoms after a recent sleeve gastrectomy. WE was suspected in our case due to typical MRI findings and neurological presentation after bariatric surgery, which was later confirmed by low serum thiamine level. Early detection and thiamine supplementation resulted in complete reversal of symptoms in our patient. WE is a rare but severe and preventable consequence of bariatric surgery that warrants attention given its rapid onset and detrimental course. Reference: (1) Estimate of Bariatric Surgery Numbers, 2011-2017. (2018, June 26). Retrieved from https://asmbs.org/resources/estimate-of-bariatric-surgery-numbers. (2) Zheng, L. (2016). Wernicke Encephalopathy and Sleeve Gastrectomy. American Journal of Therapeutics, 23(6).

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