Neurological complications and therapy of chronic alcoholism

1. Big picture

Chronic alcoholism damages the nervous system in several ways:

1. Direct toxic effect of ethanol and acetaldehyde
2. Malnutrition and vitamin deficiency, especially thiamine / vitamin B1 deficiency
3. Electrolyte disturbance, especially hyponatremia and its too-rapid correction
4. Liver disease and metabolic encephalopathy
5. Repeated trauma, especially head injury and subdural hematoma
6. Withdrawal syndromes after sudden reduction or cessation of alcohol

The key exam idea:

Chronic alcoholism can affect almost every level of the nervous system: muscle, peripheral nerve, optic nerve, spinal cord, brainstem, cerebellum, cortex, diencephalon, and corpus callosum.

The most urgent clinical rule:

In any alcoholic, malnourished, confused, ataxic, or ophthalmoplegic patient, give parenteral thiamine immediately, preferably before glucose.

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