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