Rare neurologic complication of bariatric surgery: acute motor axonal neuropathy (AMAN), a severe motor axonal form of the Guillain Barré syndrome

• DOI: 10.1016/j.soard.2014.02.019
• Publication Date: 2014-02-27T00:46:08Z
• Authors: Anne F. Landais
• Keywords: Gastric bypass surgery; Hyporeflexia

Bariatric surgery (BS) procedures are more and more common and have various neurologic complications including acute polyradiculoneuropathies [1–4]. These patients tend to have axonal degeneration rather than demyelination, and normal cerebrospinal fluid (CSF) protein levels [2]. These polyradiculoneuropathies, rapidly progressive, have been described between 6 weeks and 2 years after surgery [2]. Symptoms include pain in the feet or lower limbs, with ascending paresthesias, progressive leg weakness with ataxia, and areflexia. BS neurologic complications are usually related to micronutrients deficiencies secondary to malabsorption after surgery [1]. But immune and inflammatory processes may play a part in the pathogenesis of neuronal injury, as suggested by data from sural nerve biopsies showing inflammatory cell infiltrates in patients with acute or subacute neuropathies or radiculoplexoneuropathies post-BS [5]. We report a case where the presence of anti-GM1, anti-MAG, anti-GD1a antibodies in a patient with acute motor axonal neuropathy (AMAN), 5 months after BS supports this immunologic hypothesis.