359 - Alcoholic Polyneuropathy - Old Enough to Abuse, Old Enough to Get It

Case Diagnosis: A 24-year old healthy male presented with a 3-month history of progressive bilateral upper and lower extremity weakness with hand and foot numbness, worsening over the past two weeks.

Case Description: One week prior to admission, bilateral leg weakness caused him to crawl around his apartment until worsening hand weakness prompted him to call for an ambulance. Over the past year, he had been consuming a six-pack of tall beers daily and had decreased appetite resulting in approximately 45 lbs weight loss. He had no red flag signs and no stroke symptoms on presentation.

Infectious workup was negative. Thiamine, folate levels were normal. Cervical/lumbar MRI were negative for myelopathy. EMG studies showed severe, generalized axonal sensorimotor polyneuropathy. The patient was admitted for weakness secondary to alcoholic polyneuropathy.

Discussions: On initial examination, the patient had distal weakness including bilateral foot drop which later progressed to proximal weakness. Functionally, he was a Mod-A. The patient was discharged from acute rehabilitation at Mod-I level with home therapy, a wheelchair, AFOs, and referral for substance abuse specialist. At 3-month follow up, he reported no pain, could ambulate independently with AFOs, and with grossly normal strength except bilateral foot drop.

Alcoholic polyneuropathy can affect ages from 20 to beyond, with average age of onset between 40-60 years old. Axonal sensorimotor loss is often seen in chronic alcoholic drinkers. This case demonstrated severe damages occurring within 1 year of intense alcoholic consumption. While the acute rehabilitation course was uneventful, strong psychological counseling and patient education were paramount to help him understand the severity of his condition and promote behavior modification to ensure ongoing functional recovery.

Conclusions: Alcoholic polyneuropathy often occurs in older, chronic alcoholic patients. This case demonstrated early manifestation of severe axonal sensorimotor polyneuropathy in a young 24-year old patient within one year of alcoholic abuse.