Osman SINANOVIĆ (Tuzla)

NEUROLOŠKI KOMORBIDITET ALKOHOLIZMA
Brojni su klinički sindromi koji se javljaju u sklopu alkoholizma. Oni mogu biti psihijatrijski, internistički i neurološki. Od neuroloških najčešći su polineuropatije, alkoholni tremor, krize svijesti i Wernickeova encefalopatija. Žene koje u toku trudnoće konzumiraju alkohol mogu roditi dijete sa tzv. fetalnim alkoholnim sindromom.
Alkoholna polineuropatija je najčešći neurološki poremećaj kod alkoholičara i predstavlja nutricionu bolest sekundarno uzrokovanu zloupotrebom alkohola zbog oslabljenog unosa hranjljivih materija i vitamina uz direktni toksični efekat alkohola. Simptomi su najčešće simetrični i locirani u donjim ekstremitetima u vidu žarenja i bolova u stopalima i umjerenih distalnih slabosti. Polineuropatija je relativno često udružena sa Wernickeovom encefalopatijom.
Wernickeova encefalopatija je klinički sindrom koji se javlja kao posljedica višegodišnje zloupotrebe alkohola i posljedičnih degenerativnih sitnih hemoragijskih promjena moždanih struktura. Karakteriše se trijadom simptoma: okulomotorne promjene, poteškoće hodanja i psihičke smetnje. Netretirana Wernickeova encefalopatija rezultira razvojem Korsakovljeve psihoze, koja pored poremećaja pamčenja i polineuropatije se karakteriše i pojavom konfabulacija.
Alkoholni tremor je tipična manifestacija alkoholne apstinencije i skoro uvijek se javlja kao prvi znak kada je bolesnik uznemiren sa jasno vidljivim iregularnim tremorom ruku.
Krize svijesti su raširene kod alkoholičara i mogu se javiti u vidu apstinencijalnih generaliziranih ili alkoholom precipitiranih napada.
Fetalni alkoholni sindrom se karakteriše oštećenjem centralnog nervnog sistema (ali i perifrnog i autonomnog), fizičkim promjena lica i oštećenjem rasta. Ako je oštećenje nastupilo u prvih 6 sedmica trudnoće govorimo o alkoholnoj embripaptiji, aako se oštećenje dogodilo u razdoblju nakon 6 sedmica tada je to alkoholna fetopatija.
Ključne riječi: alkoholizam, alkoholna neuropatija, Wernicekoeva encefalopatija, alkoholni tremor, krize svijesti, fetalni alkoholni sindorm

NEUROLOGICAL COMORBIDITY OF ALCOHOLISM
Several clinical syndromes that appear within alcoholism exist. They can be psychiatric, internist and neurological. The most common neurological syndromes are polyneuropathy, alcoholic tremor, seizures and Wernicke encephalopathy. Women who during their pregnancy consume alcohol risk giving birth to a child with fetal alcohol syndrome. Alcoholic polyneuropathy is the most often neurological disorder in alcoholics and represents a nutritional disease which is secondarily caused by alcohol abuse, because of intake of nutritive substances and vitamins along with direct toxic effect of alcohol. Symptoms are mostly symmetric and located in bottom limbs, appearing in the form of annealing and pain in feet and moderate distal weaknesses. Polyneuropathy is relative commonly associated with Wernicke encephalopathy. Wernicke encephalopathy is a clinical syndrome which appears as a consequence of multiannual alcohol abuse and consequential vestigial paltry hemorrhagic modifications of cerebral structures. It is characterized by a symptom triad: abnormal eye signs, ataxia and confusional state. Non-treated Wernicke encephalopathy results in development of the Korsakoff psychosis, which is besides impairment in memory and polyneuropathy characterized with confabulation. Alcoholic tremor is a typical manifestation of alcohol abstinence and it almost always appears as the first sign when a patient is upset with clearly visible irregular tremor of hands. Seizures are expanded at alcoholics and can appear in the form of abstinence generalized or by alcohol precipitated episodes. Fetal alcohol syndrome is characterized by impairment of the central nervous system (but also a peripheral and autonomous), physical facial modification and impairment of growth. If the impairment has occurred within the first six weeks of the pregnancy we have the situation of alcohol embriopathy, but if the impairment occurred in the period after the first six weeks it is called alcohol foetopathy.
Key words: Alcoholism - Alcoholic neuropathy - Wernicke encephalopathy - Alcoholic tremor - Seizure - Fetal alcohol syndrome

Prof. dr. med. sc. Osman Sinanović, neuropsihijatar, Klinika za neurologiju, Univerzitetski klinički centar Tuzla, Medicinski fakultet Univerziteta u Tuzli, 75000 Tuzla, Bosna i Hercegovina