The CDC reports the prevalence of obesity in the US as 42.4% in 2017 – 2018. Thus, Americans have turned to surgical interventions in order to combat obesity. Per the American Society for Metabolic and Bariatric Surgery, 252,000 bariatric surgeries were performed in 2018. Surprisingly, 20-30% of patients have micronutrient deficiencies preceding surgery and the prevalence of post-surgical neurologic complications secondary to nutritional deficiencies range from 1.3 – 16%. The below case highlights under-recognized neurologic complications secondary to nutritional complications from bariatric surgery.

62-year-old woman with history of obesity presented four months post Roux-en-Y anastomosis with progressive ascending paresthesia of the lower extremities, paraparesis, and radicular pain. Post-surgical course was notable for protracted nausea and vomiting requiring recurrent hospitalizations for intravenous (IV) hydration. Examination demonstrated a large and small fiber polyneuropathy in all four extremities and a mild symmetric paraparesis. Subsequent work-up was notable for a thiamine level of 38.1 nmol/L. The patient was diagnosed with dry beriberi and admitted for IV thiamine supplementation. Treatment with thiamine 500mg three time daily for three days followed by 100mg oral supplementation daily thereafter was initiated. The patient’s neuropathic pain and sensory abnormalities improved, however she never returned to her premorbid baseline.