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Neurologic complications of gastric bypass surgery for morbid obesity

From the Department of Neurology, University of Arkansas for Medical Sciences, Little Rock.

Address correspondence and reprint requests to Dr. K. Juhasz-Pocsine, Department of Neurology, UAMS, 4301 W. Markham St., Slot 500, Little Rock, AR 72205-7199 pocsinekatalinj{at}uams.edu

Background: The number of bariatric procedures is rapidly growing as the prevalence of obesity in the USA is increasing. Such procedures are not without complications, and those affecting the nervous system are often disabling and irreversible. We now describe our experience with these complications and review the pertinent literature.

Methods: We describe 26 patients with major neurologic conditions that seemed causally related to bariatric surgery encountered in the neurology service of a tertiary referral university medical center over a decade.

Results: The neurologic complications affected most regions of the nervous system: encephalopathy, optic neuropathy, myelopathy, polyradiculoneuropathy, and polyneuropathy. Myelopathy was the most frequent and disabling problem; symptoms began about a decade after surgery. Encephalopathy and polyradiculoneuropathy were acute and early complications. Except for vitamin B₁₂ and copper deficiencies in patients with myelopathy, we could not correlate specific nutritional deficiencies to the neurologic complications. All patients had multiple nutritional deficiencies, but their correction did not often yield dramatic results. The best result was achieved in one patient after surgical revision to reduce the bypassed jejunum.

Conclusions: A wide spectrum of serious neurologic conditions may follow bariatric surgery. These complications may occur acutely or decades later.

Received July 19, 2006. Accepted in final form February 21, 2007.

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