Marchiafava–Bignami Disease: Two Chronologically Distinct Stages in the Same Patient
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.005 | 0.005 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".