Marchiafava-Bignami disease: A case report

Abstract

Rationale: Clinicians encounter multiple alcohol-related illnesses in practice, and Marchiafava-Bignami disease is a rare and devastating entity among them. It is a toxic-demyelinating disease and seen in chronic alcoholics, although it may be occasionally observed in chronically malnourished teetotalers. The clinical presentations are diverse. The symptoms and signs are non-specific, and the onset can be acute or chronic. Patient’s concerns: A 45-year-old right-handed patient suffered from alcohol use disorder with multiple non-specific neuropsychiatric manifestations. Diagnosis: Marchiafava-Bignami disease. Interventions: Thiamine, folate, vitamin B12, and steroid therapy. Outcome: The patient’s behaviour was significantly improved but dysarthria and pyramidal signs persisted. He was left with permanent cognitive impairment. Lessons: Though prompt therapy may halt the demyelinating process in this disease, the treatment remains a challenge in clinical practice. The recognition of the neuro-radiologic features is crucial to establish an early diagnosis.

Keywords

• marchiafava-bignami disease; alcohol use disorder; magnetic resonance imaging