NEUROPATHY-ALCOHOLIC

SUMMARY

1. Alcohol is directly toxic to both nerves and muscles and causes many kinds of neuropathies (peripheral, autonomic, compressive). Neuropathy is detected in 25-66% of alcoholics in EMG.

2. The polyneuropathy is typically axonal but is made worse if demyelination is superimposed (caused by nutritional deficiencies).

3. Pathogenesis: toxic effect of ethanol, thiamine deficiency, possible thiamine utilization defect, increased protein-kinase-C activity, myelin dysfunction.

4. Presentation: painful, symmetric, length-dependent sensory (more than motor) & autonomic dysfunction.

5. Treatment: cessation of alcohol intake, dietary advice, vitamin supplementation, symptomatic pain releif (with anti-neuropathic agents, opioids).

6. Note: Acute thiamine deficiency presents as Wernicke's: polyneuropathy (weakness of extraocular muscles & ataxia) assoc. with delirium.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].