Alcoholic Neuropathy – Thiamine Deficiency — SCE Neurology MCQ

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EasyPeripheral Neuropathy & NeuromuscularAlcoholic Neuropathy – Thiamine DeficiencySCE Neurology

A 50-year-old man with chronic alcoholism presents with progressive bilateral leg weakness, burning foot pain, and autonomic symptoms (postural hypotension, erectile dysfunction). NCS confirm a length-dependent sensorimotor axonal polyneuropathy. His B12 and folate are normal. What nutritional factor should also be checked?

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Correct answer: C — Thiamine (vitamin B1)

While 'alcoholic neuropathy' is often attributed to the direct toxic effects of alcohol, thiamine (B1) deficiency is a major contributing factor that is frequently under-recognised. Thiamine deficiency causes a painful axonal neuropathy and can coexist with or be mistaken for pure alcoholic neuropathy. All patients with suspected alcoholic neuropathy should have thiamine levels checked and receive parenteral thiamine replacement (Pabrinex) regardless, as the test may not reflect tissue stores. A: Vitamin D is important for bone health but does not cause neuropathy. C: Vitamin C deficiency (scurvy) does not primarily cause neuropathy. D: Iron does not cause neuropathy. E: Zinc deficiency does not cause neuropathy.

Reference: ABN Peripheral Neuropathy Guidelines; BNF – Thiamine