Neurologic Complications of Alcoholism

Practice guidelines in the addictions. Recent developments

Consensually established principles of clinical conduct, known variously as practice guidelines, standards, protocols, or algorithms, have proliferated throughout medicine over the past decade. Institutional and disciplinary efforts to develop and promulgate guidelines for the treatment of additive disorders have recently been initiated. We review guideline development activities of the American Psychiatric Association, American Psychological Association, American Society of Addiction Medicine, American Nurses Association, National Association of Social Workers, and Center for Substance Abuse Treatment of the Substance Abuse and Mental Health Services Administration. Medical care performance and outcome assessments are discussed with attention to the role they can play in evaluating and refining guidelines. Potential effects of guidelines, salutary and deleterious, on clinical practice in the addictions are delineated.

Reversible neurological deficits in a chronic alcohol abuser: a case report of Wernicke's encephalopathy

The abuse of alcohol presents daily challenges for the emergency medicine physician. Wernicke's encephalopathy represents one of the metabolic complications associated with alcoholism. A classic presentation of Wernicke's encephalopathy is reported. The patient presented to the emergency department with the chief complaint of confusion, difficulty ambulating, and visual disturbances. Following administration of intravenous thiamine, the patient's symptoms spontaneously resolved. The pathophysiology, clinical presentation and therapy of this classic disorder are discussed.

Alcohol-related seizures, Part I: Pathophysiology, differential diagnosis, and evaluation

Alcoholism may be society's most devastating problem short of war and malnutrition. Perhaps the most complex and perplexing medical complication of alcoholism is alcohol-related seizures. This article is a collective review designed to provide emergency physicians with an overview of the topic that is pertinent to their clinical practice. Part 1 addresses the pathophysiology, differential diagnosis, and evaluation of alcohol-related seizures. Part 2 will concentrate on the clinical presentation, management, and disposition. In addition, a classification of alcohol-related seizures will be proposed.