A 42-year-old man without known history of alcoholism presented comatose. CT and MRI (figure) demonstrated characteristic imaging features of Marchiafava-Bignami disease1 without signs of Wernicke encephalopathy (such as involvement of the mammillary bodies). Under symptomatic treatment including artificial respiration and parenteral nutrition, the patient's Glasgow Coma Scale score improved from 3 to 7.
(A) Axial CT showing symmetric hypodense white matter lesions. (B) Fluid-attenuated inversion recovery–weighted MRI depicting hyperintense white matter lesions predominantly involving the splenium of the corpus callosum. (C) Diffusion-weighted images revealed marked restriction with corresponding low apparent diffusion coefficient values. The mammillary bodies and the periaqueductal region appeared normal.
Marchiafava-Bignami is a rare disease associated with alcoholism though rarely also seen in patients without alcoholism,1 characterized by demyelination and necrosis of the corpus callosum.2 Since clinical symptoms can vary from cognitive impairment, gait disturbance, and hemiparesis to stupor, coma, and death, early recognition of neuroimaging characteristics is crucial for diagnosis and treatment.
AUTHOR CONTRIBUTIONS
Dr. Tozakidou: drafting/revising the manuscript, analysis or interpretation of data. Dr. Stippich: drafting/revising the manuscript, study concept or design. Dr. Fischmann: drafting/revising the manuscript, study concept or design, analysis or interpretation of data.
Footnotes
Study funding: Supported by Bracco S.A., Switzerland. The study sponsor played no role in matters of design, collection, analysis, interpretation of data, and writing the report.
Disclosure: Dr. Tozakidou and Dr. Stippich report no disclosures. Dr. Fischmann receives research support from the Lorenzo-Piaggio Foundation.
- Copyright © 2011 by AAN Enterprises, Inc.
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