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Título

EXPANDING THE DIFFERENTIAL DIAGNOSIS OF POLYNEUROPATHIES: AN ATYPICAL MANIFESTATION AFTER GASTRIC BYPASS

RESUMO

CASE REPORT: Woman, 26 years old, started to experience several episodes of nausea and vomiting 15 days after performing a Roux-en-Y gastric bypass, due to grade III obesity. During this period, she did not ingest prescribed vitamin supplementation. After two months, she developed weakness of the lower limbs, with difficulty walking without assistance. She was admitted to the neurology service with symmetrical grade III strength in the lower limbs, in addition to burning-type paresthesias in the distal extremities of the four limbs. Complementary investigation of cerebrospinal fluid, serology and vitamin B12 were normal. Homocysteine levels were elevated. The neurophysiological study showed polyneuropathy with an accentuated sensory and moderate motor axonal pattern in the lower limbs. A presumptive diagnosis of deficiency polyneuropathy was performed and vitamin B complex and folic acid replacement was performed. The patient evolved with considerable improvement, walking without assistance after 2 months. DISCUSSION: Bariatric procedures are an alternative to the treatment of morbid obesity, offering benefits in relation to weight reduction and management of associated comorbidities. However, they can contribute to the evolution with important neurological complications, due to the reduction of the absorption surface, the decrease in the production of intrinsic factor and gastric juice by the parietal cells, in addition to the possibility of dietary restriction associated with events of vomiting in the postoperative period. This leads to vitamin and mineral deficiencies, such as the commonly described vitamins B1, B6, B9, B12, A, D, E, folate and copper. Neurological complications may arise after 3 to 20 months of the procedure and involve nerves, spinal cord and brain, as in polyneuropathies, myelopathies and cognitive syndrome. Treatment consists of vitamin replacement, with a strong role in remyelination and brain glucose metabolism, which may contribute to the gradual improvement or clinical stabilization of the patient. FINAL COMMENTS: Polyneuropathy is a possible neurological complication of bariatric procedures. The urgent approach with correction of nutritional disorders is mandatory to avoid the irreversibility of the condition.