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The case report describes a 37-year-old woman treated with semaglutide who developed marked weight reduction and rapid glycemic control over three months, followed by progressive right leg numbness and weakness, then left leg symptoms and blurred vision. Initial B12 deficiency diagnosis and supplementation failed, and she progressed to acute encephalopathy. Workup identified thiamine deficiency, severe axonal polyneuropathy on NCS/EMG, and severe axonal neuropathy on nerve biopsy. The most likely causes were non-alcoholic Wernicke’s encephalopathy and treatment-induced neuropathy of diabetes.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/neurological-complications-associated-with-rapid-weight-loss-and-nutritional-deficiencies-following-glp-1-agonist-use-a-case-report/422809/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/neurological-complications-associated-with-rapid-weight-loss-and-nutritional-deficiencies-following-glp-1-agonist-use-a-case-report/422809.png","ImageObject",300,407,{"name":92,"@type":93},"mieayamfan","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-07","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",14,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What neurological complications were reported after GLP-1 agonist use?","Question",{"text":113,"@type":114},"The report describes non-alcoholic Wernicke’s encephalopathy and treatment-induced neuropathy of diabetes occurring in the same patient after GLP-1 agonist use.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"How did the patient’s symptoms progress over time?",{"text":118,"@type":114},"After significant weight loss and rapid glycemic improvement, she developed progressive right leg numbness and weakness, followed by similar left leg symptoms and blurred vision before worsening to acute encephalopathy.",{"name":120,"@type":111,"acceptedAnswer":121},"What diagnostic findings supported the final etiology?",{"text":122,"@type":114},"Workup showed thiamine deficiency, severe axonal polyneuropathy on NCS/EMG, and nerve biopsy findings demonstrating severe axonal neuropathy, leading to the favored etiologies.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},422809,1790688518,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":34,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},962090893677,"https://ap-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2","Zahir etal. BMC Neurology (2026) 26:5 [https://doi.org/10.1186/s12883-025-04540-7](https://doi.org/10.1186/s12883-025-04540-7)  \nBMC Neurology  \nCASE REPORT Open Access  \nNeurological complications associated with rapid weight loss and nutritional deficiencies following GLP-1 agonist use:  \na case report  \nAli Zahir 1,2*, David Collins 1,2, Seyvonne Ip3, Peyman Samghabadi4, Vanja C. Douglas 1,2 and Sara C. LaHue 1,2  \nAbstract  \nGLP-1 agonists have been a welcome addition to the armamentarium in the treatment of diabetes and obesity. While this class of medications is generally considered safe and effective, potentially severe neurological complications may be associated with rapid weight loss and nutritional deficiencies following GLP-1 agonist use. We present a 37-year-old woman who was prescribed semaglutide for diabetes and weight loss who subsequently experienced significant weight reduction and rapid glycemic control over three months. Thereafter, she developed progressive right leg numbness and weakness, followed by similar symptoms in the left leg, and blurred vision. Initially diagnosed with B12 deficiency, her symptoms worsened despite supplementation, leading to acute encephalopathy and transfer to a tertiary center. Neurological examination revealed disorientation, ocular abnormalities, weakness, sensory deficits, and preserved ankle jerks. Diagnostic workup was notable for thiamine deficiency, NCS/EMG showing a severe, axonal polyneuropathy, and nerve biopsy redemonstrating severe axonalneuropathy. After extensive diagnostic workup, the most likely etiology of her clinical presentation was favored tobe non-alcoholic Wernicke’s encephalopathy (NAWE) and treatment-induced neuropathy of diabetes (TIND) . This case suggests that vulnerable individuals may experience significant adverse neurological complications from the metabolic effects of GLP-1 agonist use. As a class effect, the benefits of these medications outweigh the risks, but their use warrants consideration of their potential sequelae.  \n*Correspondence:  \nAli Zahir  \n[ali.zahir@ucsf.edu](ali.zahir@ucsf.edu)  \n1Department of Neurology, School of Medicine, University of California, San Francisco, USA  \n2UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA  \n3Department of Medicine, School of Medicine, University of California, San Francisco, USA  \n4Department of Pathology, School of Medicine, University of California, San Francisco, USA  \nBackground  \nGLP-1 receptor agonists have transformed the therapeutic landscape for both type 2 diabetes mellitus and obesity, primarily by modulating appetite and gastric emptying to facilitate weight loss [1]. While these medications offer significant metabolic benefits, the physiological alterations they can induce are not without potential concerns. This case report serves to highlight a critical, albeit rare, association between GLP-1 agonist therapy and the subsequent development of two distinct neurological complications: non-alcoholic Wernicke’s encephalopathy (NAWE) and treatment-induced neuropathy of  \n© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creativecommons.org/l](http://cr","cbCaihaSQuZeWf4c","https://ap.wps.com/l/cbCaihaSQuZeWf4c","pdf",1386189,"English","# Abstract\n## Background\n## Case report","[{\"question\":\"What neurological complications were reported after GLP-1 agonist use?\",\"answer\":\"The report describes non-alcoholic Wernicke’s encephalopathy and treatment-induced neuropathy of diabetes occurring in the same patient after GLP-1 agonist use.\"},{\"question\":\"How did the patient’s symptoms progress over time?\",\"answer\":\"After significant weight loss and rapid glycemic improvement, she developed progressive right leg numbness and weakness, followed by similar left leg symptoms and blurred vision before worsening to acute encephalopathy.\"},{\"question\":\"What diagnostic findings supported the final etiology?\",\"answer\":\"Workup showed thiamine deficiency, severe axonal polyneuropathy on NCS/EMG, and nerve biopsy findings demonstrating severe axonal neuropathy, leading to the favored etiologies.\"}]","Neurological complications associated with rapid weight loss and nutritional deficiencies following GLP-1 agonist use - a case report | PDF",1790628881,18]