alcohol-toxic cerebellar degeneration
Introduction
Introduction to alcoholic cerebellar degeneration Alcoholic cerebellar degeneration (ACD) is a common cerebellar degeneration of alcoholics, and the incidence is about twice that of Wernicke encephalopathy. The clinical features are unstable gait and widened step. CT and MRI studies have shown that almost all patients with chronic alcoholism have cerebellar atrophy, the upper axillary part of the cerebellum is atrophied, the blood flow at the upper end of the ankle is reduced and the rate of glucose metabolism is significantly reduced. basic knowledge The proportion of sick people: the incidence rate of alcoholics is about 0.5%-0.8% Susceptible people: long-term heavy drinkers Mode of infection: non-infectious Complications: brain atrophy, arrhythmia, congestive heart failure, thrombosis, cardiomyopathy, myocardial infarction, hypertension
Cause
Causes of toxic cerebellar degeneration in alcohol
(1) Causes of the disease
It is believed that the lack of nutrition caused by chronic alcoholism is the cause of this disease, not caused by alcoholism or other factors. Because of the clinical manifestations and pathology of cerebellar lesions caused by vitamin B1 deficiency in Wernicke encephalopathy, it is considered to be a nutrient-derived nervous system. Disease of the nervous system of nutritional origin, associated with neurotrophic disorders.
(two) pathogenesis
The pathogenesis of ACD is still unclear. ACD has the same gait disorder as Wernicke encephalopathy. The two cerebellar lesions are the same. Some people believe that ACD is caused by thiamine deficiency, but the use of vitamin B1 to treat ataxia has not improved. ACD cerebellum The degree of dysfunction is also independent of polyneuritis.
The main pathological changes were degeneration of cerebellar cortical neurons (especially Purkinje cells), and the anterior upper part of the cerebellum was obvious. In severe cases, the anterior cerebellar lobes were involved, and the dendritic branches were reduced.
Prevention
Alcoholic cerebellar degeneration prevention
Promote the harm of alcohol to the human body, improve the cultural quality of the whole nation, strictly enforce the law on minors, strictly prohibit the drinking of minors, strengthen legal supervision, attach importance to and strengthen the mental health propaganda of wine, promote civilized drinking, do not persuade alcohol, do not drink alcohol, Do not drink on an empty stomach, treat physical or mental illnesses, avoid alcohol substitutes, promote the use of beverages to replace alcohol, reduce alcohol dependence caused by occupational reasons, promote the production of low-alcohol, control and ban the production of spirits, and crack down on illegal acts of illegal counterfeiting .
Complication
Complications of toxic cerebellar degeneration in alcohol Complications brain atrophy arrhythmia congestive heart failure thrombosis cardiomyopathy myocardial infarction hypertension
Alcoholic cerebellar degeneration can be combined with polyneuropathy, pellagra and brain atrophy, and alcohol abuse has a great detrimental effect on other systems of the human body. It has been confirmed that alcoholism can cause digestive tract inflammation, liver and kidney function damage, serious Arrhythmia, congestive heart failure, cardiac wall thrombosis, cardiomyopathy, myocardial infarction, hypertension, and increased platelet count, increased agglutination function and prolonged spontaneous dissolution of fibrin.
Symptom
Symptoms of toxic cerebellar degeneration in alcohol Symptoms of gait instability, cerebellar signs, ataxia, intentional tremor, dysarthria, alcoholism, hallucinations, mental disorders, respiratory qi
1. With a history of drinking for many years, about half of the patients have peripheral neuropathy, and men are more common than women.
2. The disease is subacute or slow onset, and there are cerebellar signs, mainly manifested as lower limbs and trunk cerebellar ataxia, showing a broad basement posture and gait, gait instability, gait squatting, obvious when going straight, not Sharp turn, suddenly standing up difficulties, check the knee and knee test is not allowed, the upper limbs are mildly awkward, can have intentional tremor, the limbs can maintain a fixed posture, there can be finger tremor similar to Parkinson's syndrome, the trunk can be in the anterior-posterior direction Specific 3Hz rhythm swing, a small number of patients with mild dysarthria and nystagmus.
3. In most cases, cerebellar symptoms progress for several weeks or months, and remain stable for many years. The cerebellar symptoms of individual patients show a leaping progression, tremors or severe infectious diseases can aggravate the symptoms, and the disease may have a special syndrome. :
1 The patient only showed posture and gait instability, limb movement was not tired, and pathological changes were limited to the anterior upper part of the cerebellum;
2 In addition to the characteristics of acute transient and reversible, the clinical manifestations are similar to the common type. This type may be a biochemical function change without structural lesions.
4. CT and MRI examination showed obvious cerebellar atrophy, and the upper part of the ankle was atrophied.
Examine
Examination of toxic cerebellar degeneration in alcohol
1. Determination of blood and urine alcohol concentration
There is a diagnostic and the degree of toxicity assessment.
2. Other blood tests
Including blood biochemistry, liver function, kidney function, coagulation function and immunoglobulin.
3. ECG, EEG, brain CT or MRI examination, there is a differential diagnosis and the significance of the degree of poisoning assessment.
4. Electromyography and neurophysiological examination have differential diagnosis significance.
Diagnosis
Diagnosis and identification of toxic cerebellar degeneration in alcohol
According to the history of chronic alcoholism, the symptoms and signs of typical cerebellar ataxia, CT or MRI found that the upper part of the cerebellar vermis is atrophied, and other causes of cerebellar atrophy and cerebellar degeneration family history can be ruled out.
The pathological and clinical manifestations of this disease are easily confused with Wernicke encephalopathy. Cerebellar symptoms with extraocular muscle paralysis and memory disorders usually indicate Wernicke encephalopathy, and alcoholic cerebellar degeneration is only manifested as cerebellar symptoms.
