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ALCOHOL AND THE NERVOUS SYSTEM
DR M KAKAZA
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COMMON COMPLICATIONS
• Nutritional deficiency• Diseases partly nutritional in origin• Direct effects of alcohol• Abnormalities of electrolytes and osmolality• Diseases of uncertain pathogenesis
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A. Nutritional Complications
• Wernicke’s Encephalopathy• Korsakoff’s syndrome• Pellagra
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1. Wernicke’s Encephalopathy
• Clinical features include:•Confusion•Opthalmoplegia•Ataxia
• MRI features: ( T2, Diffusion-weighted and FLAIR)Signal changes in periaqueductal gray matter, medial thalami and mamillary bodies
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Wernicke’s Encephalopathy….
• Treatment:– Thiamine 100mg ivi stat then daily throughout
the acute stageNB alcoholics may have poor intestinal absorption
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Wernicke’s Encephalopathy….
• Other causes:– Hyperemesis of pregnancy– Systemic malignancy– GIT surgery– Prolonged iv feeding– Re-feeding after prolonged fast– Anorexia nervosa– Dieting and gastric plication– AIDS
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2. Korsakoff’s Syndrome
• Russian Psychiatrist• Wernicke and Korsakoff’s syndrome are
different stages of the same disease process.• Korsakoff’s follows Wernicke’s and tends to
appear as ocular symptoms and encephalopathy improve
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Korsakoff’s syndrome….
• Memory is impaired out of proportion to other cognitive functions – Amnestic syndrome
• Have inability to form new memory
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Korsakoff’s Syndrome….
•Clinical features:•Memory loss•Confabulation•Alertness, attention, social behavior intact
•Localization of the lesion•Diencephalon•Temporal lobes
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3. Pellagra• Due to Nicotinic acid deficiency• From Italian ‘pelle agra’ which means ‘dry
skin’• Nicotinic acid is converted to NAD and NADP • NAD and NADP are coenzymes required in the
metabolism of carbohydrates
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Pellagra…..
• Clinical triad:–Dementia–Dermatitis–Diarrhea
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Pellagra….
• Communities that depend on corn for their diet can suffer from pellagra.
• Corn lacks tryptophan, a precursor that can be converted to nicotinic acid in the body.
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Pellagra….
• Bread is now enriched with niacin• Treatment:–Nicotinic acid ivi 25mg bd or tds
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B. Direct Effects of Alcohol
• Acute intoxication• Fetal alcohol syndrome• Alcohol withdrawal seizures• Delirium tremens
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Stages of acute alcohol intoxication
BLOOD LEVEL• 0.01 – 0.05• 0.03-0.12• 0.09-0.25• 0.18-0.30• 0.25-0.40• 0.35-0.50• 0.45+
STAGESubclinicalEuphoriaExcitementConfusionStuporComaDeath
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C. Abnormalities of Serum Electrolytes and osmolality
• Hyponatremia• Hypocalcemia• Hypomagnesemia• Hypophosphatemia
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Central pontine myelinolysis
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D. Diseases at least partly nutritional in origin
• Alcoholic neuropathy• Amblyopia
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1 Alcoholic Neuropathy
• Most common complication• Distal symmetrical polyneuropathy• Mixed sensory motor disorder• Pathology – Axonal loss• Pathogenesis:– Direct alcohol neurotoxicity– Thiamine deficiency
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2. Amblyopia
• Vision loss caused by a selective lesion of the optic nerves
• History – chronic alcoholic, poor dietary intake, loss of weight
• Most likely due to nutritional deficiency• Treatment – Good nutrition , B vitamins• Prognosis – Improves on treatment (despite
continued drinking)
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E. Diseases of uncertain pathogenesis
• Alcoholic myopathy• Alcoholic dementia• Cerebellar degeneration• Marchiafava-Bignami Syndrome
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1. Cerebellar Degeneration
• Associated with long-standing use of alcohol• Patients often have neuropathy as well• Presentation –Progressive unsteadiness of gait– Trunkal ataxia
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Cerebellar Degeneration….
•Pathological changes:•Selective atrophy of the anterior and
superior parts of the vermis
•Histological changes:•Purkinje’s cells most severely affected
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4. Marchiafava-Bignami Syndrome
• Italian pathologists • Described in 1903
• Clinical picture difficultMental slowing, Motor slowing, Personality or behaviour changes, Incontinence, Seizures, Dysarthria and hemiparesis
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Marchiafava-Bignami Syndrome….
• Patholological changes:– Selective demyelination of the corpus
callosum