Neurologic complications after surgery for obesity

[Guest guest]

Muscle Nerve. 2005 Jun 22;

Neurologic complications after surgery for obesity.

Koffman BM, Greenfield LJ, Ali II, Pirzada NA.

Department of Neurology, 3120 Glendale Avenue, RHC 1450, Medical

University of Ohio, Toledo, Ohio 43614, USA.

Bariatric surgical procedures are increasingly common. In this

review, we characterize the neurologic complications of such

procedures, including their mechanisms, frequency, and prognosis.

Literature review yielded 50 case reports of 96 patients with

neurologic symptoms after bariatric procedures. The most common

presentations were peripheral neuropathy in 60 (62%) and

encephalopathy in 30 (31%). Among the 60 patients with peripheral

neuropathy, 40 (67%) had a polyneuropathy and 18 (30%) had

mononeuropathies, which included 17 (94%) with meralgia paresthetica

and 1 with foot drop. Neurologic emergencies including Wernicke's

encephalopathy, rhabdomyolysis, and Guillain-Barre syndrome were also

reported. In 18 surgical series reported between 1976 and 2004, 133

of 9996 patients (1.3%) were recognized to have neurologic

complications (range: 0.08-16%).

The only prospective study reported a neurologic complication rate of

4.6%, and a controlled retrospective study identified 16% of patients

with peripheral neuropathy. There is evidence to suggest a role for

inflammation or an immunologic mechanism in neuropathy after gastric

bypass. Micronutrient deficiencies following gastric bypass were

evaluated in 957 patients in 8 reports. A total of 236 (25%) had

vitamin B(12) deficiency and 11 (1%) had thiamine deficiency. Routine

monitoring of micronutrient levels and prompt recognition of

neurological complications can reduce morbidity associated with these

procedures.