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Alcoholic Neuropathy Clinical Presentation

  • Author: Scott R Laker, MD; Chief Editor: Robert H Meier, III, MD  more...
Updated: Apr 21, 2015


Ascertaining the symptomatic history of a patient with alcoholic neuropathy is not specific for diagnosis. Pure alcoholic neuropathy is characterized by a progressive, sensory-dominant symptomatology. Interestingly, concomitant thiamine deficiency creates a much more variable presentation. A detailed history of alcohol use should be obtained from any patient presenting with symptoms of general neuropathy. Additionally, nutritional history and questioning regarding other neuropathy risk factors should be documented.[19]

Patients with alcoholic neuropathy typically present with a history of chronic consumption of alcohol and an insidious onset of distal lower extremity paresthesias, dysesthesias, or weakness. The most common presenting complaint seems to be paresthesias in the feet and toes. Over time, these symptoms usually progress proximally and symmetrically. Less commonly, patients present with a more rapid, acute onset of symptoms.

Patients also may have a history of gait ataxia and difficulty walking or a history of frequent falls.

In cases of more severe and advanced presentation, patients may report distal upper extremity symptoms.

In rare cases, vagus or recurrent laryngeal nerve involvement has been described. These patients may present with hoarseness and a weak voice.



Classic physical examination findings associated with alcoholic neuropathy may include the following:

  • Diminished sensation to vibration or pinprick stimulation in a "stocking-to-glove" distribution
  • Thermal and proprioceptive sensation abnormalities
  • Muscle stretch reflexes, especially of the gastrocnemius-soleus muscle complex
  • Weakness of ankle/toe dorsiflexion and/or ankle plantar flexion strength
  • Intrinsic atrophy of foot muscles in advanced cases
  • Gait ataxia with a widened base of support or bilateral foot drop
  • Patellar and Achilles deep tendon reflexes are often reduced or absent

Evidence of other alcohol-related end-organ damage also may be observed on physical examination. The patient should be examined for additional manifestations of chronic alcohol abuse such as caput medusae, ascites, digital clubbing, Dupuytren contractures, palmar erythema, gynecomastia, and jaundice.



Excess alcohol consumption causes alcoholic neuropathy. As previously stated, further studies must be performed to determine genetic influences on this disorder.

Contributor Information and Disclosures

Scott R Laker, MD Assistant Professor, Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine; Medical Director, Lone Tree Health Center

Scott R Laker, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, North American Spine Society

Disclosure: Nothing to disclose.


William J Sullivan, MD Associate Professor, Pain Medicine Fellowship Site Director, Director of Medical Student Education, Department of Physical Medicine and Rehabilitation, University of Colorado at Denver Health Sciences Center

William J Sullivan, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, North American Spine Society, International Spine Intervention Society

Disclosure: Nothing to disclose.

Mark C Osborne, MD Resident Physician, Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Michael T Andary, MD, MS Professor, Residency Program Director, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine

Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, Association of Academic Physiatrists

Disclosure: Received honoraria from Allergan for speaking and teaching.

Chief Editor

Robert H Meier, III, MD Director, Amputee Services of America; Active Medical Staff, Presbyterian/St Luke’s Hospital, Spalding Rehabilitation Hospital, Select Specialty Hospital; Consulting Staff, Kindred Hospital

Robert H Meier, III, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Additional Contributors

Daniel D Scott, MD, MA Associate Professor, Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine; Attending Physician, Department of Physical Medicine and Rehabilitation, Denver Veterans Affairs Medical Center, Eastern Colorado Health Care System

Daniel D Scott, MD, MA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Physical Medicine and Rehabilitation, Academy of Spinal Cord Injury Professionals, National Multiple Sclerosis Society, Physiatric Association of Spine, Sports and Occupational Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

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