A Marchiafava-Bignami Patient with Mild Symptoms and the Role of Diffusion-Weighted Magnetic Resonance Imaging in the Diagnosis

Abstract

Marchiafava-Bignami disease (MBD) is a rare entity associated with chronic alcoholism, with the degeneration of the corpus callosum being its most important characteristic. Clinical presentations may be in various forms, but the disorder can be divided into 2 broad clinical subtypes: a more severe type presenting with disorders of consciousness, which may lead to coma; or a second subtype with milder symptoms, easily underdiagnosed due to the similarity with alcohol withdrawal symptoms. With treatment and restoration of nutrition, the symptoms may be alleviated and the patient may even recover from the disease-induced coma. We present the case of a 40-year-old woman who was diagnosed with MBD. The patient had relatively weak symptoms and the diagnosis was made primarily on cranial imaging data. Diffusion-weighted MRI (DWI) was performed using a 1.5-Tesla MR system and it was seen to be significantly more efficient in detecting the ovoid nodular lesion of 6x10 mm size in the posterior corpus callosum, compared to FLAIR- and T1- and T2-weighted sequences. The lesion was no longer visible in the follow-up imaging studies after thiamine (100 mg/day for a week) treatment. It is concluded that DWI, a commonly used technique in the diagnosis of ischemic cerebrovascular disease, also has significant diagnostic value for MBD. In diffusion-weighted sequence, the variation from low to high intensities in apparent diffusion coefficient throughout the progression can be explained by cytotoxic edema and pure demyelination, respectively. (Archives of Neuropsychiatry 2011;48: 277-80)