Alcohol related brain damage Flashcards
Learning objectives
Alcohol related brain damage
- To be able to describe the basic diagnostic features of alcohol related brain damage
- To be able to describe the clinical features of alcohol related brain damage, including the typical pattern of cognitive deficits
- Specifically to understand the typical features of Wernicke-Korsakoff’s syndrome within alcohol related brain damage
- To be able to understand the differences between alcohol related brain damage and other causes of dementia
classification
ICD-10 F02 - Dementia in other diseases classified elsewhere
Dementias due to causes not related to Alzheimer’s disease or other cerebrovascular disease that often occur in younger ages.
classification
ICD-10 F10.6 - Amnesic syndrome
A syndrome associated with chronic prominent impairment of recent and remote memory.
What are examples of amnestic syndromes?
- Korsakov psychosis/ syndrome
- alcohol induced amnestic syndrome
- drug or psychoactive induced amnestic syndrome
What is another classification of alcohol related brain damage in ICD-10?
F10.73
Alcoholic dementia NOS
Define
Dementia due to use of alcohol
ICD11: 6D84.0
The development of persistent cognitive impairments that meet the definition of dementia but are found to be due to the direct consequence of alcohol use
What are the qualifiers for dementia due to use of alcohol
- cognitive impairments persist beyond intoxication or acute withdrawal
- alcohol consumption must be suffucently intense and for a prolonged period of time
- symptoms must not be better explained by another related disorder
Define
Wernickes-Kosakoff syndrome
Wernickes encephalopathy
A thiamine-deficiency syndrome characterised by symmetric hyperaemic (increased blood flow) lesions of the brainstem, hypothalamus, thalamus and mammmillary bodies which manifests as confusional state, disorientation, opthalmoplegia, nystagmus, diploplia, and ataxia with severe loss of memory for recent events and confabulation.
Ophthalmoplegia: paralysis or weakness of the muscles that control eye movement
DSM-IV alcohol-induced persisting dementia
The development of multiple cognitive deficits which manifests as:
- memory impairment
with one (or more) of the following:
- aphasia
- apraxia
- agnosia
- executive dysfunction disturbance
There may also be significant impaitment in social or occupational functioning.
Agnosia: failed object recognition despite intact sensory function
How can we diagnose ARBD?
- minimum 60 days abstinence
- hx of more than 35 units per week (♂) (28 units ♀) for a minimum of 5 years
Which features support a dx of ARBD?
- alcohol related systemic disease
- sensory neuropathy
- ataxia
- cognition and neuroimaging improves after 60 days
- cerebellar atrophy
Which features decrease the likelihood of ARBD dx?
- language impairment (dysnomia, anomia)
- focal neurology
Define
Dysnomia
Tip of the tongue phenomenon: difficulty recalling words, names and objects
Define
Anomia
Difficulty in finding or recalling words (for example in normal conversation)
What are clinical features of Korsakoff’s syndrome?
- pronounced anterograde amnesia
- preserved operant conditioning
- steep temporal gradient for retrograde amnesia
- spontaneous confabulation
- executive dysfunction
- blandness
- detachment
- follows episode of Wernicke’s encephalopathy
What is the classic traid of Wernicke’s encephalopathy?
- eye signs
- ataxia
- confusion
FACT
The “classic triad” of wernicke’s symptoms only occurs in around 20% of autopsy proven cases!
What are risk factors for ARBD?
- drinking from adolescence
- ♀
- older age
- weekly units correlates with ARBD likelihood
- binge drinking
- continuous drinking
- en bloc blackouts
- ethnicity
- spirits
- wine
What are the neuroimaging findings in ARBD?
- widespread volume reduction (particularly in frontal lobes)
- thinning of the corpus callosum
- cerebellar atrophy (particularly vermis)
- improvement on neuroimaging with abstinence
What are the neuroimaging findings in korsakoff’s?
- the scan may be normal
- shrinking of the mamillary bodies
- anterior thalamus hyperintensities on T2 weighted MRI
- generalised and cerebellar atrophy
