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
system
Alcoholism
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