SHM Converge Scientific Abstract ePoster Gallery-Bypass Blindness

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This case describes a 38-year-old woman who developed severe neurologic and visual symptoms shortly after Roux-en-Y gastric bypass surgery. Eight weeks after surgery in Mexico, she presented with 4 weeks of persistent nausea and vomiting, followed by 6 days of vertigo, blurred vision, and generalized weakness. Exam showed bilateral decreased visual acuity, vertical nystagmus in all gaze directions, and diffuse 4/5 weakness.<br /><br />An extensive workup for neurologic, autoimmune, infectious, and metabolic causes was negative, including normal CSF studies, endocrine testing, and inflammatory markers. Nutritional testing revealed deficiencies in vitamin A, copper, and thiamine (B1), while other vitamins were normal. Brain MRI showed bilateral optic nerve atrophy and enhancement of the left optic nerve.<br /><br />The final diagnoses were optic neuropathy from vitamin A deficiency and nystagmus/global weakness from copper and B1 deficiencies. She was treated with total parenteral nutrition and vitamin supplementation, with near-resolution of symptoms and normalization of vitamin levels. Her vision improved substantially, though she continued vitamin A supplementation.<br /><br />Key teaching points: nutritional deficiencies can occur rapidly—within days to weeks—after bariatric surgery, especially Roux-en-Y or biliopancreatic diversion. Vitamin A, thiamine, and copper are particularly vulnerable because they are absorbed in the duodenum and proximal jejunum. Protracted postoperative vomiting increases risk. Patients with new, unexplained neurologic symptoms after bariatric surgery should receive a broad nutritional evaluation and empiric supplementation promptly to prevent permanent deficits.

Asset Subtitle

Courtney E. Detwiler

Meta Tag

Author List Courtney E. Detwiler, Evan Raff, Nicholas Piazza

Category Clinical Vignettes

Concept Bariatric Surgery

Concept Nutritional Deficiency

Concept Vitamin A

Concept Thiamine

Concept Copper

Distinguished Non-Finalist

Presenter Organization UNC Hospitals

Presenting Author Courtney E. Detwiler

Track Adult

Keywords

Roux-en-Y gastric bypass

vitamin A deficiency

copper deficiency

thiamine deficiency

optic neuropathy

nystagmus

bariatric surgery complications

nutritional deficiency

postoperative vomiting

neurologic symptoms

Bariatric Surgery

Nutritional Deficiency

Vitamin A

Thiamine

Copper