Alcoholic myelopathy – contribution of a clinical case from practice

Bulgarian Medical Journal, 2024, 18(1), 47-50.

V. Georgieva

University „Prof. Dr. Asen Zlatarov“ – Burgas

Abstract. Neurological disorders associated with excessive alcohol consumption can affect the central and peripheral nervous systems. Alcoholic myelopathy without underlying liver damage is rare in the reported literature. It is described as a disease with progressive damage to the posterior and lateral columns of the spinal cord. This article presents a clinical case of a 32-year-old man with alcoholic myelopathy due to alcohol abuse for 2 years and malnutrition for the past 9 months. The patient was hospitalized with eight months of progressive gait disturbance, leg weakness, and numbness in the limbs. The neurological examination revealed: lower severe spastic paraparesis with increased muscle tone in the lower limbs, with hyperreflexia and a positive Babinski sign bilaterally; sensation to touch, joint, muscle and position sense was diminished below the level of 6-7 thoracic dermatomes; discoordination syndrome; impossible walking independently; intermittent incontinence; weakness of concentration and attention. The history of alcohol consumption and malnutrition, clinical presentation, laboratory results, and imaging findings supported a diagnosis of alcoholic myelopathy and peripheral neuropathy. The patient was abstinent from alcohol after admission and began taking food and supplements with B vitamins – folic acid, thiamine, cyanocobalamin. Two weeks after treatment, disease progression stopped. Over the next six months, the patient’s condition remained stable, with a slow recovery but with impossible independent walking and persistence of paraparesis. Alcoholic myelopathy is a rare complication of chronic alcoholism that is associated with significant disability for patients. Early recognition of the initial sensory changes and gait disturbances that precede myelopathy is important to prevent the severity of the disease. Abstinence from alcohol intake is essential to stop the progression of the disease. The presence of a nutritional deficiency, especially a deficiency of B vitamins, must be compensated in a timely manner.

Key words: alcoholic myelopathy, chronic alcoholism, spinal cord atrophy

Address for correspondence: Vanya Bozhidarova Georgieva, MD, University „Prof. Dr. Asen Zlatarov“ – Burgas, 1 Prof. Yakimov St., e-mail: docvania@abv.bg