Bilateral gluteal compartment syndrome is a rare clinical entity that can be complicated by rhabdomyolysis or acute kidney injury (AKI). We report the a case of a 30-year-old woman without any comorbid diseases who was diagnosed with bilateral gluteal compartment syndrome complicated by rhabdomyolysis and dialysis-requiring AKI, which was caused by prolonged immobilization under the influence of alcohol. Although the patient's renal function recovered fully after 5 sessions of hemodialysis, sciatic neuropathy caused by gluteal compartment syndrome led to permanent foot drop.
Acute Kidney Injury ; Alcoholic Intoxication ; Compartment Syndromes ; Female ; Foot ; Humans ; Immobilization ; Renal Dialysis ; Rhabdomyolysis ; Sciatic Neuropathy

Anemia appears frequently in patients with alcoholic liver disease (ALD) but has never been linked to bilateral nonarteritic anterior ischemic optic neuropathy (NAION). A 65-year-old woman with a medical history of alcoholic cirrhosis was admitted for bilateral NAION. On admission, she was found to have a low arterial pressure and severe normocytic anemia (48 g/L). The anemia was related to chronic bleeding due to antral gastritis along with other factors associated with ALD. The applied treatment consisted of urgent transfusion followed by high doses of proton-pump inhibitors, iron and vitamin supplementation, and support in lifestyle measures. Her hemoglobin levels remained stable after 2 years but the patient still suffered from visual loss. This case highlights the link between anemia and bilateral NAION in ALD patients. The optic nerve head is prone to infarction in this context due to the vascularization characteristics of ALD. Hemoglobin levels should be monitored in ALD patients to avoid the severe complication of NAION.
Aged ; Alcoholics* ; Anemia* ; Arterial Pressure ; Female ; Gastritis ; Hemorrhage ; Humans ; Infarction ; Iron ; Life Style ; Liver Cirrhosis, Alcoholic* ; Liver Diseases, Alcoholic ; Optic Disk ; Optic Nerve Diseases* ; Optic Neuropathy, Ischemic ; Vitamins

OBJECTIVE: Alcoholic neuropathy is characterized by allodynia (a discomfort evoked by normally innocuous stimuli), hyperalgesia (an exaggerated pain in response to painful stimuli) and spontaneous burning pain. The aim of the present study is to investigate the effect of rolipram, a phosphodiesterase 4 inhibitor, against alcohol-induced neuropathy in rats. METHODS: Allodynia was induced by administering 35% v/v ethanol (10 g/kg; oral gavage) to Spraue-Dawley rats for 8 weeks. Rolipram and saline (vehicle) were administered intraperitoneally. Mechanical allodynia was measured by using von Frey filaments. Somatosensory evoked potential (SEP) was proposed as complementary measure to assess the integrity of nerve pathway. RESULTS: The ethanol-induced mechanical allodynia began to manifest from 3 week, and then peaked within 1 week. Beginning from 3 week, latency significantly started to increased in control group. In rolipram treated rats, the shorter latency was sustained until 8 weeks (p<0.05). The mechanical allodynia, which began to manifest on the 3 weeks, intraperitoneal injections of rolipram sustained statistical difference until 8 weeks, the final week of the study (p<0.05). CONCLUSION: This study suggests that rolipram might alleviate mechanical allodynia induced by alcohol in rats, which clearly has clinical implication.
Alcoholic Neuropathy ; Alcoholics ; Animals ; Burns ; Cyclic Nucleotide Phosphodiesterases, Type 4 ; Ethanol ; Evoked Potentials, Somatosensory ; Humans ; Hyperalgesia ; Injections, Intraperitoneal ; Rats ; Rolipram

The alcoholic neuropathies developed in approximately 34% of chronic alcoholics and the sexual dysfunction had been experienced in 8-54% of male alcoholics(Schiavi 1990). The aims of this study were to identify the prevalence of subclinical polyneuropathies and sexual disorders in alcohol dependence, and to evaluate the association between them. The nerve conduction velocity(NCY), electromyography(EMG), and pudendal somatosensory evoked potentials(SEPs were tested for the male alcoholics(N=34) and controls(N=17 for NCV & EMG, N=25 for pudendal SEPs). The pudendal SEPs were measured by the following procedures, in which we simulated the dorsal nerve of penis attached by the ring electrode(stimulus intensity, three times of threshold ; stimulus rate, 1-4.7Hz: stimulus duration, 0.1 or 0.2msec), and recorded at the scalp(active electrode, 2cm behind Cz ; reference electrode, Fz. The NCV and EMG detected signs of peripheral neuropathies in 79.4% of alcoholics. Among the alcoholics, 64.7% were abnormal on the pudendal SEPs. Among the alcoholics who revealed abnormality on EMG and NCV, 81.4% were abnormal on the pudendal SEPs, in which 51.9% were not responded. The P1 latencies between peripheral neuropathies and sexual disorders in the alcoholic. The prevalence of subclinical neuropathies and sexual disorders seemed to be much higher in alcohol dependence that expectation, and these two problems were relatively correlated, and our results suggested that the peripheral polyneuropathies were one of the prerequisites of sexual disorders.
Alcoholic Neuropathy ; Alcoholics ; Alcoholism* ; Electrodes ; Humans ; Male ; Neural Conduction ; Peripheral Nervous System Diseases* ; Polyneuropathies ; Prevalence ; Pudendal Nerve

Polyneuropathy includes a lot of diseases damaging peripheral nerves. It shows roughly the same areas on both sides of the body, featuring weakness, numbness, and burning pain. Polyneuropathy is known to usually begin in the hands and feet and progress to the arms and legs. Sometimes it can involve other parts of the body such as the autonomic nervous system. Lots of causes can induce acute or chronic polyneuropathy, so finding the original cause is most important for the treatment of polyneuropathy. There are too many different types of polyneuropathies to be discussed in this review, so we will discuss some of various acquired polyneuropathies such as diabetic neuropathy, vasculitic neuropathy, alcoholic neuropathy, Vitamin B12 deficiency neuropathy, and drug-induced neuropathy, with special focus on symptoms, pathogenesis, diagnosis, treatment, and prognosis.
Alcoholic Neuropathy ; Arm ; Autonomic Nervous System ; Burns ; Diabetic Neuropathies ; Diagnosis* ; Foot ; Hand ; Hypesthesia ; Leg ; Peripheral Nerves ; Polyneuropathies* ; Prognosis* ; Vitamin B 12 Deficiency

Authors analyzed clinical and electrophysiological features of 35 patients with alcoholic neuropathy who had visited the Boramae City Hospital. All patients were men. Most of the cases drank alcohol everyday. The duration of alcohol consumption is from 2 to 47 years (mean, 17.8 years). Patients with relatively short history of alcohol consumption had a tendency to take more inadequate meals. Clinically we found two distinct separable categories ; one was sensorimotor peripheral neuropathy associated with other alcoholic complications, such as Wemicke and Pellagra disease, delirium tremens, liver disease etc(24 patients). The other had subacutely progressing prominent weakness with sensory change, especially in lower extremities(ll patients). Electrophysiological studies showed decreased amplitudes of sensory or motor compound action potentials with relative preservation of conduction velocity favoring axonal neuropathy. Among the electrophysiological parameters, abnormalities in F-wave(78.3%), H-reflex(86.4%) and sural nerve conduction studies(78.8%) were more frequently observed than in others, which were thought to be more sensitive parameters with early involvement. In terms of electrophysiological pattern there were no definite diffemeces between the two groups.
Action Potentials ; Alcohol Drinking ; Alcohol Withdrawal Delirium ; Alcoholic Neuropathy* ; Alcoholics* ; Axons ; Hospitals, Urban ; Humans ; Liver Diseases ; Male ; Meals ; Pellagra ; Peripheral Nervous System Diseases ; Sural Nerve

OBJECTIVES: The aims of this study were to evaluate changes in plasma superoxide dismutase(SOD) activities in alcohol depedence, to fine out variables to influence on the SOD activities, and finally to identify the correlation of SOD activities with the alcohol-associated cognitive disorders. METHODS: For 24 male alcoholics and 21 healthy male controls, plasma SOD activities were measured by spectrophotometry on 1-2 wks after alcohol withdrawal. Structured interviews and laboratory tests were also performed. RESULTS: 1) Upon comparing SOD activities between controls and alcoholics, the SOD activities were significantly(p<0.01) lower in alcoholics(0.308+/-0.140 units/mL) than in healthy controls(0.313+/-0.086 units/mL). 2) Upon comparing SOD activities according to the presence of alcohol-related cognitive disorders, the SOD activities were significantly(p<0.05) lower in alcoholics with cognitive disorders(0.247+/-0.049 units/mL) than in alcoholics without cognitive disorders(0.317+/-0.148 units/mL). 3) Upon comparing SOD activities according to the presence of alcoholic polyneuropathy or alcohol withdrawal seizure, the SOD activities showed no significant differences between alcoholics with polyneuropathy or epilepsy and those without. 4) Upon analyzing variables influencing on the SOD activities in alcoholics, the SOD activities had the negative correlation with hemoglobin(gamma=-0.433) and severity of alcohol withdrawal symptoms(gamma=-0.375). 5) Upon comparing variables according to the presence of alcohol-related cognitive disorders, the occurrence of alcoholic polyneuropathy(p<0.05) and blood phosphorus concentrations(p<0.01) were significantly higher in alcoholics with cognitive disorders than those without. 6) Upon analyzing an association between SOD activities and variables in alcoholics with cognitive disorders, the SOD activities were positively correlated with the onset age(gamma=0.995), and negatively correlated with the severity of alcohol withdrawal symptoms(gamma=-0.996). CONCLUSIONS: Lower SOD activities in alcohol dependence suggested alcohol-associated cognitive disorders and alcohol withdrawal symptoms might be caused by oxidative stress.
Alcohol Withdrawal Seizures ; Alcoholic Neuropathy ; Alcoholics ; Alcoholism ; Epilepsy ; Humans ; Male ; Oxidative Stress ; Phosphorus ; Plasma ; Polyneuropathies ; Spectrophotometry ; Substance Withdrawal Syndrome ; Superoxide Dismutase* ; Superoxides*

Alcohol-related disorders are among the most costly health problems worldwide. Ingested alcohol is mainly metabolized by an oxidative pathway in the liver. Alcohol and its metabolic products (e.g., acetaldehyde and reactive oxygen species) have toxic effects on multiple organs, especially the nervous system. The diverse mechanisms of alcohol-related neurologic disorders include the direct toxic effects of alcohol, the alcohol withdrawal effect, nutritional deficiency secondary to alcoholism, and abnormalities of serum electrolytes and osmolality. We analyzed 156 cases of alcoholrelated neurologic disorders among admitted patients that had been referred in Korea during the previous 10 years. The duration of alcohol consumption ranged from 0.5 to 47 years (mean=17.8 years) and the mean amount of alcohol intake per day was 245.5 g. The 156 patients had the following diseases: Wernicke's encephalopathy (n=81, 51.9%), peripheral neuropathy (n=68, 43.6%), delirium tremens (n=59, 37.8%), Rum fit (n=31, 19.9%), pellagra encephalopathy (n=29, 18.6%), Korsakoff's psychosis (n=22, 14.2%), cerebellar atrophy (n=11, 7.0%), and alcoholic myopathy (n=6, 3.8%). We report on these cases and review the literature on alcohol-related neurologic disorders.
Acetaldehyde ; Alcohol Drinking ; Alcohol Withdrawal Delirium ; Alcoholic Neuropathy ; Alcoholics ; Alcoholism ; Atrophy ; Electrolytes ; Humans ; Korea ; Liver ; Malnutrition ; Marchiafava-Bignami Disease ; Muscular Diseases ; Nervous System ; Nervous System Diseases ; Osmolar Concentration ; Oxygen ; Pellagra ; Peripheral Nervous System Diseases ; Psychotic Disorders ; Wernicke Encephalopathy

PURPOSE: To introduce a case of bilateral anterior ischemic optic neuropathy (AION) after blood loss due to gastrointestinal bleeding. CASE SUMMARY: A 50-year-old male patient with a history of type 1 diabetes mellitus and alcoholic liver cirrhosis presented with 3 days of melena and 1 day of general weakness and dizziness. Initial hemoglobin level was 4.7 g/dL and blood pressure was 100/55 mm Hg. On esophagogastroduodenoscopy, a peptic ulcer with evident recent bleeding was observed. After transfusion of packed red blood cells and endoscopic hemostasis of bleeding, his general condition improved but he complained of blurred vision in both eyes which developed immediately after the onset of melena. Initial best-corrected visual acuity (BCVA) was 0.5 in his right eye and 0.6 in the left eye. On fundus examination, swollen optic disc with blurred margin was noted and he had constricted visual fields. On follow-up, the patient received posterior subtenon triamcinolone injection in his right eye. After the procedure, the BCVA was improved to 0.8 in both eyes, but he still had bilateral pale optic disc with constricted visual field. CONCLUSIONS: In the case of visual loss after recent blood loss, AION should be considered as a diagnosis, which can present as bilateral involvement.
Blood Pressure ; Diabetes Mellitus, Type 1 ; Diagnosis ; Dizziness ; Endoscopy, Digestive System ; Erythrocytes ; Follow-Up Studies ; Hemorrhage* ; Hemostasis, Endoscopic ; Humans ; Liver Cirrhosis, Alcoholic ; Male ; Melena ; Middle Aged ; Optic Neuropathy, Ischemic* ; Peptic Ulcer ; Triamcinolone ; Visual Acuity ; Visual Fields

A 45-year-old, alcoholic liver cirrhosis patient presented to the Emergency Department(ED) with complaint of acute intense pain and weakness in the right lower extremity without trauma; hip flexor grade 3/5, knee extensor 2/5, and others normal. Initially, emergency physician diagnosed radiculopathy due to high lumbar disc herniation; however, plain a radiograph and an MRI of the lumbar spine did not revealed definitive compression of the nerve root. On the second hospital day at emergency department, swelling, tenderness of anterior proximal thigh and right inguinal pain were detected and computerized tomography (CT) of the abdomen was performed, which revealed diffuse swelling of right iliacus muscle with acute hematoma. Despite extravasation of contrast for CT imaging, the patient was managed conservatively because of improved neurologic deficit and coagulation abnormality of liver cirrhosis. An early correct diagnosis of femoral nerve palsy caused by iliacus hematoma in the ED is unlikely because of its rare incidence and it is difficult for complete history taking during physical examination involving some special case of severe pain such as this case.
Abdomen ; Diagnosis ; Emergencies ; Emergency Service, Hospital ; Femoral Nerve ; Femoral Neuropathy* ; Hematoma* ; Hip ; Humans ; Incidence ; Knee ; Liver Cirrhosis ; Liver Cirrhosis, Alcoholic ; Lower Extremity ; Magnetic Resonance Imaging ; Middle Aged ; Muscles ; Neurologic Manifestations ; Paralysis ; Physical Examination ; Radiculopathy ; Spine ; Thigh