Wernicke Encephalopathy and Possible Myelopathy Following Removal of an Intragastric Balloon: A Rare Complication in a Bariatric Patient

TL;DR

A young man developed Wernicke encephalopathy and possible myelopathy after an intragastric balloon procedure, highlighting a rare complication in non-alcoholic bariatric patients.

Contribution

This case report highlights a rare complication of Wernicke encephalopathy following an intragastric balloon procedure in a non-alcoholic patient.

Findings

A 25-year-old non-alcoholic male developed Wernicke encephalopathy after intragastric balloon removal.

MRI confirmed the diagnosis and revealed possible myelopathy.

Prompt thiamine treatment led to clinical improvement.

Abstract

Wernicke encephalopathy (WE) is a neurological emergency caused by thiamine (vitamin B1) deficiency. WE is typically diagnosed clinically in high-risk patients presenting with ophthalmoplegia, ataxia, and confusion. Thiamine deficiency is most often seen in people who consume excessive alcohol, but it can also occur in other conditions, such as chronic malnutrition, prolonged vomiting, or after bariatric procedures. Inadequate or delayed treatment can result in irreversible Korsakoff psychosis or, in severe cases, death. We report the case of a 25-year-old male patient who never consumed alcohol and underwent intragastric balloon (IGB) insertion for obesity management. Several months post-procedure, he experienced severe nausea and vomiting, necessitating the removal of the IGB. Within a couple of days of IGB removal, the patient developed dizziness and ophthalmoplegia. A clinical diagnosis of WE was established, and prompt administration of high-dose intravenous thiamine led to notable clinical improvement. The diagnosis of WE was subsequently confirmed upon MRI of the head. In addition to the manifestations of WE, the patient exhibited signs indicative of multilevel myelopathy. This report highlights a rare case of WE with possible myelopathy following IGB removal, a non-malabsorptive procedure, in a young male patient who never consumed alcohol.

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