Marchiafava-Bignami Disease (MBD) is a toxic demyelinating disease often diagnosed in chronic alcoholics. The disease process typically involves the corpus callosum and clinically presents with various manifestations resulting in MBD type A and type B on the basis of clinical condition, the extent of callosal involvement and extracallosal involvement at brain magnetic resonance imaging (MRI), and prognosis. The death rate is high. This case reports a patient affected by MBD type B, who presented an isolated reversible splenial lesion at brain MRI and achieved a favorable recovery.
A 51-year-old man was admitted to the Emergency Room in a state of altered sensorium, with a motor deficit of the lower limbs. The patient had been suffering from chronic alcohol abuse for 30 years, with an average daily intake of 700 mL/die. Physical examination revealed a Glasgow Coma Scale score of 9 (E2V3M4). No meningeal signs were present. Pupils showed normal size and were reactive to light. The patient did not suffer from diabetes, hypertension, seizure nor other significant diseases. Routine blood test and cerebrospinal fluid studies were negative. The electroencephalographic examination was normal. Brain MRI showed an area of high signal on fast-spin-echo (FSE) T2-weighted images and high signal on diffusion-weighted imaging (DWI) with a decreased apparent diffusion coefficient (ADC) value of 670 x10-3 mm2/sec, observed with a region of interest size of 19 mm2, in the splenium of the corpus callosum. On the basis of history, findings on physical examination, and MR imaging features, the diagnosis of MBD was hypothesized. He was transferred to the intensive care unit where he required noninvasive ventilation and was treated with thiamine 400 mg/day hydration and parenteral nutrition with a vitamin supplement, so the electrolyte balance was quickly restored. We did not use steroid therapy. He showed improvement of symptoms with a good recovery in twenty days. Thirty-day follow-up brain MRI showed resolution of the abnormal callosal finding on both T2-weighted images and DWI-ADC maps