Wernicke encephalopathy in a teenager following sleeve gastrectomy: a case report

Wernicke encephalopathy is classically associated with alcohol misuse in adult patients but may be caused by a variety of etiologies in pediatric patients. We present a case of a teenager presenting with Wernicke encephalopathy after sleeve gastrectomy who experienced a full neurologic recovery after thiamine repletion. A 17-year-old female who had recently undergone sleeve gastrectomy presented with acute encephalopathy accompanied by diplopia, tinnitus, gait imbalance and dysarthria. Additional history revealed that she had experienced significant weight loss since the surgery. Neurologic exam was pertinent for impaired ocular abduction bilaterally, bilateral upper extremity dysmetria and diffuse hyporeflexia. Laboratory evaluation including serum thiamine level was sent. MRI brain demonstrated symmetric T2 hyperintensity and diffusion restriction of the periaqueductal gray matter and medial thalami, suggestive of Wernicke encephalopathy. She was empirically started on high-dose intravenous thiamine repletion and experienced rapid neurologic recovery. Her initial serum thiamine level ultimately resulted at 35 nmol/L, confirming thiamine deficiency. She was asymptomatic and had a normal neurologic exam at follow-up. Although thiamine deficiency can occur due to a variety of causes, Wernicke encephalopathy may be under-recognized in the pediatric population. Our case highlights the importance of considering Wernicke encephalopathy in pediatric patients who are at risk for thiamine deficiency.