You have a lawyer at Painter Law Firm

Bariatric surgery and the dangerous complication of malnutrition-related Wernicke’s encephalopathy

When a surgeon fails to diagnose and treat Wernicke’s encephalopathy quickly, it can leave the patient with a permanent brain injury

Bariatric weight-loss surgery offers help for many people struggling to attain or manage a healthy weight. It’s not without risks, though.

Based on my experience as a Houston, Texas medical malpractice attorney, I’ve found that many bariatric surgical practices are run like an assembly line. Patients are often managed in groups, rather than as individuals. Things often start with a pre-operative group sales pitch. Next, a lobby full of patients are run through an operating room on a given day for surgery. Even post-operative follow-up care might be provided in a group lecture and question-and-answer format.

With a rushed environment aimed at maximizing profit, some things can fall through the cracks. Take diet, for instance. The truth is that when a patient has a successful bariatric surgery it’s, at best, one part of a weight-control plan. Another significant part is diet.

As weight-loss surgeries have become more popular, experts have found that many patients experience malnutrition. It’s easy to see how that could happen, considering that any bariatric procedure involves surgically modifying the stomach and sometimes even the way the intestines handle absorption of nutrients.

One of the worst malnutrition outcomes for post-operative bariatric patients is a dangerous brain injury called Wernicke’s encephalopathy.

What is Wernicke’s encephalopathy?

This condition is brought on from a nutritional deficiency of thiamine, which is also called Vitamin B1. It was originally discovered as a condition that plagued long-term alcoholics, but more recently doctors have seen a significant uptick of Wernicke’s encephalopathy diagnoses in patients who have undergone bariatric surgery.

The most common weight-loss procedure associated with this serious disorder is gastric bypass surgery, including the Roux-en-Y gastric bypass.

There are three classic signs of Wernicke’s encephalopathy:

(1) Mental confusion (altered mental status or disorientation)

(2) Ataxia (loss of balance or coordination)

(3) Opthalmoplegia (paralysis or weakness of the eye muscles)

It’s hard to overemphasize the importance of mental confusion or altered mental status after any surgery. Physicians of various specialties recognize it as one of the earliest signs of brain or neurological compromise. Quite often, the first people to recognize a change in mental status or family members or friends.

For example, a man in his 40s had a Roux-en-Y gastric bypass surgery and did pretty well postoperatively, other than some bouts of vomiting. About one month after surgery, though, family members noticed that he was occasionally having a rough time maintaining concentration, engaging in normal conversation, and even recognizing family members. Over time, these episodes became more frequent, and he became disoriented—not knowing the date or time, where he was, or even his name. His family took him to the hospital, where he was diagnosed with Wernicke’s encephalopathy.

To formally diagnose a patient with a serious neurological disorder, a physician looks for two of the following features:

(1) a deficiency in diet

(2) abnormal eye movements (oculomotor function)

(3) cerebellar dysfunction (the cerebellum is the part of the brain that controls balance and voluntary movements)

(4) confusion or mild memory impairment


Patients with a recent history of bariatric surgery have a higher risk of malnutrition and, therefore, of developing Wernicke’s encephalopathy. That’s why it’s important for surgeons to listen and take seriously the reports and complaints of their patients, including any of the signs of this condition.

When there is a reasonable basis to suspect a nutritional deficiency or Wernicke’s encephalopathy, the standard of care requires the surgeon to order lab work to assess the blood serum thiamine concentration. In some situations, an MRI scan of the brain is warranted. The MRI is recognized by experts as the most valuable method to confirm the diagnosis of Wernicke’s encephalopathy.

Fortunately, when this condition is appropriately diagnosed and treated with administration of thiamine, most patients respond well. If this condition isn’t promptly diagnosed and treated, it can lead to permanent mental impairment known as Korsakoff’s syndrome in about 85% of patients who survive.

If you or someone you care for has been seriously injured because of a botched diagnosis or treatment of Wernicke’s encephalopathy, a top-rated experienced Houston, Texas medical malpractice attorney can help you evaluate and pursue your potential case.

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him by calling 281-580-8800 or emailing him right now.

// Read full biography
// Read more expertise by Robert Painter

Discover More