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September 17, 1982

Wernicke's Encephalopathy After Gastric Plication

JAMA. 1982;248(11):1311. doi:10.1001/jama.1982.03330110019016

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To the Editor.—  Haid and co-workers (1982;247:2566) described two patients with a serious neurological complication following gastric plication procedures for morbid obesity. I would like to describe a third patient to reemphasize the potential seriousness of this neurological complication, which is totally avoidable if recognized clinically early in the course of illness.

Report of a Case.—  A 24-year-old woman had gastric plication procedure for morbid obesity in late January 1982 without apparent complication. She did well postoperatively, except for mild hypertension. Three months after the procedure, rather protracted nausea and vomiting developed with documented hypochloremic hypokalemic metabolic acidosis, and she was given appropriate fluid and electrolyte supplementation. She continued to have problems with vomiting for several weeks.A urinary tract infection was treated with ampicillin; then the patient experienced photophobia complicated by double vision, vertigo, and biparietal headaches. On neurological examination, she had gaze paretic nystagmus in both horizontal and