Alcoholic peripheral neuropathy
Introduction
Introduction to alcoholic peripheral neuropathy Alcoholic peripheral neuropathy (alcoholic peripheral neuropathy) is one of the most common complications caused by long-term drinking, mostly in patients with long-term alcohol abuse up to 100g per day. Clinically, it is also called polyneuropathycausedbychronicalcoholism, which is a common complication of chronic alcoholism, and can be affected by exercise, sensation and autonomic nerve. It usually occurs in about 10 years after cognitive dysfunction in patients with chronic alcoholism, and the incidence rate accounts for about 34% of patients with chronic alcoholism. basic knowledge Sickness ratio: 25% Susceptible people: long-term heavy drinkers Mode of infection: non-infectious Complications: insomnia, hyperhidrosis, impotence, orthostatic hypotension
Cause
Causes of alcoholic peripheral neuropathy
Neurotoxic effects of alcohol (30%):
The main cause is the neurotoxicity of alcohol and vitamin B1 deficiency. Vitamin B2, B6, B12, folic acid, niacin and pantothenic acid deficiency and metabolic disorders are also associated with the disease. Because alcoholic beverages produce 7 kilocalories per gram of alcohol, wine It does not contain vitamins, minerals, amino acids and other nutrients. Therefore, alcoholics often show obvious nutritional deficiencies. In addition to the nutritional and metabolic disorders, the direct toxicity of ethanol also causes further damage. Therefore, most cases can be At the same time, it has both nutritional dysfunction and toxic effects.
Vitamin B1 deficiency (30%):
The disease is undoubtedly related to long-term drinking, but its pathogenesis is not fully understood. Some people think that it is mainly caused by lack of nutrition, especially vitamin B1 deficiency. Some people think that it is the direct toxic effect of alcohol. Alcohol causes peripheral nerve damage and may change cell membrane. Lipid permeability is associated with free radical oxidative damage.
Pathology (30%):
The lesions are similar to peripheral neuritis. Typical pathological changes are distal axonal degeneration and segmental myelin degeneration, which is retrograde axonal damage. The neuronal chromatin is dissolved in the anterior and posterior root ganglia of the spinal cord, and the skeletal muscle is nerve. Source atrophy, and some studies suggest that autonomic nerves in patients with alcoholism, such as sympathetic and vagus nerves, as well as early damage to the brain, can cause symptoms.
It has been pointed out that alcoholic peripheral neuropathy first affects finer sensory nerve fibers, which are characterized by axonal degeneration, which shows normal nerve conduction velocity, which in turn causes large fiber segmental demyelination and axonal degeneration. The conduction speed is slowed down.
Prevention
Alcoholic toxic peripheral neuropathy 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
Alcoholic toxic peripheral neuropathy Complications, insomnia, hyperhidrosis, impotence, orthostatic hypotension
When affecting the autonomic nerve, it can be complicated by dizziness, insomnia, multiple dreams, palpitation, sweating, impotence, orthostatic hypotension and dysfunction.
Symptom
Symptoms of alcoholic peripheral neuropathy Common symptoms Facial muscle rigidity, low blood pressure, limb symmetry, soft palate, flustered, dream, dizziness, tremor, inability, insomnia, gastrocnemius
1. The patient has a long history of heavy drinking, and the incidence is more insidious and slow. The typical symptoms are the sensation and movement disorder that gradually progress toward the proximal end from the extremities of the extremities, especially the lower extremities.
2. Patients may first complain of burning or numbness in the soles of the feet, fever and gastrocnemius tendon pain. This is a characteristic of the disease. When the disease progresses, the lower limbs may be weak. The "gloves and socks-like" feelings are diminished, and severe cases may occur. The foot is drooping or the wrist is drooping, the walking is difficult or even the symmetry of the limbs is soft. The examination may have deep and shallow sensation of the extremities, muscle weakness and muscle atrophy, the distal end is heavier than the proximal end, the lower limb is heavier than the upper limb, the muscle is slack and tender, and the tendon reflex From the distal end to the proximal end gradually weakened or disappeared, the Achilles tendon reflex often disappeared first.
3. Because of peripheral poisoning, the peripheral nerve is more sensitive to mechanical and ischemic damage. Once it is stressed or pulled, it is more prone to neural crest. It is called oppressive or alcoholic peripheral neuropathy. The upper limbs are extremely susceptible to pressure and cause paralysis of the sacral nerves. When the lower extremities are in the squat position, the sacral nerves are pulled and compressed, which can also cause paralysis. Most of them are acute after onset or wake up, and most of them are single peripheral nerve spasms.
4. If the lesion affects the autonomic nerve, there may be dizziness, insomnia, multiple dreams, palpitation, excessive sweating, impotence, orthostatic hypotension and dysfunction, etc., known as alcoholic autonomic neuropathy, if it affects the cranial nerve, such as, Listening, exhibition, eye movement, glossopharynx and vagus nerve, etc., may have corresponding symptoms and signs. In addition, patients with this disease may have other manifestations of chronic alcoholism, such as Wernicke-Korsakoff syndrome, mild hand tremor More common.
5. Electromyography can reveal the characteristics of neurogenic damage such as denervation potential, multiphase potential, prolonged time course, and decreased motor unit. The motor and sensory nerve conduction velocity is slowed down, and the EMG changes the lower limb weight or Earlier than the upper limbs.
Examine
Examination of alcoholic peripheral neuropathy
1. Determination of blood and urine alcohol concentration: There is a diagnosis and the significance of the degree of alcoholism.
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 diagnosis of alcoholic peripheral neuropathy
According to the patient's long-term heavy drinking history, combined with typical clinical manifestations, as well as EMG conduction slowdown and neurogenic damage, the general diagnosis is not difficult.
It should be differentiated from peripheral neuropathy caused by other causes.
