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Ethanol causes diverse neurologic conditions caused by acute and chronic brain damage. This review provides an overview of Wernicke encephalopathy and other ethanol-related brain changes, such as chronic brain atrophy, Marchiafava-Bignami disease, osmotic demyelination syndrome, chronic hepatic encephalopathy, and acute alcohol withdrawal. As clinical symptoms of this spectrum of diseases have nonspecific neurologic alterations, radiologists should have current radiologic information and understand the imaging findings pertaining to the pathophysiology to support diagnosis.

Summary Objective To describe nursing utilisation of a purpose-designed alcohol withdrawal management chart in terms of completeness of recording assessment measures, and use of recommended dose of diazepam and observation intervals. A secondary objective was to compare utilisation between the emergency department short stay ward and hospital wards. Methods A retrospective review was performed on data collected on a standardised chart for management of alcohol withdrawal. The convenience sample was 200 consecutive patients admitted through the emergency department from October till December 2007 and placed on the alcohol withdrawal chart. Assessment items, drug doses, observation intervals and admitting ward were recorded. Deviations from recommendations were calculated. Results A total of 3096 assessments were recorded. There was 85% compliance in completing assessment items and 84% compliance with recommended dose of diazepam. Incomplete assessments were mainly due to the patient being sleeping or because the patient's temperature was not recorded. There was similar performance between the short stay ward and hospital wards. Compliance with observation intervals was much lower at 49%, with observations being made early as well as late. Conclusions High compliance was achieved with the assessment tool and dosing regime, but not with recommended observation intervals. High compliance may be related to the brevity and standardisation of assessment and use of a single page format but requires further study.

In the elderly population, alcohol-related problems may be misinterpreted as normal consequences of aging. However, alcohol is a commonly abused substance among older adults, and age-related changes predispose these patients to a greater sensitivity to its effects. All older patients should be screened for alcohol dependence and abuse on admission to an acute care facility. If identified, the plan of care must include close observation for acute alcohol withdrawal and prompt intervention if it occurs.

The alcohol withdrawal syndromes are generally self-limited processes from which spontaneous recovery can be anticipated. To achieve this outcome, the various types of withdrawal must be managed in such a way as to prevent the occurrence of life-threatening situations. This begins with a good initial evaluation, followed by the appropriate pharmacologic and behavioral steps to control the severity of withdrawal symptoms and to manage complications. Once the withdrawal process is completed, the patient can then be entered into a long-term treatment program.

A case of severe alcohol withdrawal complicated by seizures, hallucinosis, hypertension, and supraventricular tachycardia is presented. When the patient showed no response to intravenous diazepam (total, 70 mg over 30 minutes) three 0.5-mg increments of propranolol were administered intravenously, resulting in immediate conversion to sinus rhythm and reduction of blood pressure from 210/130 mm Hg to 130/80 mm Hg. The use of intravenous propranolol as an adjunct to standard therapy in the alcohol withdrawal syndrome is discussed.