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The authors report the neuropathologic findings in a case of Sneddon's syndrome. There were multiple small, predominantly cortical, infarcts, with focal hyperplasia and fibrotic occlusion of arterial vessels in the superficial white matter, cortex, and leptomeninges. A very occasional arterial thrombus was seen. These findings suggest that Sneddon's syndrome is caused by a noninflammatory arteriopathy affecting superficial cerebral vessels.

Despite widespread uptake of bariatric procedures for severe obesity, changes in pharmacodynamics after surgery are poorly understood. We report an epileptic patient who had a seizure following gastric bypass, although he had been asymptomatic for 30 years and without any change in his treatment. Phenytoin levels were undetectable despite a high dose. Drugs with a narrow therapeutic range such as phenytoin should be prescribed with caution after bariatric surgery.

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