Delayed inflammatory leukoencephalopathy after gastric bypass surgery.

We describe an unusual leukoencephalopathy in a female who developed global language and memory difficulties as well as diffuse FLAIR lesions in the cerebral white matter (WM) ~ 30 months after bariatric surgery. She had no detectable nutritional deficiency. She died suddenly due to cardiovascular disease. The cerebral WM revealed perivascular T-cell infiltrations and strong immunoreactivity for the amyloid precursor protein limited to axons, without signs of myelin or neuronal injury. Unexplained WM lesions have been reported in post-bariatric-surgery patients. Our findings suggest that altered immunity and axonal dysfunction could be responsible for leukoencephalopathy in some patients undergoing bariatric procedures.
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