Skip to main content Accessibility help

Brain Injury Associated With Chronic Alcoholism

  • Paul W. Ragan, Charles K. Singleton and Peter R. Martin


Alcoholism can result in a number of severe consequences to the central nervous system, including Korsakoff's psychosis, delusions, delirium, Wernicke's encephalopathy, and cerebellar degeneration. Many of these disorders have a substantially higher prevalence than had been previously believed. Neuropathologic and neuroimaging studies have been instrumental in identifying the changes undergone by the alcoholic brain and the factors that may contribute to alcohol-induced brain damage. Biologic differences appear to make women especially susceptible to central nervous system insult from alcohol abuse. The damage caused by alcohol may be associated, in part, with thiamine deficiency, neuronal excitotoxicity, and magnesium wasting.



Hide All
1.Hunt, WA, Nixon, SJ, eds. Alcohol-Induced Brain Damage. Rockville, Md: National Institute on Alcoholism and Alcohol Abuse; 1993. No. 22.
2.Porjesz, B, Begleiter, H. Brain dysfunction and alcohol. In: Kissin, B, Begleiter, H, eds. The Pathogenesis of Alcoholism: Biological Factors. New York, NY: Plenum Press; 1983:415483.
3.Dufour, MC. The epidemiology of alcohol-induced brain damage. In: Hunt, WA, Nixon, SJ, eds. Alcohol-Induced Brain Damage. Rockville, Md: National Institute on Alcoholism and Alcohol Abuse; 1993:314. No. 22.
4.Ninth Special Report to the US Congress on Alcohol and Health. Washington, DC: National Institute on Alcoholism and Alcohol Abuse; 1997:1314.
5.International Classification of Diseases, 9th Revision, Clinical Modification. 5th ed. Salt Lake City, UT: Medicode, Inc.; 1997.
6.Umbricht-Schneiter Santora, A, Santora, P, Moore, RD, Alcohol abuse: comparison of two methods for assessing its prevalence and associated morbidity in hospitalized patients. Am J Med. 1991;91:110118.
7.Sharkey, J, Brennan, K, Curran, P. The pattern of alcohol consumption of a general hospital population in North Belfast. Alcohol Alcohol. 1996;31:279285.
8.Eckardt, MJ, Martin, PR. Clinical assessment of cognition in alcoholism. Alcohol Clin Exp Res. 1986;10:123127.
9.Grant, BF, Harford, TC, Dawson, DA, Chou, P, Dufour, M, Pickering, R. Prevalence of DSM-IV alcohol abuse and dependence: United States 1992. Alcohol Health Res World. 1994;18:243248.
10.Smith, DM, Atkinson, RM. Alcohol and dementia. Intl J Addictions. 1995;30:18431869.
11.Welch, LW, Cunningham, AT, Eckardt, MJ, Martin, PR. Fine motor speed deficits in alcoholic Korsakoff's syndrome. Alcohol Clin Exp Res. 1997;21:134139.
12.Martin, PR, Adinoff, B, Weingartner, H, Mukherjee, AB, Eckardt, MJ. Alcholic organic brain disease: nosology and pathophysiologic mechanisms. Prog Neuro Psychopharmacol Biol Psychiatry 1986;10:147164.
13.Victor, M, Adams, RD, Collins, GH. The Wernicke-Korsakoff Syndrome and Related Neurologic Disorders Due to Alcoholism and Malnutrition. 2nd ed. Philadelphia, Pa: FA Davis Co; 1989.
14.Charness, ME. Brain lesions in alcoholics. Alcohol Clin Exp Res. 1993;17:211.
15.Lishman, WL. Organic Psychiatry. Oxford, England: Blackwell Scientific Publications; 1978.
16.Greenberg, DA, Diamond, I. Wernicke-Korsakoff Syndrome. In: Tarter, RE, Van Thiel, DH, eds. Alcohol and the Brain: Chronic effects. New York, NY: Plenum Medical Book Co; 1985.
17.Franklin, JE, Frances, RJ. Alcohol-induced organic mental disorders. In: Yudofsky, SC, Hales, RE, eds Textbook of Neuropsychiatry. Washington, DC: American Psychiatric Press; 1992:563583.
18.Harper, C. The neuropathology of alcohol-specific brain damage, or does alcohol damage the brain? J Neuropath Exp Neurol. 1998;57:101110.
19.Harper, C. The incidence of Wernicke's encephalopathy in Australia–a neuropathological study of 131 cases. J Neurol Neurosurg Psychiatry. 1983;46:593598.
20.Ma, JJ, Truswell, AS. Wernicke-Kosakoff syndrome in Sydney hospitals: before and after thiamine enrichment of flour. Med J Aust. 1995;163:531534.
21.Harper, CG, Sheedy, DL, Lara, AI, Garrick, TM, Hilton, JM, Raisnen, J. Prevalence of Wernicke-Korsakoff syndrome in Australia: has thiamine fortification made a difference? Med J Aust. 1998;168:542545.
22.Freund, G. Chronic central nervous system toxicity of alcohol. Ann Rev Pharmacol. 1973;13:217227.
23.Kopelman, MD. The Korsakoff syndrome. Br J Psychiatry. 1995;166:154173.
24.Adams, RD, Victor, M. Principles of Neurology. 3rd ed. New York, NY: McGraw-Hill; 1985.
25.Adams, RD, Victor, M, Mancall, EL. Central pontine myelinolysis: a hitherto underscribed disease occuring in alcoholic and malnourished patients. Arch Neurol Psychiatry. 1959;81:154172.
26.Harper, CG, Kril, JJ. Neuropathological changes in alcoholics. In: Hunt, WA, Nixon, SJ, eds. Alcohol-Induced Brain Damage. Rockville, Md: National Institute on Alcoholism and Alcohol Abuse; 1993:3969. No. 22.
27.Estol, CJ, Faris, AA, Martinez, J, Ahab-Barmada, M. Central pontine myelinolysis after liver transplantation. Neurol. 1989;39:493498.
28.Charness, ME, Clinical and pathologic overview of the brain disorders in alchoholics. In: Hunt, WA, Nixon, SJ, eds. Alcohol-Induced Brain Damage. Rockville, Md: National Institute on Alcoholism and Alcohol Abuse; 1993:16. No. 22.
29.Harper, C, Kril, J. Brain atrophy in chronic alcoholic patients: a quantitative pathological study. J Neurol Neurosurg Psychiatry. 1985;48:211217.
30.Torvik, A. Brain lesions in alcoholics: neuropathological observations. Acta Med Scand Suppl. 1987;717:4754.
31.Harper, C, Kril, J, Daly, J. Are we drinking our neurons away? Br Med J. 1987;294:534536.
32.Brewer, C, Perrett, L. Brain damage due to alcohol consumption: an air-encephalographic, psychometric and electroen-cephalographic study. Br J Addict. 1971;66:170182.
33.Wilkinson, DA. Neuroradiologic investigations of alcoholism. In: Tarter, RE, Van Thiel, DH, eds. Alchohol and the Brain: Chronic Effects. New York, NY: Plenum Press; 1985:183215.
34.Carlen, PL, Wortzman, G, Holgate, R, et al.Reversible cerebral atrophy in recently abstinent chronic alcoholics measured by computed tomography scan. Science. 1978;200:10761078.
35.Pfefferbaum, A, Rosenbloom, M. In vivo imaging of morphological brain alterations associated with alcoholism. In: Hunt, WA, Nixon, SJ. eds. Alcohol-Induced Brain Damage. Rockville, Md: National Institute on Alcoholism and Alcohol Abuse; 1993:7187. No. 22.
36.Clavier, E. Thiebot, J, Delangre, T, Hannequin, D, Samson, M, Benozio, M. Marchiafava-Bignami diease: a case studied by CT and MR imaging. Neuroradiology. 1986;28:376.
37.Gass, A, Birtsch, G, Olster, M, Schwartz, A, Hennerici, MG. Marchiafava-Bignami disease: reversibility of neuroimaging abnormality. J Comput Assist Tomogr. 1998;22:503504.
38.Gass, A, Birtsch, G, Olster, M, Schwartz, A, Hennerici, MG. Marchiafava-Bignami disease: reversability of neuroimaging abnormality. J Comput Assist Tomogr. 1998;22:503504.
39.Martin, PR, Gibbs, SJ, Nimmerrichter, AA, Riddle, WR, Welch, LW, Willcott, MR. Brain proton magnetic resonance spectroscopy studies in recently abstinent alcoholics. Alcohol Clin Exp Res. 1995;19:10781082.
40.Fellios, PG. Alcoholism in women: causes, treatment, and prevention. In: Lawson, GW, Lawson, AW, eds. Alcoholism and Substance Abuse in Special Populations. Rockville, Md: Aspen Publishers; 1989:1136.
41.Smith, EM, Cloninger, R, Bradford, S. Predictors of mortality in alcoholic women: a prospective follow-up study. Alcohol Clin Exp Res. 1983;7:237243.
42.Morgan, MY, Sherlock, S. Sex-related differences among 100 patients with alcoholic liver disease Br Med J. 1977;1:939941.
43.Loft, S, Olesen, KL, Dossing, M. Increased susceptibility to liver disease in relation to alcohol consumption in women. Scand J Gastroenterol. 1987;22:12511256.
44.Lieber, CS. Medical disorders of alcoholism. N Engl J Med. 1995;333:10581065.
45.Frezza, M, Di Padova, C, Pozzato, G, Terpin, M, Baraona, E, Lieber, CS. High blood alcohol levels in women: the role of decreased gastric alcohol dehydrogenase activity and first-pass metabolism. N Engl J Med. 1990;322:9596.
46.Seitz, HK, Egerer, G, Simanowski, UA, et al.Human gastric alcohol dehydrogenase activity: effect of age, sex, and alcoholism. Gut. 1993;34:14331437.
47.Grant, BF. Prevalence and correlates of alcohol use and DSM-IV alcohol dependence in the United States: results of the National Longitudinal Alcohol Epidemiologic Survey. J Stud Alcohol. 1997;58:464473.
48.Harper, CG, Smith, NA, Kril, JJ. The effect of alcohol on the female brain: a neuropathological study. Alcohol Alcohol. 1990;25:445448.
49.Jacobson, R. The contributions of sex and drinking history to the CT brain scan changes in alcoholics. Psychol Med. 1986;16:547559.
50.Mann, K, Batra, A, Gunthner, A, Schroth, G. Do women develop alcoholic brain damage more readily than men? Alcohol Alcohol. 1992;16:10521056.
51.Kroft, CL, Gescuk, B, Woods, BT, Mello, NK, Weiss, RD, Mendelson, JH. Brain ventricular size in female alcoholics: an MRI study. Alcohol. 1991;8:3134.
52.Harper, CG, Kril, JJ. Corpus callosal thickness in alcoholics. Br J Addict. 1998;83:577580.
53.Hommer, D, Momenan, R, Rawlings, R, et al.Decreased corpus callosum size among alcoholic women. Arch Neurol. 1996;53:359363.
54.Pfefferbaum, A, Lim, KO, Desmond, JE, Sullivan, EV. Thinning of the corpus callosum in older alcoholic men: a magnetic resonance imaging study. Alcohol Clin Exp Res. 1996;20:752757.
55.Roebuck, TM, Mattson, SN, Riley, EP. A review of the neuroanatomical findings in children with fetal alcohol syndrome or prenatal exposure to alcohol. Alcohol Clin Exp Res. 1998:22:339344.
56.Curerris, C. Neuroanatomical and neurophysiological mechanisms involved in central nervous system dysfunctions induced by prenatal alcohol exposure. Alcohol Clin Exp Res. 1998;22:304312.
57.Gabrielli, O, Salvolini, U, Coppa, GV, et al.Magnetic resonance imaging in the malformative syndromes with mental retardation. Pediatr Radiol. 1990;21:1619.
58.Riley, EP, Mattson, SN, Sowell, ER, Jernigan, TL, Sobel, DF, Jones, KD. Abnormalities of the corpus callosum in children prenatally exposed to alcohol. Alcohol Clin Exp Res. 1995;19:11981202.
59.Kandel, DB, Wu, P, Davies, M. Maternal smoking during pregnancy and smoking by adolescent daughters. Am J Psychiatry. 1998;84:14071413.
60.Yates, WR, Cadoret, RJ, Troughton, EP, Stewart, M, Guinta, TS. Effect of fetal alcohol exposure on adult sumptoms of nicotine, alcohol and drug dependence. Alcohol Clin Exp Res. 1998;22:914920.
61.Famy, C, Strissguth, AP, Unis, AS. Mental illness in adults with fetal alcohol syndrome or fetal alcohol effects. Am J Psychiatry. 1998;155:552554.
62.Martin, PR, McCool, BA, Singleton, CK. Genetic sensitivity to thiamine deficiency and development of alcoholic organic brain disease. Alcohol Clin Exp Res. 1993;17:3137.
63.Hoyumpa, AM. Mechanisms of thiamine deficiency in chronic alcoholism. Am J Clin Nutr. 1980;33:27502761.
64.Morgan, MY. Alcohol and nutrition. Br Med Bull. 1982;38:2129.
65.Tsai, G, Gastfriend, DR, Coyle, JT. The glutamatergic basis of human alcoholism. Am J Psychiatry. 1995;152:332340.
66.Lovinger, DM, White, G, Weight, FF. Ethanol inhibits NMDA-activated ion current in hippocampal neurons. Science. 1989;243:17211724.
67.Hunt, WA. Are binge drinkers more at risk of developing brain damage? Alcohol. 1993;10:559561.
68.Breese, CR, Freedman, R, Leonard, SS. Glutamate receptor subtype expression in human postmortem brain tissue from schizophrenics and alcohol abusers. Brain Res. 1995;674:8290.
69.Tsai, Ge, Ragan, P, Chang, R, Chen, S, Linnoila, M, Coyle, JT. Increased glutamatergic neurotransmission and oxidative stress after alcohol withdrawal. Am J Psychiatry. 1998;155:726732.
70.Moak, DH, Anton, RF. Alcohol-related seizures and the kindling effect of repeated detoxifications: the influence of cocaine. Alcohol Alcohol. 1996;31:135143.
71.Lovinger, DM. Excitotoxicity and alcohol-related brain damage. Alcohol Clin Exp Res. 1993;17:1927.
72.Todd, KG, Butterworth, RF. Evaluation of the role of NMDA-medicated excitoxicity in the selective neuronal loss in experimental Wemicke encephalopathy. Exp Neurol. 1998;149:130138.
73.Lehninger, AL. Biochemistry. 2nd ed. New York, NY: Worth Publishers; 1975:337.
74.Dingledine, R, McBain, CJ. Excitatory amino acid transmitters. In: Seigel, GJ, Agranoff, BW, Albers, RW, Molinoff, PB, eds. Basic Neurochemistry. 5th ed. New York, NY: Raven Press; 1994:367387.
75.Altura, BM, Gebrewold, A, Zhang, A, Altura, BT, Gupta, RK. Magnesium deficiency exacerbates brain injury and stroke mortality induced by alcohol; a31 P-NMR in vivo study. Alcohol. 1998;15:181183.
76.Langlais, PJ, Anderson, G, Guo, SX, Bondy, SC. Increased cerebral free radical production during thiamine deficiency. Med Brain Dis. 1997;12:137143.
77.Halliwell, B, Gutteridge, JMC. Free Radicals in Biology and Medicine. 2nd ed. Oxford, England: Clarendon Press; 1989.
78.Hunt, WA. Role of free radical reactions in ethanol-induced brain damage: an introduction. In: Hunt, WA, Nixon, SJ, eds. Research Monograph No. 22, Alcohol-Induced Brain Damage. Rockville, Md: National Institute on Alcoholim and Alcohol Abuse; 1993:327338.
79.Clarke, DD, Sokoloff, L. Circulation and energy metabolism of the brain. In: Siegel, GJ, Agranoff, BW, Albers, RW, Molinoff, PB, eds. Basic Neurochemistry. 5th ed. New York, NY: Raven Press; 1994:645680.
80.Juhnke, H, Krems, B, Kotter, P, Entian, KD. Mutants that show increased sensitivity to hydrogen peroxide reveal an important role for the pentose phosphate pathway in protection of yeast against oxidative stress. Mol Gen Genet. 1996;252:456464.
81.Fein, G, Gletcher, DJ, Ki Sclafani, V. Effect of chronic alcohol abuse on the CNS morbidity of HIV disease. Alcohol Clin Exp Res Suppl. 1998;22:196200.
82.Weinstein, DD, Martin, PR. Psychiatric implications of alcoholism and traumatic brain injury. Am J Addict. 1995;4:285296.
83.Ramayya Ajauhar, P. Increasing incidence of Korsakoff's psychosis in the East End of Glasgow. Alcohol Alcohol. 1997;32:281285.

Related content

Powered by UNSILO

Brain Injury Associated With Chronic Alcoholism

  • Paul W. Ragan, Charles K. Singleton and Peter R. Martin


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.