{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T05:06:40Z","timestamp":1766725600421,"version":"3.48.0"},"reference-count":11,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,12,3]]},"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:p>We describe an unusual case of a woman in her 30s who had recently undergone Roux-en-Y gastric bypass and presented to the emergency department with a 6-week history of intractable nausea and vomiting, accompanied by progressively worsening bilateral leg weakness. Examination revealed persistent upbeat nystagmus, paraparesis, areflexia in the lower extremities, brisk reflexes in the upper extremities and diminished sensation across all modalities in lower limbs. Brain and spine MRIs were unremarkable, there was no nerve root enhancement. Laboratory tests revealed thiamine deficiency, with a level of 28 nmol\/L (reference range: 70\u2013108 nmol\/L). No gangliocyte antibodies were detected. Cerebrospinal fluid study showed no albuminocytological dissociation. Electrodiagnostic studies showed evidence of lumbosacral polyradiculopathy. The patient was eventually diagnosed with thiamine deficiency-related acute nutritional axonal neuropathy and Wernicke\u2019s encephalopathy. After aggressive thiamine supplementation and 8 weeks of physical rehabilitation, her leg strength improved, but she still requires assistance to ambulate.<\/jats:p>","DOI":"10.1136\/bcr-2025-265745","type":"journal-article","created":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T05:05:15Z","timestamp":1766725515000},"page":"e265745","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Acute nutritional axonal neuropathy and Wernicke\u2019s encephalopathy status post Roux-en-Y gastric bypass"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-5806-4441","authenticated-orcid":false,"given":"Eduardo A","family":"Canto","sequence":"first","affiliation":[{"name":"School of Medicine, Creighton University, Omaha, Nebraska, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammad R","family":"Asghar","sequence":"additional","affiliation":[{"name":"School of Medicine, Creighton University, Omaha, Nebraska, USA"},{"name":"CHI Health Clinic Neurological Institute at Immanuel, Omaha, Nebraska, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saif","family":"Bawaneh","sequence":"additional","affiliation":[{"name":"School of Medicine, Creighton University, Omaha, Nebraska, USA"},{"name":"CHI Health Clinic Neurological Institute at Immanuel, Omaha, Nebraska, USA"},{"name":"Department of Vascular Neurology, Mayo Clinic Jacksonville Campus, Jacksonville, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9775-627X","authenticated-orcid":false,"given":"Yu-Ting","family":"Chen","sequence":"additional","affiliation":[{"name":"School of Medicine, Creighton University, Omaha, Nebraska, USA"},{"name":"CHI Health Clinic Neurological Institute at Immanuel, Omaha, Nebraska, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,12,25]]},"reference":[{"key":"2025122521050620000_18.12.e265745.1","unstructured":"Estimate of bariatric surgery numbers, 2011-2022 - American society for metabolic and bariatric surgery."},{"key":"2025122521050620000_18.12.e265745.2","doi-asserted-by":"publisher","DOI":"10.4065\/80.1.136-b"},{"key":"2025122521050620000_18.12.e265745.3","unstructured":"Wernicke encephalopathy - uptodate."},{"key":"2025122521050620000_18.12.e265745.4","first-page":"e2134","article-title":"Clinical Spectrum and Prognosis in Patients With Acute Nutritional Axonal Neuropathy","volume":"100","author":"Hamel","year":"2023","journal-title":"Neurology (ECronicon)"},{"key":"2025122521050620000_18.12.e265745.5","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1002\/mus.25702","article-title":"Acute nutritional axonal neuropathy","volume":"57","author":"Hamel","year":"2018","journal-title":"Muscle Nerve"},{"key":"2025122521050620000_18.12.e265745.6","unstructured":"Overview of water-soluble vitamins - uptodate."},{"key":"2025122521050620000_18.12.e265745.7","doi-asserted-by":"publisher","DOI":"10.1007\/s10571-008-9297-7"},{"key":"2025122521050620000_18.12.e265745.8","doi-asserted-by":"crossref","DOI":"10.3390\/nu15132823","article-title":"The Role of Vitamin B6 in Peripheral Neuropathy: A Systematic Review","volume":"15","author":"Muhamad","year":"2023","journal-title":"Nutrients"},{"key":"2025122521050620000_18.12.e265745.9","unstructured":"Causes and pathophysiology of vitamin b12 and folate deficiencies - uptodate."},{"key":"2025122521050620000_18.12.e265745.10","doi-asserted-by":"crossref","first-page":"309","DOI":"10.4103\/aian.AIAN_24_17","article-title":"Post bariatric Surgery Acute Axonal Polyneuropathy: Doing Your Best is Not Always Enough","volume":"20","author":"Yasawy","year":"2017","journal-title":"Ann Indian Acad Neurol"},{"key":"2025122521050620000_18.12.e265745.11","doi-asserted-by":"crossref","first-page":"1304","DOI":"10.1080\/00207454.2023.2263811","article-title":"Acute polyneuropathies after bariatric surgery: does immunity play a role? Case series and literature review","volume":"133","author":"Keskin","year":"2023","journal-title":"Int J Neurosci"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-265745","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T05:05:16Z","timestamp":1766725516000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-265745"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12]]},"references-count":11,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12,25]]},"published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1136\/bcr-2025-265745"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-265745","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12]]}}}