CNS COMPLICATIONS OF ALCOHOL

CNS COMPLICATIONS OF ALCOHOL

Alcoholism causes dysfunction at all levels of nervous systems.

Alcohol is a central nervous system (CNS) depressant that acts on receptors for -aminobutyric acid (GABA), the major inhibitory neurotransmitter in the nervous systemAlcoholism

Def- Regular and excessive use of alcohol with concomitant social, interpersonal, legal, occupational, and/or physical problems

Alcohol dependence - Repeated alcohol-related difficulties in at least 3 areas of functioning that cluster together over any 12-month period.

.

Acute alcohol intoxication

Individuals with Acute alcohol intoxication are initially euphoric, expansive with increased self-confidence, and garrulous with loss of social inhibitions. Neurological signs include impaired judgment, slurred speech, in coordination, mild truncal ataxia, double vision and nystagmus

Depressant features such as hypotension, bradycardia and diminished respiration, coma occur later in the clinical course. Acute alcohol intoxication is defined in legal terms as blood alcohol level in excess of 100 mg/dl.

Alcohol withdrawal There is a wide spectrum of manifestations of alcoholic withdrawal, ranging from anxiety, decreased cognition, and tremulousness through increasing irritability and hyper reactivity to full-blown delirium tremens

Delirium tremens

It is an acute organic psychosis that is usually manifest within 24-72 hours after the last drink (but may occur up to 7-10 days later).

It is characterised by mental confusion, tremor, sensory hyperacuity, visual hallucinations, autonomic hyperactivity, diaphoresis, dehydration, electrolyte disturbances (hypokalaemia, hypomagnesaemia), seizures, and cardiovascular abnormalities.

Management

Adequate nutrition - Oral multiple B vitamins, including 50 to 100 mg of thiamine daily for a week or more

Benzodiazepines: highest margin of safety and lowest cost; preferred class of drugs.

Short acting benzodiazepines like oxazepam, lorazepam are preferred.

Rum fits- a person may have GTCS 24 48 hrs after heavy alcohol consumption. These are generally self limiting.

Alcoholic (organic) hallucinosis This syndrome occurs either during heavy drinking or on withdrawal and is characterized by a paranoid psychosis without the tremulousness, confusion, and clouded sensorium seen in withdrawal syndromes

Chronic alcoholic brain syndromes These encephalopathies are characterized by increasing erratic behavior, memory and recall problems, and emotional instability

Wernicke-Korsakoff syndrome

The Wernicke - Korsakoff syndrome may develop with a series of episodes. Nerves around floor of 4th ventricle, aque duct of sylvius are damaged due thimine deficiency. Wernickes encephalopathy consists of a triad of confusion, ataxia and ophthalmoplegia (typically internuclear).

Korsakoffs psychosis is characterised by both anterograde and retrograde amnesia, with confabulation early in the course

Treatment - intravenous thiamine and B-complex vitamins can minimize damage.

Other neurological effects of alcohol Peripheral neuropathy

Cerebellar degeneration

Cerebral haemorrhage

Dementia