Clinical and pathological features of alcohol-related brain damage

Abstract

One of the sequelae of chronic alcohol abuse is malnutrition. Importantly, a deficiency in thiamine (vitamin B(1)) can result in the acute, potentially reversible neurological disorder Wernicke encephalopathy (WE). When WE is recognized, thiamine treatment can elicit a rapid clinical recovery. If WE is left untreated, however, patients can develop Korsakoff syndrome (KS), a severe neurological disorder characterized by anterograde amnesia. Alcohol-related brain damage (ARBD) describes the effects of chronic alcohol consumption on human brain structure and function in the absence of more discrete and well-characterized neurological concomitants of alcoholism such as WE and KS. Through knowledge of both the well-described changes in brain structure and function that are evident in alcohol-related disorders such as WE and KS and the clinical outcomes associated with these changes, researchers have begun to gain a better understanding of ARBD. This Review examines ARBD from the perspective of WE and KS, exploring the clinical presentations, postmortem brain pathology, in vivo MRI findings and potential molecular mechanisms associated with these conditions. An awareness of the consequences of chronic alcohol consumption on human behavior and brain structure can enable clinicians to improve detection and treatment of ARBD.

Figure 1 |

Brain regions targeted by alcohol-related disease. Figure courtesy of A. Pfefferbaum, SRI International, CA, USA and E. V. Sullivan, Stanford University, CA, USA.

Figure 2 |

Interactions between alcohol consumption and thiamine deficiency.

Figure 3 |

Functions and associated brain regions targeted by alcohol abuse and alcoholism. Figure courtesy of A. Pfefferbaum, SRI International, CA, USA and E. V. Sullivan, Stanford University, CA, USA.

Figure 4 |

Graded brain-volume deficits in alcoholism and its sequelae. T1-weighted MRI scans from a | a 63-year-old healthy control male, b | a 59-year-old man with alcoholism, and c | a 63-year-old man with WKS. Graded enlargement of the ventricles (indicating shrinkage of the surrounding tissue) can be observed from the healthy control to the individual with WKS. Sagittal (left column), axial (middle column) and coronal (right column) brain images are shown. Abbreviation: WKS, Wernicke–Korsakoff syndrome. Figure courtesy of A. Pfefferbaum, SRI International, CA, USA.