Nutritional deficiency after bariatric surgery has its consequence on nervous system. Thiamine reduction occurs weeks after surgery, which results in dysfunction of both central and peripheral nervous system. We report a case of a young female patient who was subjected to bariatric surgery four months ago, then she developed ascending flaccid paresis due to polyradiculoneuropathy, facial diplegia and respiratory distress; these manifestations were preceded by ataxia and disturbed conscious level. After an initial diagnosis of Miller Fisher variant of Guillain-Barré Syndrome, the patient received two sessions of plasma exchange, then we revised our diagnosis based on clinical signs and brain imaging which was suggestive of Wernicke’s encephalopathy. Consequently, we started thiamine infusion which resulted in improvement of both power and cognitive functions. Upon this case, we can deduce two key points: first, the importance of good nutritional support after bariatric surgery; second, the importance of considering nutritional deficiency as a differential diagnosis when facing any case with prior history of bariatric surgery.

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