Many deaths were attributed to strokes, since heavy alcohol consumption is a significant factor. Sensory symptoms include early numbness of the soles, followed by dysesthesias of feet and legs especially at night. Motor manifestations include distal weakness and muscle-wasting. Dysphagia and dysphonia are prominent secondary to degeneration of the vagus nerve. Other parasympathetic abnormalities include depressed reflex heart rate responses, abnormal pupillary function, sexual impotence and sleep apnea.
Sympathetic dysfunction is rare but if present can produce orthostatic hypotension and hypothermia.
Frequent falls and accidents secondary to gait unsteadiness and ataxia are secondary to cerebellar degeneration, sensory ataxia or distal weakness. In severe cases, the hands may be involved. In addition to distal atrophy and weakness, deep tendon reflex usually is decreased or absent. The diagnosis is based on an accurate history of prolonged and excessive alcohol intake, clinical signs and symptoms and electrophysiologic testing. The electrophysiologic findings primarily reveal evidence of primary axonal polyneuropathy.