Alcohol and the brain

  • Central nervous system depressant primary interfering with GABA receptors
  • Pleasure comes from release of endorphins and dopamine
Acute phase
  • usually CT is done
  • Quite often CT is normal
  • Sometimes mild cerebral edema is seen in the form of effacement of sulci and reduced size of ventricles
Chronic phase
  • Non specific atrophy: atrophy disproportionate for age and involving all areas of brain
  • Non specific white matter demyelination: confluent or focal
  • Cirrhosis: deposition of toxic substance in globus pallidus (T1 hyper)
  • Osmotic demyelination: chronic drinkers are malnourished, dehydrated and hyponatremic. T2 hyper intense pons  with sparing of corticospinal tracts
  • Corpus callosum atrophy 
  • Marchiafava-Bignami disease: malnourished chronic alcoholics with lesions in corpus callosum. Severe hypotrophy and necrosis of corpus seen. 
Wernicke’s encephalopathy
  • Chronic thiamine deficiency
  • Reversible
  • Nystagmus, ataxia, confusion
  • Ophthalmoplegia
  • T2 hyperintense thalamic lesions
  • T1 hyperintense atrophic mamillary bodies 
Korsakoff’s dementia
  • Chronic thiamine deficiency
  • Irreversible
  • Range of neuropsychiatric features
  • Delirium, amnesia, confusion