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Tatsuo Shimomura, MD; Etsuro Mori, MD; Nobutsugu Hirono, MD; Toru Imamura, MD; Hikari Yamashita, MA

Arch Neurol. 1998;55:1242-1245.

Background  Surgical exclusion of portions of the gastrointestinal tract is a predisposing risk factor for the development of Wernicke-Korsakoff syndrome. When this disease occurs, it is usually within weeks after the gastrointestinal surgery. However, it is not well known that Wernicke-Korsakoff syndrome may occur after a long latent interval following gastrectomy.

Setting  A research-oriented hospital.

Patients  Three patients without a history of alcoholism or dietary deprivation developed Wernicke-Korsakoff syndrome 2 to 20 years after undergoing gastrectomy. In these patients, minor changes in dietary habit led to the development of Wernicke-Korsakoff syndrome.

Conclusions  In addition to a long-standing latent deficiency in thiamin levels due to defective absorption following gastrectomy or gastrojejunostomy, other minor factors that may influence the intake of thiamin and the need for thiamin in subjects who have undergone gastrectomy may cause a state of thiamin deficiency resulting in Wernicke-Korsakoff syndrome. Results from our study indicate that the following measures are mandatory: educating patients about proper dietary habits, carefully monitoring their thiamin intake, recognizing Wernicke-Korsakoff syndrome early, and treating it immediately with appropriate measures.

From the Departments of Clinical Neurosciences (Drs Shimomura, Mori, Hirono, and Imamura and Mr Yamashita) and Neurology Service (Drs Shimomura, Mori, Hirono, and Imamura), Hyogo Institute for Aging Brain and Cognitive Disorders, Himeji, Japan.

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