713 - A Rare Neurologic Complication of Bariatric Surgery: Dry Beri Beri Syndrome

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

VB

Valerie Bresier, MD

Resident Physician
Rutgers New Jersey Medical School/Kessler Rehab
Bloomfield, New Jersey, United States

Co-Author(s)

SS

Sona Santy, DO

Medical Student
New York Institute College of Osteopathic Medicine
Syosset, New York, United States
KB

Katherine Bentley, MD

Chief Physiatry
Children's Specialized Hospital/ Rutgers Medical school
Union, New Jersey, United States

Submitter(s)

VB

Valerie Bresier, MD

Rutgers NJMS/Kessler
Bloomfield, New Jersey, United States

Case Diagnosis: Dry Beri Beri Syndrome Secondary to Bariatric Surgery

Case Description: Patient is a 15 year old female with a past medical history of anxiety, depression, pancreatitis, obesity status post gastric sleeve surgery who after cholecystectomy started developing dragging of her feet, increased falls, and mild confusion. Symptoms later included progressive weakness and difficulty walking. Workup included MRI spine which was negative, bilateral venous doppler negative for DVT, and vitamin panels which revealed thiamine and vitamin D deficiency. She received three doses of intravenous thiamine and later transitioned to oral. Given otherwise negative workup, she was admitted to inpatient rehabilitation for functional neurological disorder.

Discussions: The decision was made to pursue use of bilateral toe off ankle foot orthoses (AFOs) which were helpful in assisting with gait and standing. Though her progress was often limited by anxiety and fear, due to the use of thiamine supplementation and AFOs, she was able to progress to trials of standing with Evolv stander and walking up to 100 feet which had not been attempted prior. Gabapentin was also started and increased for neuropathic pain.

Conclusions: This patient developed dry beri beri syndrome, a rare but severe form of thiamine deficiency affecting the peripheral nervous system. This may present with foot drop, peripheral neuropathy, and/or cognitive impairment, all of which were present in her case. Patients who have undergone bariatric surgery are at risk of developing vitamin deficiencies and vitamin panels can be used to provide supplementation if necessary. Multiple diagnoses often coexist especially in pediatric and adolescent populations. It is important not to dismiss the presence of true neurologic concerns in the case of a patient with concomitant functional neurologic disorder. This case involved the interdisciplinary effort from physiatry, nutrition, psychology, physical and occupational therapy to properly address her needs.