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Alcoholic Encephalopathy
Miral D. Jhaveri, MD, MBA
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Abbreviations

                • Alcohol [ethanol (EtOH)]
                • Acute alcohol poisoning (AAP)
                • Chronic alcoholic encephalopathy (CAE)
                • Wernicke encephalopathy (WE)
                • Marchiafava-Bignami disease (MBD)
              • Definitions

                • Acute, subacute, or chronic toxic effects of EtOH, potent neurotoxin on CNS
                • Can be primary (direct) or secondary (indirect)
                  • Primary (direct) effects of EtOH = neurotoxicity
                    • Cortical/cerebellar degeneration, peripheral polyneuropathy
                  • Secondary (indirect) effects
                    • Trauma, malnutrition, coagulopathy
                • Rare treatable complication = WE

              IMAGING

              • General Features

                • CT Findings

                  • MR Findings

                    • Nuclear Medicine Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          Selected References

                                          1. Tian TY et al: Marchiafava Bignami Disease. StatPearls Publishing, 2020
                                          2. Fouarge E et al: [Neurological consequences of alcoholism.] Rev Med Liege. 74(5-6):310-3, 2019
                                          3. Hammoud N et al: Chronic neurologic effects of alcohol. Clin Liver Dis. 23(1):141-55, 2019
                                          4. Sinha S et al: Wernicke encephalopathy-clinical pearls. Mayo Clin Proc. 94(6):1065-72, 2019
                                          5. Harrison NL et al: Effects of acute alcohol on excitability in the CNS. Neuropharmacology. 122:36-45, 2017
                                          6. Dujmović I et al: Teaching NeuroImages: reversible widespread brain MRI lesions in Marchiafava-Bignami disease. Neurology. 84(11):e81-2, 2015
                                          7. de la Monte SM et al: Human alcohol-related neuropathology. Acta Neuropathol. 127(1):71-90, 2014
                                          8. Kim TE et al: Wernicke encephalopathy and ethanol-related syndromes. Semin Ultrasound CT MR. 35(2):85-96, 2014
                                          9. Leon-Hernandez A et al: [Marchiafava-Bignami disease.] Rev Neurol. 58(11):516-7, 2014
                                          10. Manzo G et al: MR imaging findings in alcoholic and nonalcoholic acute Wernicke's encephalopathy: a review. Biomed Res Int. 2014:503596, 2014
                                          11. Wicklund MR et al: Brain MRI findings in Wernicke encephalopathy. Neurol Clin Pract. 3(4):363-4, 2013
                                          12. Francini-Pesenti F et al: Wernicke's syndrome during parenteral feeding: not an unusual complication. Nutrition. 25(2):142-6, 2009
                                          13. Sullivan EV et al: Neuroimaging of the Wernicke-Korsakoff syndrome. Alcohol Alcohol. 44(2):155-65, 2009
                                          14. Wobrock T et al: Effects of abstinence on brain morphology in alcoholism: a MRI study. Eur Arch Psychiatry Clin Neurosci. 259(3):143-50, 2009
                                          15. Zuccoli G et al: MR imaging findings in 56 patients with Wernicke encephalopathy: nonalcoholics may differ from alcoholics. AJNR Am J Neuroradiol. 30(1):171-6, 2009
                                          16. Hagiwara K et al: Extensive central and extrapontine myelinolysis in a case of chronic alcoholism without hyponatremia: a case report with analysis of serial MR findings. Intern Med. 47(5):431-5, 2008
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Pathology

                                                  • Clinical Issues

                                                    • Diagnostic Checklist

                                                      TERMINOLOGY

                                                      • Abbreviations

                                                        • Alcohol [ethanol (EtOH)]
                                                        • Acute alcohol poisoning (AAP)
                                                        • Chronic alcoholic encephalopathy (CAE)
                                                        • Wernicke encephalopathy (WE)
                                                        • Marchiafava-Bignami disease (MBD)
                                                      • Definitions

                                                        • Acute, subacute, or chronic toxic effects of EtOH, potent neurotoxin on CNS
                                                        • Can be primary (direct) or secondary (indirect)
                                                          • Primary (direct) effects of EtOH = neurotoxicity
                                                            • Cortical/cerebellar degeneration, peripheral polyneuropathy
                                                          • Secondary (indirect) effects
                                                            • Trauma, malnutrition, coagulopathy
                                                        • Rare treatable complication = WE

                                                      IMAGING

                                                      • General Features

                                                        • CT Findings

                                                          • MR Findings

                                                            • Nuclear Medicine Findings

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Gross Pathologic & Surgical Features

                                                                      • Microscopic Features

                                                                        CLINICAL ISSUES

                                                                        • Presentation

                                                                          • Demographics

                                                                            • Natural History & Prognosis

                                                                              • Treatment

                                                                                DIAGNOSTIC CHECKLIST

                                                                                • Consider

                                                                                  Selected References

                                                                                  1. Tian TY et al: Marchiafava Bignami Disease. StatPearls Publishing, 2020
                                                                                  2. Fouarge E et al: [Neurological consequences of alcoholism.] Rev Med Liege. 74(5-6):310-3, 2019
                                                                                  3. Hammoud N et al: Chronic neurologic effects of alcohol. Clin Liver Dis. 23(1):141-55, 2019
                                                                                  4. Sinha S et al: Wernicke encephalopathy-clinical pearls. Mayo Clin Proc. 94(6):1065-72, 2019
                                                                                  5. Harrison NL et al: Effects of acute alcohol on excitability in the CNS. Neuropharmacology. 122:36-45, 2017
                                                                                  6. Dujmović I et al: Teaching NeuroImages: reversible widespread brain MRI lesions in Marchiafava-Bignami disease. Neurology. 84(11):e81-2, 2015
                                                                                  7. de la Monte SM et al: Human alcohol-related neuropathology. Acta Neuropathol. 127(1):71-90, 2014
                                                                                  8. Kim TE et al: Wernicke encephalopathy and ethanol-related syndromes. Semin Ultrasound CT MR. 35(2):85-96, 2014
                                                                                  9. Leon-Hernandez A et al: [Marchiafava-Bignami disease.] Rev Neurol. 58(11):516-7, 2014
                                                                                  10. Manzo G et al: MR imaging findings in alcoholic and nonalcoholic acute Wernicke's encephalopathy: a review. Biomed Res Int. 2014:503596, 2014
                                                                                  11. Wicklund MR et al: Brain MRI findings in Wernicke encephalopathy. Neurol Clin Pract. 3(4):363-4, 2013
                                                                                  12. Francini-Pesenti F et al: Wernicke's syndrome during parenteral feeding: not an unusual complication. Nutrition. 25(2):142-6, 2009
                                                                                  13. Sullivan EV et al: Neuroimaging of the Wernicke-Korsakoff syndrome. Alcohol Alcohol. 44(2):155-65, 2009
                                                                                  14. Wobrock T et al: Effects of abstinence on brain morphology in alcoholism: a MRI study. Eur Arch Psychiatry Clin Neurosci. 259(3):143-50, 2009
                                                                                  15. Zuccoli G et al: MR imaging findings in 56 patients with Wernicke encephalopathy: nonalcoholics may differ from alcoholics. AJNR Am J Neuroradiol. 30(1):171-6, 2009
                                                                                  16. Hagiwara K et al: Extensive central and extrapontine myelinolysis in a case of chronic alcoholism without hyponatremia: a case report with analysis of serial MR findings. Intern Med. 47(5):431-5, 2008