Alcohol-related acute axonal polyneuropathy: a differential diagnosis of Guillain-Barré syndrome.
BACKGROUND
Chronic axonal polyneuropathy is a well-known clinical sequela of excessive alcohol consumption; however, acute axonal polyneuropathy related to alcohol abuse is less well recognized.


OBJECTIVE
To describe alcohol-related acute axonal polyneuropathy in 5 chronic alcoholics who developed ascending flaccid tetraparesis and areflexia within 14 days.


METHODS
Case series with clinical, laboratory, electrophysiological, and, in 1 patient, biopsy data.


RESULTS
All 5 patients consumed a daily average of 250 g of alcohol, and 4 had lost a substantial amount of weight recently. Additional clinical features included painful paresthesia, myalgia, and glove and stocking-type sensory loss. Repeated cerebrospinal fluid examinations failed to show the marked increase of protein concentration with normal cell count typical of Guillain-Barré syndrome, although the protein level was mildly elevated in 1 patient. Blood laboratory findings were consistent with longstanding alcohol abuse. Compound muscle and sensory nerve action potentials were absent or reduced, while conduction velocities were normal or mildly reduced. Three to 4 weeks after onset, needle electromyography displayed moderate to severe fibrillations and positive sharp waves in addition to normal motor unit potentials, indicating an acute axonal polyneuropathy; this was confirmed by sural nerve biopsy in 1 patient.


CONCLUSIONS
Excluding other factors, we assume that in these patients the combination of alcohol abuse and malnutrition caused severe acute axonal polyneuropathy. Its distinction from Guillain-Barré syndrome is important because treatment requires balanced diet, vitamin supplementation, and abstinence from alcohol, while immunotherapy may not be indicated.
Wöhrle
J C
JC
Department of Neurology, Klinikum Mannheim of the University of Heidelberg, Germany. woehrle@neuro.ma.uni-heidelberg.de
Spengos
K
K
Steinke
W
W
Goebel
H H
HH
Hennerici
M
M
D000208:Acute Disease; D000328:Adult; D001259:Ataxia / Q000209:etiology; D001369:Axons / Q000187:drug effects* / Q000473:pathology; D001706:Biopsy; D003711:Demyelinating Diseases / Q000473:pathology; D003937:Diagnosis, Differential; D000431:Ethanol / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced* / Q000150:complications / Q000473:pathology; D011129:Polyradiculoneuropathy / Q000473:pathology; D012720:Severity of Illness Index
D000431:Ethanol