Peripheral Neuropathy and Alcoholism
Peripheral Neuropathy due to Alcoholism.
Alcohol abuse continues to be a major problem in our contemporary society. Alcohol remains the most harmful and abused drug. Alcoholism affects both sexes , spares no race , colour, or religious group, and is seen in all ages from preadolescent to the elderly. Alcoholism and alcohol related illnesses are among the top medical and public health problems. The neurological complications of alcoholism are readily seen in both the outpatient and the hospital setting on both medical and surgical services.
Ethanol can affect the nervous system through a variety of ways including direct neurotoxic effects of ethanol or its metabolites, especially among protein and lipids of neuronal membranes , nutritional deficiencies , metabolic disturbances(especially through liver damage). Not every alcoholic develops neurological complications, and why one neurological syndrome occurs in one patient and another type in another patient is not known; genetic factors may influence the susceptibility of certain alcoholics to neurological complications.
Alcoholic polyneuropathy is the most common complication of alcoholism. It is a length –dependent , axonal neuropathy affecting the legs before arms and relatively sparing the trunk and cranial nerves, although neuropathies of the vagus nerve have been described leading to vocal cord paralysis and dysphagia; even lesions of the phrenic nerve have been described. Alcoholic polyneuropathy is insidious and slowly progressive with sensory, motor, and autonomic signs and symptoms. The muscle stretch reflexes, especially the ankle reflexes, are typically depressed or absent, even in the early asymptomatic state . The findings are usually symmetrical predominately distal and include numbness, paresthesias, burning dysethesias. Allodynia, hyperpathia, hyperesthesia, distal and lateral proximal weakness, cramps and tenderness of the leg muscles, impairment of pain, touch and temperature sensation, and occasionally proprioception. There can be excessive sweating of the hands and feet. Peripheral autonomic dysfunction may be more common than previously thought and when present may be associated with increased mortality. Autonomic dysfunction may lead to impotence, orthostatic hypotension, bladder and bowel dysfunction and papillary abnormalities. (Taken from Textbook of Neurological Surgery)