Alcohol can cause a spectrum of untoward structural and functional changes in the brainThe spectrum of disruption includes alcohol-related brain damage at one end and complications such as hepatic encephalopathy, Wernicke encephalopathy, Korsakoff syndrome, Marchiafava–Bignami disease and central pontine myelinolysis at the otherThe clinical diagnoses of alcohol-related brain damage and even Wernicke encephalopathy can be difficult to make, and many cases of these conditions are missedChanges to the brain associated with alcohol intake are regionally specific and can affect both gray and white matter; some of these changes are reversible with abstinencePathogenic mechanisms associated with alcoholism are under investigation, with neuroinflammation currently receiving particular attention
Alcoholism is an addictive disorder with multifaceted biological underpinnings (Box 1). Frequent concomitants of alcoholism are liver disease (steatosis, hepatitis and cirrhosis),1 cardiovascular disease2 and malnutrition.3 The neurological consequences associated with this addictive disorder include hepatic encephalopathy, Wernicke encephalopathy (WE), Korsakoff syndrome (KS), Marchiafava–Bignami disease (MBD) and central pontine myelinolysis (CPM). Each of these relatively well-characterized alcohol-related CNS disorders is associated with a unique clinical presentation and a discrete neuropathological and neuroradiological signature (Figure 1).4 The structural changes to the brain and functional consequences that occur with chronic alcohol consumption in the absence of diagnosable neurological concomitants of alcoholism (that is, in cases of uncomplicated alcoholism) are grouped under the term 'alcohol-related brain damage' (ARBD).Figure 1Brain regions targeted by alcohol-related disease.Figure courtesy of A. Pfefferbaum, SRI International, CA, USA and E. V. Sullivan, Stanford University, CA, USA.
