Alcohol abuse and its neurologic complications

Kelly G Devers MD (Dr. Devers of the Office of the Hillsborough County Medical Examiner and the University of South Florida has no relevant financial relationships to disclose.)
Zachary N London MD, editor. (Dr. London of the University of Michigan has no relevant financial relationships to disclose.)
Originally released October 9, 1997; last updated January 2, 2017; expires January 2, 2020

This article includes discussion of alcohol abuse and its neurologic complications, alcoholism, alcohol abuse, alcohol dependence disorder, alcohol misuse disorder, and alcohol use disorder. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

The topic of alcohol abuse related to acute and chronic exposure covers a wide spectrum of neurologic syndromes involving the central and peripheral nervous system. Historical perspectives, clinical manifestations, clinical vignettes, etiology, pathogenesis, pathophysiology, epidemiology, prognosis, complications, and management are all discussed in this updated article. In addition, the authors discuss select mechanisms of cellular injury by alcohol.

Key points

 

• Alcohol intoxication has an acute and chronic symptomatology.

 

• The lethal dose of alcohol varies widely and depends on many external and internal factors. Tolerance develops with repeated exposures.

 

• Wernicke-Korsakoff syndrome is particularly found in the alcoholic population.

 

• Alcohol affects almost all areas of the brain.

 

• Alcohol affects the functioning of many systems in the body (heart, liver, muscle, nerve).

 

• A chronic, nondiabetic abuser of ethyl alcohol who presents to the emergency room with abdominal pain, nausea, intractable emesis, and dyspnea should prompt consideration of alcoholic ketoacidosis.

Historical note and terminology

Alcohol has been consumed by humans for thousands of years. Stone Age beer jugs from the Neolithic period (circa 10,000 B.C.) have been discovered. Its effects on the central and peripheral nervous system are varied, and overuse of alcohol can have serious medical and neurologic consequences, even death. The role of alcoholism in the development of cognitive and functional decline has been known since the time of Hippocrates and has received serious study within Western medicine for more than a century.

Alcoholic neuropathy was documented at least as early as 1787 by Lettsom, but other neurologic complications of alcoholism were probably not recognized until the end of the 19th century or later. Deficits in memory and intellectual ability were reported by Lawson in 1878, and, soon afterward, Korsakoff described a profound memory impairment that occurred in some patients with a history of alcohol abuse. Subsequently, it was realized that Korsakoff psychosis was 1 potential outcome from Wernicke encephalopathy, first described in 1881, and the 2 terms became linked as Wernicke-Korsakoff syndrome. The term “alcoholism” was first used by a Swedish physician in 1849 to describe adverse systemic effects of alcohol. Also, early psychiatry texts described a syndrome of alcohol-related deterioration characterized by intellectual and behavioral abnormalities (American Psychiatric Association 1968).

In the last century, through careful observation and description, Maurice Victor and Raymond Adams made the most prodigious contributions in understanding the neurologic complications of alcohol abuse (Adams et al 1959; Victor et al 1959; Victor et al 1989; Victor and Brausch 1967; Victor 1994; Victor and Ropper 2001). The DSM-IV defines alcoholism as “maladaptive alcohol use with clinically significant impairment.”

Alcoholism affects all socioeconomic levels of society and appears to have a strong genetic predisposition (Prescott and Kendler 1999), although environmental and cultural influences also clearly play a role (Victor and Ropper 2001). The definition of alcoholism by the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine is “a primary, chronic disease characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking.”

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