A 25-year-old man’s sudden complaints of blurred vision, double vision, forgetfulness, and difficulty walking led to a rare diagnosis that his doctor says could have been prevented. Dr. Sudhir Kumar, a senior neurologist at Apollo Hospitals, Hyderabad, shared the case on X (formerly Twitter), calling it “a rare but preventable complication after weight loss surgery.”
The patient’s symptoms had developed within three days, and when he arrived at the hospital, he appeared anxious, confused, and struggled to maintain balance — all of which suggested a neurological issue.
Recent bariatric surgery provided the missing clue
On further discussion, Dr. Kumar learned that the man had undergone bariatric (weight loss) surgery about three weeks earlier. Since then, he had been following a severely restricted diet and had not been able to take adequate nutritional supplements. Connecting these details, Dr. Kumar suspected a nutritional deficiency that had affected his brain function.
An MRI scan confirmed the suspicion, showing specific abnormalities in the periaqueductal region and mammillary bodies — hallmark indicators of Wernicke’s encephalopathy (WE), a neurological disorder caused by an acute deficiency of thiamine (vitamin B₁).
Understanding Wernicke’s encephalopathy
Dr. Kumar explained that Wernicke’s encephalopathy is a medical emergency that results from a severe lack of thiamine, an essential nutrient for brain energy metabolism. When the brain runs short of it, areas responsible for memory, eye movement, and coordination can be damaged quickly. Although it is most commonly associated with chronic alcoholism, it can also appear in cases of starvation, prolonged vomiting, HIV infection, or after bariatric surgery.
Treatment and recovery
Recognizing the urgency, Dr. Kumar began high-dose intravenous thiamine treatment immediately, followed by oral supplementation. Within days, the patient showed remarkable improvement — his vision cleared, balance returned, and memory function improved, highlighting how timely thiamine therapy can reverse damage if started early.
Dr. Kumar cautioned that while bariatric surgery can be life-changing, it must be followed by strict nutritional monitoring and regular vitamin supplementation. He stressed that any neurological symptoms such as confusion, imbalance, or visual disturbances after such surgery require urgent medical attention.
For doctors, he advised considering Wernicke’s encephalopathy in patients with recent weight loss surgery or poor nutrition, even if they are not alcohol consumers. Thiamine administration, he noted, should never be delayed as it is a safe, inexpensive, and potentially life-saving treatment.
The patient’s symptoms had developed within three days, and when he arrived at the hospital, he appeared anxious, confused, and struggled to maintain balance — all of which suggested a neurological issue.
Recent bariatric surgery provided the missing clue
On further discussion, Dr. Kumar learned that the man had undergone bariatric (weight loss) surgery about three weeks earlier. Since then, he had been following a severely restricted diet and had not been able to take adequate nutritional supplements. Connecting these details, Dr. Kumar suspected a nutritional deficiency that had affected his brain function.An MRI scan confirmed the suspicion, showing specific abnormalities in the periaqueductal region and mammillary bodies — hallmark indicators of Wernicke’s encephalopathy (WE), a neurological disorder caused by an acute deficiency of thiamine (vitamin B₁).
Understanding Wernicke’s encephalopathy
Dr. Kumar explained that Wernicke’s encephalopathy is a medical emergency that results from a severe lack of thiamine, an essential nutrient for brain energy metabolism. When the brain runs short of it, areas responsible for memory, eye movement, and coordination can be damaged quickly. Although it is most commonly associated with chronic alcoholism, it can also appear in cases of starvation, prolonged vomiting, HIV infection, or after bariatric surgery.Treatment and recovery
Recognizing the urgency, Dr. Kumar began high-dose intravenous thiamine treatment immediately, followed by oral supplementation. Within days, the patient showed remarkable improvement — his vision cleared, balance returned, and memory function improved, highlighting how timely thiamine therapy can reverse damage if started early.Dr. Kumar cautioned that while bariatric surgery can be life-changing, it must be followed by strict nutritional monitoring and regular vitamin supplementation. He stressed that any neurological symptoms such as confusion, imbalance, or visual disturbances after such surgery require urgent medical attention.
For doctors, he advised considering Wernicke’s encephalopathy in patients with recent weight loss surgery or poor nutrition, even if they are not alcohol consumers. Thiamine administration, he noted, should never be delayed as it is a safe, inexpensive, and potentially life-saving treatment.
