Optic neuropathy and a reversible splenial lesion after gastric bypass: shared pathophysiology?

A 22-year-old female presented 2months after a laparascopic gastic bypass with 3weeks of progressive painless visual loss. Ophthalmologic exam revealed severely reduced visual acuity, central scotomas, and optic nerve edema bilaterally. She was noted to have a mild encephalopathy. MRI of the brain revealed restricted diffusion in the splenium of the corpus callosum. The patient was treated with 3days of intravenous methylprednisolone, intravenous fluids, and re-institution of vitamin supplementation. Four weeks later, she had significant improvement in her visual acuity and marked reduction in central scotomas. Her encephalopathy resolved and the splenial abnormality disappeared on repeat brain MRI. This is the first reported case of a bilateral optic neuropathy and a reversible splenial lesion syndrome after gastric bypass. The presentation of both conditions in our patient may suggest a shared pathophysiology.