Alcoholic Neuropathy Clinical Presentation

  • Author: Scott R Laker, MD; Chief Editor: Robert H Meier III, MD   more...
 
Updated: Dec 5, 2011
 

History

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.[13]

  • Patients with alcoholic neuropathy typically present with a history of alcoholism and an insidious onset of distal lower extremity paresthesias, dysesthesias, or weakness. The most common symptom seems to be burning dysesthesias in the feet and toes. 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 advanced presentation, patients may report upper extremity symptoms.
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Physical

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

Evidence of other alcohol-related, end-organ damage also may be observed on physical examination.

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Causes

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

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Contributor Information and Disclosures
Author

Scott R Laker, MD  Staff Physician, Department of Rehabilitation, University of Colorado Health Sciences Center

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

Disclosure: Nothing to disclose.

Coauthor(s)

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, International Spine Intervention Society, and North American Spine Society

Disclosure: Nothing to disclose.

Specialty Editor Board

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, American Association of Neuromuscular and Electrodiagnostic Medicine, American Paraplegia Society, Association of Academic Physiatrists, National Multiple Sclerosis Society, and Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

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, and Association of Academic Physiatrists

Disclosure: Allergan Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching

Kelly L Allen, MD  Medical Director, Medevals

Disclosure: Nothing to disclose.

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 and Association of Academic Physiatrists

Disclosure: Nothing to disclose.

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