Wernicke’s encephalopathy-induced hearing loss complicating sleeve gastrectomy

2020 ◽  
Vol 13 (9) ◽  
pp. e233144
Author(s):  
Elaf Abdulnabi Mohammed ◽  
Sulaiman Ali Hajji ◽  
Khaled Aljenaee ◽  
Mohammad Ibrahim Ghanbar

A 25-year-old woman brought to the hospital with symptoms of acute confusion, disorientation, diplopia, hearing loss and unsteady gait which started 4 days prior to her presentation with rapid worsening in its course until the day of admission. She had a surgical history of laparoscopic sleeve gastrectomy 2 months earlier which was complicated by persistent vomiting around one to three times per day. She lost 30 kg of her weight over 2 months and was not compliant to vitamin supplementation. CT of the brain was unremarkable. Brain MRI was done which showed high signal intensity lesions involving the bilateral thalamic regions symmetrically with restricted diffusion on fluid-attenuated inversion recovery imaging. Other radiological investigations, such as magnetic resonance venography and magnetic resonance angiography of the brain were unremarkable. An official audiogram confirmed the sensorineural hearing loss. A diagnosis of Wernicke’s encephalopathy due to thiamin deficiency post-sleeve gastrectomy was made based on the constellation of her medical background, clinical presentation and further supported by the distinct MRI findings. Consequently, serum thiamin level was requested and intravenous thiamin 500 mg three times per day for six doses was started empirically, then thiamin 250 mg intravenously once daily given for 5 more days. Marked improvement in cognition, eye movements, strength and ambulation were noticed soon after therapy. She was maintained on a high caloric diet with calcium, magnesium oxide, vitamin D supplements and oral thiamin with successful recovery of the majority of her neurological function with normal cognition, strength, reflexes, ocular movements, but had minimal resolution of her hearing deficit. Serum thiamin level later was 36 nmol/L (67–200).

2016 ◽  
Vol 20 ◽  
pp. 92-95 ◽  
Author(s):  
Fernando Pardo-Aranda ◽  
Noelia Perez-Romero ◽  
Javier Osorio ◽  
Joaquín Rodriguez-Santiago ◽  
Emilio Muñoz ◽  
...  

2021 ◽  
Vol 91 (11) ◽  
pp. 2549-2549
Author(s):  
Cheuk Wing Jeffrey Lee ◽  
Lucy Tuck ◽  
Shanal Kumar ◽  
Elisabeth Nye

2012 ◽  
Vol 46 (1) ◽  
pp. 70-71 ◽  
Author(s):  
Sang Min Lee ◽  
Won Sub Kang ◽  
Ah Rang Cho ◽  
Jin Kyung Park

2019 ◽  
Vol 12 (11) ◽  
pp. e230763
Author(s):  
Mark D Theodoreson ◽  
Ausrine Zykaite ◽  
Michael Haley ◽  
Saroj Meena

A 61-year-old obese man presented with 8-week history of nausea and occasional vomiting. He reported poor appetite and unintentional weight loss of more than 20 kg of his body mass. A week after admission, he developed double vision and unsteady gait. Neurological examination revealed isolated sixth cranial nerve palsy on the left side with horizontal nystagmus that progressed to bilateral lateral gaze palsy with normal vertical gaze. Brain MR revealed T2/fluid attenuation inversion recovery (FLAIR) high signal in mammillary bodies, tectum of the midbrain and the periaqueductal grey matter. He was diagnosed with Wernicke’s encephalopathy (WE). WE is a medical emergency that carries high mortality yet can be often under-diagnosed in the non-alcoholic patient. Varied presentation and absence of alcohol dependence lowers the degree of suspicion and this was true in this case. The patient was given intravenous thiamine and made a rapid and dramatic recovery.


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