Neurology of Alcoholism
CASE
The chief executive officer of a small company is admitted for an appendectomy. Two days postsurgery, he experiences two generalized tonic–clonic seizures that occur within 15 minutes of each other. The patient is jittery, anxious, and sweating, with a moderate tachycardia. He admits that he drinks three large Manhattans every night, and more on weekends. Results of an electroencephalogram (EEG) and magnetic resonance imaging scan with gadolinium are normal.
SEIZURES
Seizures are common in the person who is an alcoholic, and represent at least two different phenomena. It is important to distinguish the two types of “alcoholic seizures,” because treatment and workup are different.
Alcoholic Withdrawal Seizures
Alcoholic withdrawal seizures are brief, self-limited, generalized seizures secondary to abstinence from alcohol, or a reduction in the usual intake. They do not represent a true convulsive disorder and most occur 12 to 48 hours after cessation of drinking (rarely after 96 hours). Remember, alcohol withdrawal seizures can occur in the “businessman drinker” who comes to the hospital for other reasons; often for an operation. Alcohol withdrawal seizures tend to appear in groups of two or three, and then stop. The patient is usually tremulous and jittery. The interictal EEG in these patients is usually normal, and if the history is characteristic, the patient requires no further neurologic workup, or
anticonvulsant medication. Standard treatment for alcohol withdrawal is sufficient. A subgroup of alcoholics has seizures for other reasons, such as subdural hemotoma, head injury, and the like.
anticonvulsant medication. Standard treatment for alcohol withdrawal is sufficient. A subgroup of alcoholics has seizures for other reasons, such as subdural hemotoma, head injury, and the like.
Some imaging study is probably important in alcoholics with seizures.
ALCOHOLIC TREMULOUSNESS— DELIRIUM TREMENS (DTS)
The spectrum of alcohol withdrawal symptoms ranges from mild tremulousness to fatal DTs. The underlying physiology in these states is related to abstinence from alcohol, not to specific dietary or vitamin insufficiency. Similar withdrawal states can occur after stopping other central nervous system (CNS) depressants (e.g., barbiturates, diazepam). DTs and withdrawal seizures can be produced in normal people with good diets who are placed on large amounts of alcohol, and then withdrawn. Seizures are a point on the spectrum of withdrawal symptomatology. An alcoholic who stops drinking is subject to the following:
Tremulousness is one of the first signs of alcohol withdrawal; beginning approximately 8 hours after cessation of drinking (often after a night’s sleep), and reaching its peak at 24 hours. The patient is jittery, startles easily, and often shows a gross irregular tremor of the hands. There are signs of sympathetic overactivity, with increased sweating and heart rate. Although these symptoms are most severe at 24 hours, it may take 7 to 10 days before the patient is back to normal.Related posts:
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