Case report: Alcohol use disorder and noncompliance as factors in a case of probable Korsakoff syndrome diagnosed 10 years after gastric bypass

Abstract

Background

Wernicke-Korsakoff syndrome (WKS) is a neuropsychiatric condition caused by thiamine deficiency, often associated with chronic alcohol use. We report a case of probable Korsakoff syndrome 10 years after bariatric weight loss surgery in a patient with alcohol use disorder.

Case presentation

A 53-year-old male with a history of alcohol use disorder and Roux-en-Y gastric bypass surgery presented with severe memory impairment, confabulation, nystagmus, and ataxia. He had discontinued his vitamin supplements and increased his alcohol consumption after the surgery. MRI of the brain showed significant atrophy of the mammillary bodies and mild to moderate cerebral volume loss. He was diagnosed with probable Korsakoff syndrome and treated with parenteral and intramuscular thiamine, with minor improvement.

Discussion

This case illustrates the risk of developing WKS following bariatric surgery, especially in patients with alcohol use disorder. Thiamine deficiency can result from malabsorption, malnutrition, or excessive vomiting after the surgery. Alcohol use can exacerbate the deficiency by impairing thiamine absorption and utilization. The diagnosis of WKS is often delayed or missed due to its variable presentation and low clinical suspicion.

Conclusions

WKS is a potentially preventable and treatable condition that can have devastating consequences if left untreated. Patients undergoing bariatric surgery should be screened for alcohol use disorder and counseled on the importance of adhering to vitamin supplementation and avoiding alcohol. Clinicians should be aware of the possibility of WKS in patients with bariatric surgery and alcohol use disorder who present with cognitive or neurological symptoms. Early diagnosis and treatment with thiamine can improve outcomes and prevent irreversible brain damage.