[Reversible neurological complications in chronic alcohol abuse with hypophosphatemia]

Severe hypophosphatemia is rare, usually affecting chronic alcoholics and patients under total parenteral nutrition. The most important clinical features are rhabdomyolysis and neurological deficits. The latter may take various forms and can affect the peripheral as well as the central nervous system. Symptoms of polyradiculitis with progressive paresis or cerebellar symptoms such as dysarthria, dysphagia and ataxia are frequent manifestations. Rarely, hypophosphatemia can cause confusional states, epileptic seizure or coma. The differential diagnosis includes Guillain-Barré polyradiculitis, diffuse encephalopathy, Wernicke encephalopathy and central pontine myelinolysis. We describe the neurological signs in a female chronic alcoholic who developed severe ataxia and tetraparesis after a week's course of parenteral, phosphate-free nutrition. Complete recovery occurred after adequate substitution of phosphate.