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45 y/o, History of Alcoholism, Seizures

45 y/o, History of Alcoholism, Seizures

  • No history of fever. On further enquiry, history of gait disturbance identified.
  • Figure 1. On MRI, altered signal intensity (hyperintense on T2WI and hypointense on T1WI) is noted along corpus callosum, predominantly involving genu and splenium of corpus callosum.
  • Figure 2. Diffusion restriction on DWI and low values on ADC are noted predominantly involving genu and splenium of corpus callosum.
  • Figure 3. On Plain CT, diffusely hypodense areas are noted involving corpus callosum and subcortical white matter of bilateral fronto-parieto-temporal lobes.
  • Figure 4. On Contrast CT, diffusely nonenhancing hypodense areas are noted involving corpus callosum and subcortical white matter of bilateral fronto-parieto-temporal lobes.
  • Diagnosis: Marchiafava Bignami disease
  • Blood labs revealed low serum glucose and low vitamin B12 and folic acid levels.
  • Marchiafava-Bignami disease (MBD) is characterized by corpus callosum necrosis and is observed predominantly in alcoholics.
  • Involvement of hemispheric white matter has been described in 40% of necropsy cases of known MBD.
  • The disease can follow one of three clinical courses, a fulminate acute form, subacute, or chronic form.
  • CT brain may typically demonstrate hypo-attenuating regions in corpus callosum. In exceptional situations of hemorrhage, these regions may turn into iso- or hyper-attenuating.

Case History: A 45-year-old male with history of alcoholism presents to emergency department with history of four seizures one day earlier.

Comments

Very good case

mohammad @

Good case!

Mehmet Ali @

Good case

Mehmet Ali @

want to study the case!

kolawole @

MBD is a very rare disease and has been beautifully been highlighted in the above study.

M Ramesh @

Excellent case

Mohamed @

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