AN is related to chronic alcohol abuse, and the disease follows a slowly progressive course. Superficial sensory alterations are noted first and dominate the clinical picture throughout the disease [6]. Patients typically claim intense, burning pain in the lower limbs. Both hyperalgesia and allodynia have been reported. As the disease progresses, the arms become involved while sensory deficits and weakness set in [5]. Due to reduced sensations in arms and legs, AN patients are prone to injuries. Affected individuals frequently describe paresthesias, which are initially noted in hands and feet, but that subsequently progress towards proximal portions of the extremities. An unsteady gait and walking disabilities may be observed in advanced stages of the disease. In AN patients, muscle strength is largely unaltered [7].

• Plethora

  The finding of a strong correlation between polyneuropathy and the presence of liver disease and macrocytosis confirms yet again the plethora of diseases related to alcohol misuse. Table 1. [dx.doi.org]

• Virilization

  Also noteworthy is that in Italy heavy drinking in men is often regarded as an expression of virility or strength, whereas in women it is openly condemned and so tends to be more surreptitious and kept behind closed doors. [dx.doi.org]

• Hyperhidrosis

  Autonomic disturbances were present in all patients, consisting of hyperhidrosis or tachycardia. Tachycardia resolved within 2 to 3 weeks after admission; however, hyperhidrosis persisted throughout the period of observation. [jamanetwork.com]

• Numbness of the Feet

  You might not feel temperature changes or pain on parts of your body that are numb. Infection. Your feet and other areas lacking sensation can become injured without your knowing. [mayoclinic.org]

• Restless Legs Syndrome

  Lyme disease community... by MuonOne 05-04-2019 03:25 PM 146 644 Health Conditions M - Z Movement Disorders (2 Viewing) Including essential tremor, dystonia and Restless Leg Syndrome (RLS). [neurotalk.psychcentral.com]

• Peripheral Neuropathy

  We suggest that a defect in thiamine utilization is involved in peripheral neuropathy of alcoholics, rather than a lack of thiamine itself. [ncbi.nlm.nih.gov]

  A person with this condition is at the same risk, and should take the same precautions as people with diabetic peripheral neuropathy. [universityfootassociates.com]

• Foot Drop

  Foot braces may also be helpful if you have problems with foot drop. If you have weakness in your arms, a wrist splint may be helpful. A physiotherapist may be the best person to help you with such aids. [patient.info]

• Absent Deep Tendon Reflex

  Individuals also may experience muscle wasting and decreased or absent deep tendon reflexes. Some people may experience frequent falls and gait unsteadiness due to ataxia. [en.wikipedia.org]

The diagnosis of AN is based on a prior diagnosis of alcoholism which, in turn, relies on anamnestic data provided by the patient and third parties [8]. Although electrophysiological studies may be conducted to confirm a clinical diagnosis of polyneuropathy, findings such as decreased amplitudes of sensory potentials and mild to moderate reductions of nerve conduction velocities are not specific for AN [4].

Patients suffering from chronic alcoholism frequently present comorbidities such as alcoholic hepatitis, cardiomyopathy, and nutrient deficiencies. Workup should thus include studies to assess the condition of the respective organ systems and the patient's nutritional status. In this context, it should be noted that long-term alcohol abuse is associated with thiamine deficiency and possibly Wernicke-Korsakoff syndrome, a brain disorder. Even if thiamine deficiency is not a prerequisite for AN, it may modify the patient's clinical presentation [6] [9].

In detail, the following diagnostic measures may be undertaken [10]:

• Laboratory analyses of blood samples, paying particular attention to liver enzyme levels (γ-glutamyltransferase, alanine aminotransferase, aspartate aminotransferase, ratio aspartate aminotransferase/alanine aminotransferase), carbohydrate deficient transferrin, markers of cardiac involvement (NT-proBNP, troponins, creatine kinase-MB), nutrient concentrations (thiamine, vitamin B12) and erythrocyte counts
• Assessment of fasting glucose levels and glucose tolerance to rule out diabetic neuropathy
• Imaging studies focusing on liver and brain
• Electrocardiography, echocardiography

Long-term, excessive consumption of alcoholic beverages is known to adversely affect distinct organ systems. Chronic alcoholism may cause alcoholic hepatitis and cirrhosis, arrhythmias and alcoholic cardiomyopathy, alcoholic neuropathy (AN) and epilepsy [1]. A causal relation between alcohol abuse and hypertension has repeatedly been suggested but has recently been questioned [2] [3].

AN is a neurological, potentially reversible disorder affecting the peripheral nervous system. Histopathological analyses of biopsy specimens obtained from AN patients reveal an overall reduced nerve fiber density as well as axonal degeneration with diminished axonal sprouting [4]. The clinical equivalents of these lesions are a pain, increased sensitivity to pain, dysesthesias, and weakness. Abstinence is the mainstay of treatment, but patients may benefit from supportive measures such as physical and occupational therapy as well as dietary supplementation [5].

1. Hillbom M, Pieninkeroinen I, Leone M. Seizures in alcohol-dependent patients: epidemiology, pathophysiology and management. CNS Drugs. 2003;17(14):1013-1030.
2. Grogan JR, Kochar MS. Alcohol and hypertension. Arch Fam Med. 1994;3(2):150-154.
3. Lip GY, Beevers DG. Alcohol and cardiovascular disease--more than one paradox to consider. Alcohol and hypertension--does it matter? (no!). J Cardiovasc Risk. 2003;10(1):11-14.
4. Maiya RP, Messing RO. Peripheral systems: neuropathy. Handb Clin Neurol. 2014;125:513-525.
5. Chopra K, Tiwari V. Alcoholic neuropathy: possible mechanisms and future treatment possibilities. Br J Clin Pharmacol. 2012;73(3):348-362.
6. Koike H, Sobue G. Alcoholic neuropathy. Curr Opin Neurol. 2006; 19(5):481-486.
7. Marchettini P, Lacerenza M, Mauri E, Marangoni C. Painful peripheral neuropathies. Curr Neuropharmacol. 2006;4(3):175-181.
8. Madden JS. The definition of alcoholism. Alcohol Alcohol. 1993;28(6):617-620.
9. Mellion M, Gilchrist JM, de la Monte S. Alcohol-related peripheral neuropathy: nutritional, toxic, or both? Muscle Nerve. 2011;43(3):309-316.
10. Maisch B. Alcoholic cardiomyopathy : The result of dosage and individual predisposition. Herz. 2016;41(6):484-493.