Disclosures: Nicholas Donohue, MD: No financial relationships or conflicts of interest

Case Description: A 26-year-old female was admitted to inpatient rehabilitation for strength and balance deficits due to severe nutrient deficiencies following bariatric surgery six months prior. She initially presented to the local Emergency Department for progressive diplopia, ataxia, and lower extremity weakness. Magnetic Resonance Imaging (MRI) brain and entire spine showed three hyperintense lesions in the pons and upper cervical spinal cord. An extensive autoimmune and infectious workup was unrevealing. Laboratory work up was significant for very low thiamine and copper levels. An electrodiagnostic evaluation was performed and showed an acute, symmetric, length-dependent, primarily axonal sensorimotor polyneuropathy. She was treated with intravenous copper and thiamine and was admitted to the rehabilitation unit. Upon discharge, she still required a wheelchair for mobility with moderate assistance for various activities of daily living. One year following her admission, she was ambulating without assistive device and had met all of her therapy goals.

Setting: An inpatient rehabilitation unit and physiatry clinic at an academic medical center

Patient: 26-year-old female with history of migraine and obesity who had recently undergone a laparoscopic sleeve gastrectomy. Assessment/

Results: This patient was diagnosed with a Combined Central and Peripheral Demyelinating process in the context of thiamine and copper deficiency following sleeve gastrectomy.

Discussion: Vitamin and other nutrient deficiencies is a known risk to bariatric surgery and can result in severe neurological deficits. While much in the literature has been written about central and peripheral demyelination due to Vitamin B12 and thiamine deficiency, demyelination due to copper deficiency is less common.

Conclusion: This case not only sheds light on this pathological process following sleeve gastrectomy, but it also provides an example of a good prognosis in a young patient who progressed from wheelchair mobility to walking without an assistive device in just 12 months.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/combined-central-and-peripheral-demyelination-in-a-26-year-old-female-following-bariatric-surgery/