Neurologic Complications of Alcohol and B12 Deficiency

This chapter reviews the major neurologic complications from alcohol intoxication and withdrawal plus vitamin B12 deficiency syndromes. Alcoholism, the addiction to alcohol, is characterized by a craving for alcohol and a tolerance to its intoxicating effects. Worldwide, alcoholism has an enormous societal impact and is the number one abused drug in the world. The metabolism and rapid distribution of ethanol is described. Complications of alcoholism involve many organs but damage to the central nervous system and peripheral nervous system is particularly common. Specific alcohol syndromes are described, including drunkenness and alcoholic coma, alcohol withdrawal syndromes, alcohol withdrawal seizures, delirium tremens, Wernicke’s encephalopathy and Korsakoff’s syndrome, alcoholic cerebellar degeneration, alcoholic polyneuropathy, and fetal alcohol syndrome. Attention is given to their pathophysiology, major clinical features, major laboratory findings, and principles of management and prognosis. The chapter then switches to vitamin B12 (cyanocobalamin) deficiency, or subacute combined degeneration. Again its pathophysiology, major clinical features, major laboratory findings, and principles of management and prognosis are discussed.