A 66-year-old female patient with a past medical history of obesity and ORBERA@ intragastric balloon placement presented with Wernicke’s encephalopathy (WE) features without social history of alcoholism. The patient was subjected to ORBERA@ balloon bariatric procedure in Egypt and subsequently developed episodes of uncontrolled emesis which prompted removal of the intragastric balloon placement one month later. Two weeks after removal of the intragastric balloon placement, vomiting still persisted. Patient suddenly developed altered mental status and weakness which prompted admission to our hospital. Initial clinical examination was largely inconclusive, bilateral horizontal nystagmus was noted after subsequent days. A tentatively diagnosis of WE was made based on clinical presentation and magnetic resonance imaging (MRI) scan results; vitamin B1 (thiamine) levels were ordered but were still pending. Empiric treatment with vitamin B1 infusion was initiated which resulted in improvement of both motor function and cognitive functions. Patient was given 200 mg IV TID for 8 days, then 100 mg po for 6 months. Patient was also started on folic acid and vitamin B12. WE diagnosis was supported one week later after lab results showed low vitamin B1 level (21 nmol/L). The patient was sent to rehabilitation center for 6 weeks then was able to be discharged home with a 6-month supply of vitamin B1 supplements. On discharge, memory deficits, loss of appetite and docility were noted.

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