Cerebral lesions and causes of death in male alcoholics (original) (raw)

Summary

Autopsies on 195 male alcoholics aged 30–64 years who died outside hospitals and nursing homes in Oslo from 1984 to 1988, were carried out at the Institute of Forensic Medicine, Rikshospitalet. In 127 cases brain tissue was examined neuropathologically, 86 (67.7%) showed abnormalities and 28 contained lesions of more than one type. Lesions associated with alcoholism were found in 61 cases (48%), 18 (14.2%) showed Wernicke's encephalopathy, 47 (37%) cerebellar atrophy, 2 central pontine myelinolysis and 1 hepatic encephalopathy. Subdural haematoma and/or cortical contusions were found in 30 cases (23.6%) and cerebrovascular lesions in 19 (15%). Of the 195 cases, 22 had a history of recurrent convulsive attacks of which 19 were examined neuropathologically and 13 had focal damage that could have caused epileptic fits. Although cerebral damage was more frequent among vagrants and other persons dependant on social support, 50% of the alcoholics living in their own homes were also affected. Alcohol-related disease was considered the cause of death in 15 of 127 cases examined neuropathologically and 9 of these died from acute Wernicke's encephalopathy all of whom were sober at death. Although the post mortem analyses included neuropathological examination of the brain, the cause of death remained unknown in 27 (21%) of the 127 cases.

Zusammenfassung

Obduktionen an 195 männlichen Alkoholikern, welche im Lebensalter zwischen 30 und 64 Jahren in den Jahren 1984–1988 verstarben, wurden am Institut für Gerichtliche Medizin des Rikshospitalet in Oslo durchgeführt. Die Personen starben außerhalb von Krankenhäusern und von Pflegeheimen. In 127 Fällen wurde Hirngewebe neuropathologisch untersucht. 86 Fälle (67,7%) zeigten abnorme Befunde und 28 Fälle zeigten Läsionen von mehr als einem Typ. Alkohol assoziierte Läsionen wurden in 61 Fällen gefunden (48%); 18 (14,2%) zeigten die Wernicke'sche Encephalopathie, 47 (37%) eine cerebellare Atrophie, 2 eine zentrale pontine Myelinolyse und einer eine hepatogene Encephalopathie. Subdurale Hämatome und/oder Rindenprellungen wurden in 30 Fällen (23,6%) gefunden und cerebro-vasukläre Läsionen in 19 Fällen (15%). 22 der insgesamt 195 Fälle zeigten in ihrer Vorgeschichte wiederholte Anfälle. 19 hiervon wurden neuropathologisch untersucht und 13 hatten fokale Schäden, die die epiletpischen Anfälle verursacht haben konnten. Obwohl der Hirnschaden häufiger unter Obdachlosen und anderen Personen, welche von einer Sozialhilfe abhänging sind, war, waren 50% der Alkoholiker, welche in ihren eigenen Häusern lebten, ebenfalls befallen. In 15 der 127 neuropathologisch untersuchten Fälle wurde die alkoholinduzierte Erkrankung als Todesursache angesehen. 9 dieser Fälle verstarben an einer akuten Wernicke-Encephalopathie, alle waren nüchtern zum Zeitpunkt des Todes. Obwohl die postmortalen Untersuchungen eine neuropathologische Untersuchung des Hirns einbezog, blieb die Todesursache in 27 von 127 Fällen (= 21%) unbekannt.

Access this article

Log in via an institution

Subscribe and save

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Adams RD, Victor M, Mancall EL (1959) Central pontine myelinolysis. Arch Neurol Psychiatr 81:154–172
    Google Scholar
  2. Bergman MM, Cleckman RA (1988) Infectious complications in alcohol abusers. Hosp Pract 23: 145–156
    Google Scholar
  3. Bratzke H, Neumann K (1989) Zentrale Pontine Myelinolyse Morphologie und Forensische Bedeutung. Z Rechtsmed 102: 79–97
    PubMed Google Scholar
  4. Brennan FN, Lyttle JA (1987) Alcohol and seizures: a review. J R Soc Med 80:571–573
    PubMed Google Scholar
  5. Chan AWK (1985) Alcoholism and epilepsy. Epilepsia 26: 323–333
    PubMed Google Scholar
  6. Estrin WJ (1987) Alcoholic cerebellar degeneration is not a dosedependent phenomenon. Alcoholism (NY) 11: 372–375
    Google Scholar
  7. Harper C (1979) Wernicke's encephalopathy: a more common disease than realised. A neuropathological study of 51 cases. J Neurol Neurosurg Psychiatr 42:226–231
    PubMed Google Scholar
  8. Harper C (1983) The incidence of Wernicke's encephalopathy in Australia — a neuropathological study of 131 cases. J Neurol Neurosurg Psychiatr 46:593–598
    PubMed Google Scholar
  9. Hauser WA, Kurland LT (1975) The epidemiology of epilepsy in Rochester, Minnesota, 1935 through 1967. Epilepsia 16: 166
    Google Scholar
  10. Lindboe CF, Loberg EM (1988) The frequency of brain lesions in alcoholics. Comparison between the 5-year-periods 1975–1979 and 1983–1987. J Neurol Sci 88:107–113
    PubMed Google Scholar
  11. Mancall EL, McEntee WJ (1965) Alterations of the cerebellar cortex in nutritional encephalopathy. Neurology 15:303–313
    PubMed Google Scholar
  12. Phillips SC, Harper CG, Kril J (1987) A quantiative histological study of the cerebellar vermis in alcoholic patients. Brain 110:301–314
    PubMed Google Scholar
  13. Rogde S, Skullerud K (1982) Alkoholrelaterte hjerneskader i et rettsmedisinsk materiale. In: Voigt J, Gürtler H, Hennings K, Keiser-Nielsen S, Stentoft A (eds) 8. möde i Nordisk Rettsmedicinsk forening. Rettsmedicinsk institut, Kobenhavn, pp 185–188
    Google Scholar
  14. Skullerud K (1985) Variations in the size of the human brain. Influence of age, sex, body length, body mass index, alcoholism, Alzheimer changes, and cerebral atherosclerosis. Acta Neurol Scand 71, (Suppl) 102:1–94
    Google Scholar
  15. Tavares MA, Paula-Barbosa MM, Cadete-Leite A (1987) Chronic alcohol consumption reduces the cortical layer volumes and the number of neurons of the rat cerebellar cortex. Alcoholism (NY) 11: 315–319
    Google Scholar
  16. Torvik A (1987) Brain lesions in alcoholics: Neuropathological observations. Acta Med Scand (Suppl) 717:47–54
    Google Scholar
  17. Torvik A, Lindboe CF, Rogde S (1982) Brain lesions in alcoholics. A neuropathological study with clinical correlations. J Neurol Sci 56:233–248
    PubMed Google Scholar
  18. Torvik A, Stenwig JT (1981) Changes in frequency of cerebrovascular diseases in Oslo, Norway, 1958–1977. An autopsy study. Stroke 12:816–823
    PubMed Google Scholar
  19. Torvik A, Torp S (1986) The prevalence of alcoholic cerebellar atrophy. A morphometric and histological study of an autopsy material. J Neurol Sci 75:43–51
    PubMed Google Scholar
  20. Victor M, Adams RD, Collins GH (1971) The Wernicke-Korsakoff syndrome. Contemporary Neurology Series, vol 7. Blackwell Scientific Publications, Oxford
    Google Scholar
  21. Adams RD, Victor M, Mancall EL (1959) A restricted form of cerebellar cortical degeneration occuring in alcoholic patients. Arch Neuro 11:579–688
    Google Scholar
  22. Welte E (1948) Ober die Zusammenhänge zwischen anatomischem Befund und klinischem Bild bei Rindenprellungsherden nach stumpfen Schädeltrauma. Arch Psychiatr Nervenkr 179: 243–315
    Google Scholar

Download references

Author information

Authors and Affiliations

  1. Division of Neuropathology, Department of Pathology, Rikshospitalet, N-0027, Oslo 1, Norway
    Kari Skullerud & Solveig Norheim Andersen
  2. Institute of Forensic Medicine, Rikshospitalet, N-0027, Oslo 1, Norway
    Jon Lundevall

Authors

  1. Kari Skullerud
  2. Solveig Norheim Andersen
  3. Jon Lundevall

Rights and permissions

About this article

Cite this article

Skullerud, K., Andersen, S.N. & Lundevall, J. Cerebral lesions and causes of death in male alcoholics.Int J Leg Med 104, 209–213 (1991). https://doi.org/10.1007/BF01369809

Download citation

Key words

Schlüsselwörter