Objective: Our objective is to report 6 cases series of MD after Bariatric surgeries (BS) and one case after hiatal surgery, with BS behavior.

Background: Several acute and long-term neurological complications after BS have been identified. Ba F and Siddigi ZA published a paper that described 2 two cases of Parkinsonism after BS^1,2,3. In 2014 we described our first patient, a 42-year-old female patient submitted to BS that developed PD 4 months after the surgery³.

Method: We describe a total of 7 patients, with severe weight loss after GI surgeries, one after hiatal surgery with 30 Kg loss.

Results: Patient 1: A 42-year-old female developed PD after BS. The Brain SPECT with TRODAT – ^99mTc showed severe binding reduction on the right striatum and discrete on the left. Patient 2: A 40-year-old female submitted to BS performed a non-complicated liposuction and immediately afterwards started with severe symptoms of RLS. The brain MRI demonstrated scattered and diffuse lesions on brain. Patient 3: A male patient, 43 years old, submitted to a BS developed major depressive mood and behavioral changes and cerebellar syndrome. The serum ammonia was elevated, 193 mcmol/L. The Brain MRI (T2/Flair weighted) demonstrated bilateral symmetric hypersignal affecting the spinal tract and cerebellar peduncles. Patient 4: A 60 years-old female was submitted to hiatal hernia surgery with total weight loss of 30 Kg. After the surgery she developed PD symptoms. The SPECT with TRODAT – 99mTc showed accentuate binding reduction on the left striatum. Patient 5: A 50 years-old female started with oromandibular dystonia after after the BS. Patient 6: A 28 years-old female with BS reported worsening of the ET tremors. The SPECT with TRODAT – 99mTc was normal. Patient 7: A 37 years-old female was submitted to BS and one year latter she developed PD.

Conclusion: The most common neurologic complications after BS are peripheral neuropathy and Wernicke encephalopathy. MD after bariatric surgeries are rare. Parkinsonism is a very rare complication with few case reports. Palacios et al in 2018 suggested limited to no association between appendectomy and PD. Parkinsonism is a very rare complication with few case reports. Aaron de Souza et al described some MD as consequence of chronic B12 low levels. We can’t do any further remarks, but we suggest Neurologists should keep in mind the possibility.

References: REFERENCES: 1) National Center for Health Statistics Health, United States, 2005. With Chartbook on Trends in the Health of Americans Hyattsville, Maryland: 2005. 2) Christou NV, Sampalis JS, Liberman M, et al. Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg. 2004;240(3):416–424. doi:10.1097/01.sla.0000137343.63376.19 3) Fang BA, Siddiqi A. Neurologic complications of Bariatric surgery. Rev Neurol Dis. 2010;7(4):119–124. 4) Fabiani G, Teive H. Parkinsonism onset after bariatric surgery, MDS 18th International Congress of Parkinson’s Disease and Movement Disorders, vol. 29, Abstract. Stockholm: Sweden: 2014. Jun 8-12. 5) Koffman, B. M., Greenfield, L. J., Ali, I. I. and Pirzada, N. A. (2006), Neurologic complications after surgery for obesity. Muscle Nerve, 33: 166-176. 6) Kamel WA, Hashel JY, Kilany A, Altailji S. Parkinsonism as a Complication of Bariatric Surgery. Open Access Maced J Med Sci. 2015;3(4):710–712. 7) Kromas ML, Mousa OY, John S. Hyperammonemia-induced encephalopathy: A rare devastating complication of bariatric surgery. World J Hepatol 2015; 7(7): 1007-1011 8) Palacios, N. , Hughes, K. C., Cereda, E. , Schwarzschild, M. A. and Ascherio, A. (2018), Appendectomy and risk of Parkinson’s disease in two large prospective cohorts of men and women. Mov Disord., 33: 1492-1496. 9) Acharya G, Mehra S, Patel R, Frunza-Stefan S, Kaur H. Fatal Nonhepatic Hyperammonemia in ICU Setting: A Rare but Serious Complication following Bariatric Surgery. Case Rep Crit Care. 2016; 2016:8531591. 10) Hu WT, Kantarci OH, Merritt JL, et al. Ornithine Transcarbamylase Deficiency Presenting as Encephalopathy During Adulthood Following Bariatric Surgery. Arch Neurol. 2007;64(1):126–128 11) Aaron de Souza & M. W. Moloi (2014) Involuntary movements due to vitamin B12 deficiency,Neurological Research, 36:12, 1121-1128

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