Andrew N. Wilner, MD

Disclosures

July 09, 2010

Discussion and Conclusion

Alcohol dependence may be considered a chronic disease, with significant medical and neurologic complications.[1] Neurologic complications include central nervous system effects, such as alcoholic cerebellar degeneration, brain atrophy and cognitive dysfunction, Korsakoff's syndrome, Wernicke's encephalopathy, and rarely Marchiafava-Bignami disease. In addition, neuromuscular complications, such as peripheral neuropathy (autonomic, compression mononeuropathies, and polyneuropathy) and acute and chronic myopathy, may occur. Patients may manifest 1 or more of these neurologic complications. Multiple movement disorders, such as ataxia, myoclonus, and tremor, may also occur due to alcohol abuse.[2]

Alcoholic cerebellar degeneration may slowly evolve or have relatively sudden onset, as in this case. Movement disorders associated with alcoholic cerebellar degeneration include cerebellar ataxia, 3-Hz leg tremor, and parkinsonian tremor.[2] This patient demonstrated an unsteady gait and poor coordination of the lower extremities. Continued alcoholism would likely lead to upper extremity ataxia, which was minor in this patient, and dysarthria. His dramatic improvement after hospitalization suggests that the ataxia was exacerbated by acute alcoholic intoxication.

MRI revealed generalized cortical atrophy with striking cerebellar atrophy, suggesting a chronic, severe, degenerative process. Neuropsychological testing, which was not performed in this case, would likely have revealed cognitive deficits consistent with the observed cortical atrophy. Alcoholic cerebellar degeneration typically occurs after 10 years of excessive drinking and is likely due to the combined effects of alcohol neurotoxicity plus nutritional deficiency. Cerebellar Purkinje cells are particularly affected, along with all neurocellular elements in the anterosuperior aspect of the vermis and cerebellar hemispheres.[2]

The patient was instructed to stop drinking, which, along with nutritional supplementation, is the only treatment for alcoholic cerebellar degeneration. Sobriety is likely to stabilize, but not improve, his gait disturbance.

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