Acute Marchiafava-Bignami disease: clinical and serial MRI correlation

Abstract

Marchiafava-Bignami disease (MBD) is a form of toxic demyelinating disease more often seen in chronic alcoholics. The disease process typically involves the corpus callosum and clinically often presents with altered sensorium, neurocognitive defects or seizures with acute cases often deteriorating to comatose state. The death rate is high. We report a rare case of MBD with complete clinical recovery. A 50-year-old male patient presented in an unconscious state and underwent MRI of the brain which showed significant lesions involving the corpus callosum. Following treatment with thiamine and supportive therapy, he improved clinically and a follow-up MRI revealed significant resolution of the earlier lesions. Diffusion-weighted MRI showed the changes more conspicuously as compared with conventional imaging. The clinical resolution corresponded well with the MRI pattern. The case highlights that diffusion-weighted MRI is an extremely useful tool in evaluation and prognostication of MBD.

Figure 1

(A, B) Sagittal fluid attenuation inversion recovery (FLAIR) and coronal T2 images show hyperintensity in the splenium of the corpus callosum (arrow) with associated chronic subdural hygromas along the cerebral convexities. (C, D) Diffusion-weighted images show hyperintensity involving the splenium of the corpus callosum (arrow) with corresponding hypointensity on apparent diffusion coefficient (ADC) images. (E, F) Diffusion-weighted images show subtle hyperintensity in the left parietal subcortical white matter (*) with corresponding changes on ADC images.

Figure 2

(A, B) Follow-up MRI fluid attenuation inversion recovery (FLAIR) and diffusion images revealed persistent hyperintensity in the splenium. (C) Apparent diffusion coefficient images do not reveal corresponding hypointensity suggestive of T2 shine through. As compared with the prior MRI, there is a significant decrease in the extent of involvement.