Abstract: A case of a 20 year old male with opthalmoplegia, nystagmus, distal weakness and ataxia 10 weeks after sleeve gastrectomy for weight loss. Nerve conduction studies revealed axonal sensory motor neuropathy consistent with vitamin B1 (thiamine) deficiency. His condition improved with IV thiamine replacement however ataxia persisted. One year later, at the age of 21, gait disturbance remained and he was using Dictus bands to assist with persisting foot drop. The case highlights the important of adequate nutritional investigation and supplementation both before and after sleeve gastrectomy.