Case series of acute nutritional neuropathies after gastric bypass: A Guillain Barré syndrome mimic

Abstract

Gastric bypass procedures for morbid obesity are increasingly common in the United States. Neuropathy following gastric bypass surgeries is estimated at 6%. Most practitioners recognize this as a chronic complication due to nutritional deficiencies. We present three cases of severe, acute, nutritional neuropathy occurring after gastric bypass surgeries. We retrospectively reviewed charts of three patients with acute to subacute neuropathies following gastric bypass surgeries presenting over one year to UTHealth. Data regarding clinical presentation, electrophysiology, diagnostic studies and outcomes are collected. We identified three patients with acute, disabling, ascending numbness and weakness. All patients had intractable vomiting and significant rapid weight loss. Electrodiagnostic studies revealed axonal sensory-motor neuropathy. Cerebrospinal fluid (CSF) studies did not show albuminocytologic dissociation. Two patients were treated with immunomodulation. Nutritional deficiencies were identified as the etiology in all patients. Further reports and research may prevent unnecessary and costly immunomodulatory treatments.