Marchiafava–Bignami Disease: Two Chronologically Distinct Stages in the Same Patient

A 43-year-old man with chronic alcoholism came to the emergency department due to a 1-week history of severe asthenia, memory loss, and dizziness, associated with weight loss (8 kg in the previous 4 months).Neurological examination revealed temporal disorientation, scarce speech, perseveration, and bradykinesia.Brain magnetic resonance imaging (MRI) showed symmetrical lesions in the rostrum, genu, body, and splenium of the corpus callosum, which were hyperintense on fluid-attenuated inversion recovery sequence, and showed restricted diffusion (Figure 1), much more pronounced in the splenium.These findings were consistent with Marchiafava-Bignami disease (MBD).Intravenous thiamine (500 mg, three times a day), oral oxazepam, and folic acid were given, with progressive clinical improvement.The patient was discharged and referred to a specialized appointment in alcohol dependence recovery.MBD is a rare disorder that can be associated with all types of alcoholic beverages, and even with malnourished nonalcoholic patients.1 The disease typically affects the body of the corpus callosum, followed by the genu, and ultimately the splenium, 1,2 being also possible the involvement of the entire corpus callosum.1 MRI plays a key role in the diagnosis of MBD, and in distinguishing it from other diseases, as in this case lesions typically affect the central layers of the corpus callosum and are remarkably symmetric 3 ; they are hyperintense on T2-weighted sequences and might show restricted diffusion due to the presence of cytotoxic edema/active fiber demyelination.4 The peculiar finding in our patient was the detection of two chronologically distinct stages: a subacute lesion extending along the rostrum, genu, and body of the corpus callosum (i.e., with less pronounced restricted diffusion), and an acute lesion in the splenium (i.e., with more pronounced restricted diffusion).Interestingly, tractography showed selective focal distortion of the posterior commissural fibers, and spectroscopy revealed a lactate peak at 1.3 ppm (Figure 2); findings that were consistent with an active demyelination process in the splenium.4 With the assumption of successful alcoholic cessation, the preserved N-acetylaspartate/creatine ratioa marker of neuronal integrityargues against necrotic lesions and might be an indicator of good prognosis to our patient.Nine months after the episode, the patient was reevaluated by the psychiatrist and had maintained alcoholic abstinence, being capable of doing all of his daily activities.

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.