神経学的障害

Inflammatory Polyneuropathy after Bariatric Surgery: Report of Two Cases

Abstract

Joana Carvalho Dias, Cecília de Medeiros Vidal and Marcos R.G. de Freitas

Obesity is an important health problem worldwide. The bariatric surgeries (BS) are becoming more frequent due to the high prevalence of obesity. Acute and chronic neurological complications have been reported after this procedure, and can result mainly from nutritional deficiency. There are some reports of peripheral neuropathies due to mechanical or inflammatory mechanisms.

Objective: To report two cases of inflammatory polyneuropathy (PN) after bariatric surgery, without nutritional deficiency.

Case reports: The first patient was a young woman who presents a painful sensorial-motor PN, months after a BS. The other patient was an old man with a pure painful small-fiber PN, one year after the BS. In both patients, there was no nutritional deficiency and blood “screening” for polyneuropathy was unremarkable. The patients underwent a sural nerve biopsy.

Results: The nerve biopsy demonstrated a mild inflammatory infiltrate around epineural vessels and a few axonal and demyelination changes. They were treated with intravenous immunoglobulin with good results.

Conclusion: Although most of the peripheral neuropathies complications after BS are due to nutritional deficiencies, some neuropathies are due to inflammatory involvement of the peripheral nerve. An autoimmune process has been accepted as the underlying pathophysiology in these cases. We think that the nerve biopsy is necessary to support this diagnosis in order to initiate an efficacious treatment.