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Abstract: This patient presented with bilateral lower extremity weakness. After consultation, we learned that the patient had been drinking a lot of liquor for a long time, and we considered that the peripheral nerves were damaged by long-term alcohol consumption, which led to neuropathy. The patient was recommended to be admitted to hospital for 7 days. After hospitalization, the patient improved through treatment such as nerve nutrition and improvement of microcirculation, and the weakness of both lower limbs was relieved, but due to the slow recovery of nerves, the patient was recommended to continue medication after discharge.
Basic information】Male, 55 years old
Disease Type】Neuropathy
Hospital】The Second Hospital of Harbin Medical University
Date of consultation】February 2022
Treatment plan】Medication (methylcobalamin injection, prostaglandin injection, hemosiderin injection, Chuan Huang oral solution)
Treatment Period】Hospitalization for 7 days, review in 3-6 months
Treatment effect】Weakness of both lower limbs relieved
I. Initial consultation
The patient, Mr. Gao, presented with weakness of both lower limbs half a month before admission, complaining of difficulty in lifting both lower limbs, unstable walking and swaying sensation, no abnormalities in both upper limbs and hands, no headache sensation, no dizziness, breathlessness, choking and coughing symptoms, and normal communication with others. The patient was asked to drink alcohol for years, 2 taels of liquor per day, and the skin temperature of both lower limbs was normal by touching the patient.
II. Treatment history
After admission, the patient was clear, with fluent speech, blood pressure of 130/90 mmHg, heart rate of 65 beats/min, respiration of 17 breaths/min, muscle strength of both lower limbs of grade 3, no abnormal sensory examination, and good dorsalis pedis artery pulsation. Cranial MRI showed multiple lacunar cerebral infarcts with partial softening, and DWI did not show diffusion restriction. Vascular ultrasound of both lower extremities showed bilateral lower extremity arteriosclerosis without small ischemic foci in the brain with limited stenosis. Nerve conduction velocity examination of both lower extremities showed bilateral lower extremity tibial nerve motor impairment, and cranial MRI results showed the patient’s own arteriosclerosis and vascular occlusion, so the final diagnosis was weakness of both lower extremities due to neuropathy. Due to the slow recovery of peripheral nerve injury, the efficacy of treatment during hospitalization may be very minimal. After full communication with the patient’s family, the patient was given methylcobalamin injection to nourish the nerves, prostaglandin injection to dilate blood vessels, hemosiderin injection to improve microcirculation, and Chuanhuang oral solution to nourish peripheral nerves.
III. Treatment effect
After 7 days of inpatient drug treatment, the patient’s weakness of both lower limbs was relieved, but the relief was not obvious because of the slow recovery of nerve damage, and generally recovered by millimeters per month. Moreover, the patient was persuaded to gradually quit drinking alcohol because of the perennial alcoholic beverage, which caused peripheral nerve damage. The patient needs to continue to take nerve-nourishing drugs orally after discharge from the hospital, review the nerve conduction velocity of both lower limbs in 3-6 months, and pay attention to local cold-proof and warmth.
IV. Notes
We are glad that the patient’s symptoms of bilateral lower extremity weakness are relieved after treatment, but after discharge from the hospital, we should minimize downward activities because excessive activities may wear out the joints, muscles, nerves and other motor-related structures, resulting in poor treatment effect. Also localized limbs should avoid contact with cool water to avoid slowing down recovery. Patients also need to be regular in their diet and avoid spicy, stimulating, and cold foods such as ginger, garlic, and chili peppers. In life, it is important to maintain a good state of mind, pay attention to rest, avoid staying up late, getting cold, and pay attention to cold and warmth when going out in winter. After discharge from the hospital, patients should continue to take oral nerve-nourishing drugs and follow the doctor’s prescription for review.
V. Personal insight
Chronic alcoholism is one of the main causes of peripheral neuropathy, so the patient should abstain from alcohol as much as possible, not to mention alcohol abuse. Neuropathy starts slowly, sensory and motor nerves are often involved at the same time, symptoms appear earlier in both feet, both upper limbs are less involved, patients need to use high doses of B vitamins for long-term treatment, which may improve the symptoms.