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Brain Injury Associated With Chronic Alcoholism

Published online by Cambridge University Press:  07 November 2014

Abstract

Alcoholism can result in a number of severe consequences to the central nervous system, including Korsakoff's psychosis, delusions, delirium, Wernicke's encephalopathy, and cerebellar degeneration. Many of these disorders have a substantially higher prevalence than had been previously believed. Neuropathologic and neuroimaging studies have been instrumental in identifying the changes undergone by the alcoholic brain and the factors that may contribute to alcohol-induced brain damage. Biologic differences appear to make women especially susceptible to central nervous system insult from alcohol abuse. The damage caused by alcohol may be associated, in part, with thiamine deficiency, neuronal excitotoxicity, and magnesium wasting.

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Feature Articles
Copyright
Copyright © Cambridge University Press 1999

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References

REFERENCES

1.Hunt, WA, Nixon, SJ, eds. Alcohol-Induced Brain Damage. Rockville, Md: National Institute on Alcoholism and Alcohol Abuse; 1993. No. 22.Google Scholar
2.Porjesz, B, Begleiter, H. Brain dysfunction and alcohol. In: Kissin, B, Begleiter, H, eds. The Pathogenesis of Alcoholism: Biological Factors. New York, NY: Plenum Press; 1983:415483.Google Scholar
3.Dufour, MC. The epidemiology of alcohol-induced brain damage. In: Hunt, WA, Nixon, SJ, eds. Alcohol-Induced Brain Damage. Rockville, Md: National Institute on Alcoholism and Alcohol Abuse; 1993:314. No. 22.Google Scholar
4.Ninth Special Report to the US Congress on Alcohol and Health. Washington, DC: National Institute on Alcoholism and Alcohol Abuse; 1997:1314.Google Scholar
5.International Classification of Diseases, 9th Revision, Clinical Modification. 5th ed. Salt Lake City, UT: Medicode, Inc.; 1997.Google Scholar
6.Umbricht-Schneiter Santora, A, Santora, P, Moore, RD, Alcohol abuse: comparison of two methods for assessing its prevalence and associated morbidity in hospitalized patients. Am J Med. 1991;91:110118.Google Scholar
7.Sharkey, J, Brennan, K, Curran, P. The pattern of alcohol consumption of a general hospital population in North Belfast. Alcohol Alcohol. 1996;31:279285.Google Scholar
8.Eckardt, MJ, Martin, PR. Clinical assessment of cognition in alcoholism. Alcohol Clin Exp Res. 1986;10:123127.CrossRefGoogle ScholarPubMed
9.Grant, BF, Harford, TC, Dawson, DA, Chou, P, Dufour, M, Pickering, R. Prevalence of DSM-IV alcohol abuse and dependence: United States 1992. Alcohol Health Res World. 1994;18:243248.Google ScholarPubMed
10.Smith, DM, Atkinson, RM. Alcohol and dementia. Intl J Addictions. 1995;30:18431869.Google Scholar
11.Welch, LW, Cunningham, AT, Eckardt, MJ, Martin, PR. Fine motor speed deficits in alcoholic Korsakoff's syndrome. Alcohol Clin Exp Res. 1997;21:134139.Google Scholar
12.Martin, PR, Adinoff, B, Weingartner, H, Mukherjee, AB, Eckardt, MJ. Alcholic organic brain disease: nosology and pathophysiologic mechanisms. Prog Neuro Psychopharmacol Biol Psychiatry 1986;10:147164.Google Scholar
13.Victor, M, Adams, RD, Collins, GH. The Wernicke-Korsakoff Syndrome and Related Neurologic Disorders Due to Alcoholism and Malnutrition. 2nd ed. Philadelphia, Pa: FA Davis Co; 1989.Google Scholar
14.Charness, ME. Brain lesions in alcoholics. Alcohol Clin Exp Res. 1993;17:211.Google Scholar
15.Lishman, WL. Organic Psychiatry. Oxford, England: Blackwell Scientific Publications; 1978.Google Scholar
16.Greenberg, DA, Diamond, I. Wernicke-Korsakoff Syndrome. In: Tarter, RE, Van Thiel, DH, eds. Alcohol and the Brain: Chronic effects. New York, NY: Plenum Medical Book Co; 1985.Google Scholar
17.Franklin, JE, Frances, RJ. Alcohol-induced organic mental disorders. In: Yudofsky, SC, Hales, RE, eds Textbook of Neuropsychiatry. Washington, DC: American Psychiatric Press; 1992:563583.Google Scholar
18.Harper, C. The neuropathology of alcohol-specific brain damage, or does alcohol damage the brain? J Neuropath Exp Neurol. 1998;57:101110.Google Scholar
19.Harper, C. The incidence of Wernicke's encephalopathy in Australia–a neuropathological study of 131 cases. J Neurol Neurosurg Psychiatry. 1983;46:593598.Google Scholar
20.Ma, JJ, Truswell, AS. Wernicke-Kosakoff syndrome in Sydney hospitals: before and after thiamine enrichment of flour. Med J Aust. 1995;163:531534.Google Scholar
21.Harper, CG, Sheedy, DL, Lara, AI, Garrick, TM, Hilton, JM, Raisnen, J. Prevalence of Wernicke-Korsakoff syndrome in Australia: has thiamine fortification made a difference? Med J Aust. 1998;168:542545.Google Scholar
22.Freund, G. Chronic central nervous system toxicity of alcohol. Ann Rev Pharmacol. 1973;13:217227.Google Scholar
23.Kopelman, MD. The Korsakoff syndrome. Br J Psychiatry. 1995;166:154173.Google Scholar
24.Adams, RD, Victor, M. Principles of Neurology. 3rd ed. New York, NY: McGraw-Hill; 1985.Google Scholar
25.Adams, RD, Victor, M, Mancall, EL. Central pontine myelinolysis: a hitherto underscribed disease occuring in alcoholic and malnourished patients. Arch Neurol Psychiatry. 1959;81:154172.Google Scholar
26.Harper, CG, Kril, JJ. Neuropathological changes in alcoholics. In: Hunt, WA, Nixon, SJ, eds. Alcohol-Induced Brain Damage. Rockville, Md: National Institute on Alcoholism and Alcohol Abuse; 1993:3969. No. 22.Google Scholar
27.Estol, CJ, Faris, AA, Martinez, J, Ahab-Barmada, M. Central pontine myelinolysis after liver transplantation. Neurol. 1989;39:493498.Google Scholar
28.Charness, ME, Clinical and pathologic overview of the brain disorders in alchoholics. In: Hunt, WA, Nixon, SJ, eds. Alcohol-Induced Brain Damage. Rockville, Md: National Institute on Alcoholism and Alcohol Abuse; 1993:16. No. 22.Google Scholar
29.Harper, C, Kril, J. Brain atrophy in chronic alcoholic patients: a quantitative pathological study. J Neurol Neurosurg Psychiatry. 1985;48:211217.CrossRefGoogle ScholarPubMed
30.Torvik, A. Brain lesions in alcoholics: neuropathological observations. Acta Med Scand Suppl. 1987;717:4754.Google Scholar
31.Harper, C, Kril, J, Daly, J. Are we drinking our neurons away? Br Med J. 1987;294:534536.Google Scholar
32.Brewer, C, Perrett, L. Brain damage due to alcohol consumption: an air-encephalographic, psychometric and electroen-cephalographic study. Br J Addict. 1971;66:170182.Google Scholar
33.Wilkinson, DA. Neuroradiologic investigations of alcoholism. In: Tarter, RE, Van Thiel, DH, eds. Alchohol and the Brain: Chronic Effects. New York, NY: Plenum Press; 1985:183215.Google Scholar
34.Carlen, PL, Wortzman, G, Holgate, R, et al.Reversible cerebral atrophy in recently abstinent chronic alcoholics measured by computed tomography scan. Science. 1978;200:10761078.CrossRefGoogle Scholar
35.Pfefferbaum, A, Rosenbloom, M. In vivo imaging of morphological brain alterations associated with alcoholism. In: Hunt, WA, Nixon, SJ. eds. Alcohol-Induced Brain Damage. Rockville, Md: National Institute on Alcoholism and Alcohol Abuse; 1993:7187. No. 22.Google Scholar
36.Clavier, E. Thiebot, J, Delangre, T, Hannequin, D, Samson, M, Benozio, M. Marchiafava-Bignami diease: a case studied by CT and MR imaging. Neuroradiology. 1986;28:376.Google Scholar
37.Gass, A, Birtsch, G, Olster, M, Schwartz, A, Hennerici, MG. Marchiafava-Bignami disease: reversibility of neuroimaging abnormality. J Comput Assist Tomogr. 1998;22:503504.Google Scholar
38.Gass, A, Birtsch, G, Olster, M, Schwartz, A, Hennerici, MG. Marchiafava-Bignami disease: reversability of neuroimaging abnormality. J Comput Assist Tomogr. 1998;22:503504.Google Scholar
39.Martin, PR, Gibbs, SJ, Nimmerrichter, AA, Riddle, WR, Welch, LW, Willcott, MR. Brain proton magnetic resonance spectroscopy studies in recently abstinent alcoholics. Alcohol Clin Exp Res. 1995;19:10781082.CrossRefGoogle ScholarPubMed
40.Fellios, PG. Alcoholism in women: causes, treatment, and prevention. In: Lawson, GW, Lawson, AW, eds. Alcoholism and Substance Abuse in Special Populations. Rockville, Md: Aspen Publishers; 1989:1136.Google Scholar
41.Smith, EM, Cloninger, R, Bradford, S. Predictors of mortality in alcoholic women: a prospective follow-up study. Alcohol Clin Exp Res. 1983;7:237243.Google Scholar
42.Morgan, MY, Sherlock, S. Sex-related differences among 100 patients with alcoholic liver disease Br Med J. 1977;1:939941.Google Scholar
43.Loft, S, Olesen, KL, Dossing, M. Increased susceptibility to liver disease in relation to alcohol consumption in women. Scand J Gastroenterol. 1987;22:12511256.CrossRefGoogle ScholarPubMed
44.Lieber, CS. Medical disorders of alcoholism. N Engl J Med. 1995;333:10581065.Google Scholar
45.Frezza, M, Di Padova, C, Pozzato, G, Terpin, M, Baraona, E, Lieber, CS. High blood alcohol levels in women: the role of decreased gastric alcohol dehydrogenase activity and first-pass metabolism. N Engl J Med. 1990;322:9596.Google Scholar
46.Seitz, HK, Egerer, G, Simanowski, UA, et al.Human gastric alcohol dehydrogenase activity: effect of age, sex, and alcoholism. Gut. 1993;34:14331437.Google Scholar
47.Grant, BF. Prevalence and correlates of alcohol use and DSM-IV alcohol dependence in the United States: results of the National Longitudinal Alcohol Epidemiologic Survey. J Stud Alcohol. 1997;58:464473.Google Scholar
48.Harper, CG, Smith, NA, Kril, JJ. The effect of alcohol on the female brain: a neuropathological study. Alcohol Alcohol. 1990;25:445448.Google Scholar
49.Jacobson, R. The contributions of sex and drinking history to the CT brain scan changes in alcoholics. Psychol Med. 1986;16:547559.Google Scholar
50.Mann, K, Batra, A, Gunthner, A, Schroth, G. Do women develop alcoholic brain damage more readily than men? Alcohol Alcohol. 1992;16:10521056.Google Scholar
51.Kroft, CL, Gescuk, B, Woods, BT, Mello, NK, Weiss, RD, Mendelson, JH. Brain ventricular size in female alcoholics: an MRI study. Alcohol. 1991;8:3134.Google Scholar
52.Harper, CG, Kril, JJ. Corpus callosal thickness in alcoholics. Br J Addict. 1998;83:577580.Google Scholar
53.Hommer, D, Momenan, R, Rawlings, R, et al.Decreased corpus callosum size among alcoholic women. Arch Neurol. 1996;53:359363.Google Scholar
54.Pfefferbaum, A, Lim, KO, Desmond, JE, Sullivan, EV. Thinning of the corpus callosum in older alcoholic men: a magnetic resonance imaging study. Alcohol Clin Exp Res. 1996;20:752757.Google Scholar
55.Roebuck, TM, Mattson, SN, Riley, EP. A review of the neuroanatomical findings in children with fetal alcohol syndrome or prenatal exposure to alcohol. Alcohol Clin Exp Res. 1998:22:339344.Google Scholar
56.Curerris, C. Neuroanatomical and neurophysiological mechanisms involved in central nervous system dysfunctions induced by prenatal alcohol exposure. Alcohol Clin Exp Res. 1998;22:304312.Google Scholar
57.Gabrielli, O, Salvolini, U, Coppa, GV, et al.Magnetic resonance imaging in the malformative syndromes with mental retardation. Pediatr Radiol. 1990;21:1619.Google Scholar
58.Riley, EP, Mattson, SN, Sowell, ER, Jernigan, TL, Sobel, DF, Jones, KD. Abnormalities of the corpus callosum in children prenatally exposed to alcohol. Alcohol Clin Exp Res. 1995;19:11981202.Google Scholar
59.Kandel, DB, Wu, P, Davies, M. Maternal smoking during pregnancy and smoking by adolescent daughters. Am J Psychiatry. 1998;84:14071413.Google Scholar
60.Yates, WR, Cadoret, RJ, Troughton, EP, Stewart, M, Guinta, TS. Effect of fetal alcohol exposure on adult sumptoms of nicotine, alcohol and drug dependence. Alcohol Clin Exp Res. 1998;22:914920.Google Scholar
61.Famy, C, Strissguth, AP, Unis, AS. Mental illness in adults with fetal alcohol syndrome or fetal alcohol effects. Am J Psychiatry. 1998;155:552554.Google Scholar
62.Martin, PR, McCool, BA, Singleton, CK. Genetic sensitivity to thiamine deficiency and development of alcoholic organic brain disease. Alcohol Clin Exp Res. 1993;17:3137.CrossRefGoogle ScholarPubMed
63.Hoyumpa, AM. Mechanisms of thiamine deficiency in chronic alcoholism. Am J Clin Nutr. 1980;33:27502761.Google Scholar
64.Morgan, MY. Alcohol and nutrition. Br Med Bull. 1982;38:2129.Google Scholar
65.Tsai, G, Gastfriend, DR, Coyle, JT. The glutamatergic basis of human alcoholism. Am J Psychiatry. 1995;152:332340.Google ScholarPubMed
66.Lovinger, DM, White, G, Weight, FF. Ethanol inhibits NMDA-activated ion current in hippocampal neurons. Science. 1989;243:17211724.Google Scholar
67.Hunt, WA. Are binge drinkers more at risk of developing brain damage? Alcohol. 1993;10:559561.Google Scholar
68.Breese, CR, Freedman, R, Leonard, SS. Glutamate receptor subtype expression in human postmortem brain tissue from schizophrenics and alcohol abusers. Brain Res. 1995;674:8290.Google Scholar
69.Tsai, Ge, Ragan, P, Chang, R, Chen, S, Linnoila, M, Coyle, JT. Increased glutamatergic neurotransmission and oxidative stress after alcohol withdrawal. Am J Psychiatry. 1998;155:726732.Google ScholarPubMed
70.Moak, DH, Anton, RF. Alcohol-related seizures and the kindling effect of repeated detoxifications: the influence of cocaine. Alcohol Alcohol. 1996;31:135143.Google Scholar
71.Lovinger, DM. Excitotoxicity and alcohol-related brain damage. Alcohol Clin Exp Res. 1993;17:1927.Google Scholar
72.Todd, KG, Butterworth, RF. Evaluation of the role of NMDA-medicated excitoxicity in the selective neuronal loss in experimental Wemicke encephalopathy. Exp Neurol. 1998;149:130138.Google Scholar
73.Lehninger, AL. Biochemistry. 2nd ed. New York, NY: Worth Publishers; 1975:337.Google Scholar
74.Dingledine, R, McBain, CJ. Excitatory amino acid transmitters. In: Seigel, GJ, Agranoff, BW, Albers, RW, Molinoff, PB, eds. Basic Neurochemistry. 5th ed. New York, NY: Raven Press; 1994:367387.Google Scholar
75.Altura, BM, Gebrewold, A, Zhang, A, Altura, BT, Gupta, RK. Magnesium deficiency exacerbates brain injury and stroke mortality induced by alcohol; a31 P-NMR in vivo study. Alcohol. 1998;15:181183.Google Scholar
76.Langlais, PJ, Anderson, G, Guo, SX, Bondy, SC. Increased cerebral free radical production during thiamine deficiency. Med Brain Dis. 1997;12:137143.Google Scholar
77.Halliwell, B, Gutteridge, JMC. Free Radicals in Biology and Medicine. 2nd ed. Oxford, England: Clarendon Press; 1989.Google Scholar
78.Hunt, WA. Role of free radical reactions in ethanol-induced brain damage: an introduction. In: Hunt, WA, Nixon, SJ, eds. Research Monograph No. 22, Alcohol-Induced Brain Damage. Rockville, Md: National Institute on Alcoholim and Alcohol Abuse; 1993:327338.Google Scholar
79.Clarke, DD, Sokoloff, L. Circulation and energy metabolism of the brain. In: Siegel, GJ, Agranoff, BW, Albers, RW, Molinoff, PB, eds. Basic Neurochemistry. 5th ed. New York, NY: Raven Press; 1994:645680.Google Scholar
80.Juhnke, H, Krems, B, Kotter, P, Entian, KD. Mutants that show increased sensitivity to hydrogen peroxide reveal an important role for the pentose phosphate pathway in protection of yeast against oxidative stress. Mol Gen Genet. 1996;252:456464.Google Scholar
81.Fein, G, Gletcher, DJ, Ki Sclafani, V. Effect of chronic alcohol abuse on the CNS morbidity of HIV disease. Alcohol Clin Exp Res Suppl. 1998;22:196200.Google Scholar
82.Weinstein, DD, Martin, PR. Psychiatric implications of alcoholism and traumatic brain injury. Am J Addict. 1995;4:285296.Google Scholar
83.Ramayya Ajauhar, P. Increasing incidence of Korsakoff's psychosis in the East End of Glasgow. Alcohol Alcohol. 1997;32:281285.Google Scholar