Diseases of the nervous system

Delirium tremens occurs in acute withdrawal after prolonged heavy alcohol intake. Patients usually report trembling of their hands (relieved by alcohol intake), increased sweating, irritability, restless sleep and sometimes sensory delusions (hallucinations) that have been present for some time. These symptoms are called predelir.

In addition, morning cramps (withdrawal cramps) may occur, but the exact cause must be clarified. The alcohol delirium, which occurs after about 2-3 days from interruption of the alcohol supply, is then characterized by the following symptoms: Vegetative symptoms of alcohol delirium are: Some vegetative symptoms of alcohol withdrawal delirium are life-threatening and must be treated in the intensive care unit. The described delirious syndrome can also occur in other diseases (head injuries, inflammation of the brain, etc.).

For diagnosis, EEG and other additional examinations (laboratory values, etc.) are used if necessary. Therapeutically, clomethiazole capsules and vitamin B1 are often administered in the predelir, alternatively carbamazepine.

If the predelir develops into a full delirium, clomethiazole is administered by infusion. Clonidine is also given in cases of severe vegetative symptoms. If symptoms of agitation are predominant, butyrophenone and tranquilizers (sedatives) may be used.

Jerkiness
Gross tremor (tremor)
Incomprehensible language
Disturbance of attention
Disorientation
Psychomotor agitation
Sensory illusions (illusions, hallucinations)
Suggestibility
Enlargement of the pupils
Sweating
Facial flushing
Accelerated pulse (> 120 beats per minute)
Accelerated breathing frequency
Strong fluctuations in blood pressure

In contrast to withdrawal delirium, alcohol hallucinosis is characterized by psychopathological symptoms and less vegetative symptoms.

Thus, the patients are often awake and oriented. After the psychosis there are usually no memory gaps. The following symptoms occur: The psychotic symptoms initially appear at night until the full psychosis breaks out, which can last for several days.

After treatment with appropriate medication (neuroleptics) the symptoms decrease. For treatment the patient must be admitted to a psychiatric clinic. There he will receive emergency treatment with e.g. butyrophenone.

Anxious excitement
Acoustic sensory illusions (hallucinations)
Escape or suicide actions due to hallucinations

This clinical picture occurs after many years of alcohol abuse or coexists (or emerges) with a Wernicke’s encephalopathy (see below). The disease can also occur after an alcohol delirium. The Korsakov psychosis is characterized by: Although Korsakow’s psychosis is treated with vitamin B1, there are no significant treatment successes.

Wrong orientation about the own person and the place
Lack of ability to remember or learn something
Confabulations (invented and non-matching statements)

(poly = many nerves are affected; neuropathy = damage to the nerve endings) In this disease, which affects only a small number of alcoholics and occurs after years of alcohol abuse, malnutrition (lack of vitamin B1) is the cause of the disorder. In most cases, a functional disorder of the liver and blood count changes (lack of magnesium, lack of platelets, etc.) are also proven.

Alcohol-induced neuropathy usually begins with tingling, sensation and pain in the feet and lower legs. These symptoms then spread further into the arms. In severe cases, paralysis of the legs may occur.

With adequate nutrition, vitamin B1 therapy and appropriate physical treatment, an alcohol-induced polyneuropathy can partially regress within several weeks or months. In general, Wernicke’s encephalopathy is a syndrome that occurs particularly in chronic alcoholism, but also in a range of other diseases. The disease occurs in alcoholics due to malnutrition, as alcoholics “feed” themselves almost exclusively on alcohol.

The associated thiamine (vitamin B1) deficiency leads to bleeding and vascular damage in numerous areas of the brain. The disease sets in acutely and can also occur as a life-threatening complication of delirium tremens. If the disease is not treated in time with high doses of vitamin B1, it will be fatal within a few days.

Even with appropriate treatment, the death rate is 10-20%. The most noticeable symptoms are:

Paralysis of eye muscles and gaze
Pathological nystagmus (eye movement disorder)
Disturbed movement coordination of trunk, gait, standing
Mental disorders (sensory delusions, excitement, apathy and lack of drive)
Pupillary disorders
Korsakov Syndrome
Vegetative symptoms (sweating, tremor, accelerated heart rate)

This is a malformation of the embryo, which was caused by the chronic alcohol abuse of the mother during pregnancy. Physical and mental malformations of the child may occur.

For example, the birth weight of these children is lower than that of healthy children. Even later these children are small and underweight (up to 7 years of age). Malformations are especially hydrocephalus internus (enlargement of certain brain structures) and congenital heart defects.