Alcohol-Related Neuropathy — MRCPsych Paper B MCQ

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EasySubstance MisuseAlcohol-Related NeuropathyMRCPsych Paper B

A 60-year-old woman with alcohol dependence has consumed very little food for several weeks. She develops a rapidly progressive, symmetrical sensorimotor peripheral neuropathy. Examination also shows confusion and horizontal nystagmus. Which vitamin deficiency best explains this presentation?

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Correct answer: A — Thiamine (vitamin B1)

The correct answer is **B, thiamine (vitamin B1)**. Severe dietary restriction in someone with alcohol dependence places her at high risk of thiamine deficiency. The rapidly progressive sensorimotor neuropathy is compatible with dry beriberi, while confusion and nystagmus indicate associated Wernicke encephalopathy. Vitamin B12 deficiency can cause peripheral neuropathy and subacute combined degeneration but does not best explain this alcohol-associated syndrome with Wernicke features. Folate deficiency mainly causes megaloblastic anaemia and does not typically cause this neuropathy. Vitamin D deficiency causes osteomalacia and proximal muscle weakness, while vitamin C deficiency causes scurvy. Alcohol-related neuropathy more generally is multifactorial and may reflect direct alcohol neurotoxicity; it should not automatically be attributed to thiamine deficiency without discriminating clinical features.

Reference: Galen Limited. Thiamine Hydrochloride 50 mg/ml solution for injection: Summary of Product Characteristics, section 4.1 Therapeutic indications. Updated 14 November 2024. https://www.medicines.org.uk/emc/product/100206/smpc