Diagnosing neurological comorbidities in patients with alcohol use disorder: Case report

Background: Long-term complications of alcohol use disorder (AUD) include severe neurological diseases like Wernicke-Korsakoff syndrome and alcohol-related dementia. Furthermore, acute alcohol intoxication and acute withdrawal syndrome can mimic neurological symptoms. Clinicians may overlook underlying comorbidities by focusing excessively on AUD in these patients. We report two cases wherein AUD was a significant confounding factor in the diagnosis of underlying neurological conditions. Case presentations: A 46-year-old male with AUD developed delirium tremens due to severe AAI. Despite initiating treatment for acute withdrawal syndrome which resolved delirium tremens, space-time disorientation persisted for a week. A brain MRI showed signal abnormalities in the centra semiovalia. A rachicentesis and repeat brain and spine MRI later revealed oligoclonal bands in cerebrospinal fluid and bone marrow signal abnormalities, indicating multiple sclerosis. A 61-year-old female with AUD presented with disorientation and memory deficits following a car accident. One month after discharge, the patient developed left hemidysesthesia, walking instability, strength deficits and hallucinations. Biohumoral tests confirmed that she was still in recovery. An electroencephalogram and brain CT scan and MRI raised the suspicion of Creutzfeldt-Jakob disease; elevated tau protein levels confirmed the diagnosis. The patient's condition deteriorated rapidly, leading to death. Conclusions: Persistent neurological symptoms in AUD patients even after receiving treatment for acute alcohol intoxication or withdrawal syndrome, may indicate the presence of underlying neurodegenerative conditions such as multiple sclerosis and Creutzfeldt-Jakob disease.