Abstract
A 34-year-old man developed muscular weakness and atrophy of the hands, gait disturbance, numbness of the lower limbs and hyperreflexia about 4 years ago. At that time his illness was tentatively diagnosed as motor neuron disease, although the sensory disturbance was not an usual symptom in this disease. On admission after his spastic gait was worsened, nystagmus and hyperhidrosis were observed in addition to the symptoms mentioned above. Laboratory examination revealed an increase in the mean corpuscular volume of erythrocytes, moderate reduction of serum folate level and liver damage of slight degree. Slowing of nerve conduction velocities and large grouped atrophy in muscle histology were also detected. His past history disclosed that he had been drinking much alcohol every day for about 14 years. From these results, most of his neurological abnormalities were considered to be due to alcoholic polyneuropathy. The main lesions of alcoholic nervous disease are found in the peripheral nerve, causing its degeneration. As the result, deep tendon reflexes are generally decreased or lost. However, all the deep reflexes of the extremities except for Achilles tendon reflex have been continuously exaggerated in our patient. This is rather unique, indicating the presence of lesion in the pyramidal tract. Although the incidence of pyramidal tract damage in chronic alcholism is not known, its clinical diagnosis might be difficult because of the marked lesion in the peripheral nerve.
