Neuropsychiatric manifestations after gastric bypass progressing to status epilepticus resolving with pyridoxine: a case report and literature review.

INTRODUCTION AND

IMPORTANCE

Vitamin B6 (pyridoxine) deficiency is a rare but reversible cause of seizures in adults, which is often overlooked in post gastrectomy patients. This case highlights the critical role of nutritional supplementation in preventing severe complications such as neuropsychiatric manifestations and seizures, emphasizing the importance of vigilance in postoperative care and patient follow-up.

CASE PRESENTATION: A 46-year-old woman with a history of partial gastrectomy presented with intermittent confusion and somnolence for a duration of 6 months. Physical exam revealed temporal wasting, dry skin, and a low BMI. Laboratory tests showed undetectable levels of vitamin B6, while an electroencephalogram (EEG) demonstrated electrographic status epilepticus. Despite antiepileptic therapy the patient's symptoms continued until high dose intravenous vitamin B6 was administered, leading to rapid improvement clinically and on EEG. The patient was discharged on oral pyridoxine and multivitamins, remaining seizure-free including at her 6-month follow-up.

CLINICAL DISCUSSION: This case illustrates the rare occurrence of adult-onset seizures due to vitamin B6 deficiency, following gastric surgery. A thorough literature review shows a link between pyridoxine deficiency and seizures, specifically in the context of malnutrition or chronic health conditions. This case underscores a need for routine preoperative and postoperative nutritional assessments, including micronutrient level monitoring in order to mitigate these risks.

CONCLUSION

This case illustrates an extremely rare but preventable clinical syndrome of vitamin B6 deficiency and re-emphasizes the role of nutritional supplementation after gastrectomy. Prompt recognition and treatment of this condition are essential, highlighting the critical role of comprehensive nutritional care and postoperative management of gastrectomy patients.