International Journal of Research in Medical Sciences | November 2022 | Vol 10 | Issue 11 Page 2702 International Journal of Research in Medical Sciences Jaganathan S et al. Int J Res Med Sci. 2022 Nov;10(11):2705-2705 www.msjonline.org pISSN 2320-6071 | eISSN 2320-6012 Case Report Marchiafava-Bignami disease: an interesting case report! Sriram Jaganathan 1 *, Medhini Rangarajan 2 INTRODUCTION Marchiafava Bignami is a rare affliction of chronic alcoholism primarily involving the corpus callosum resulting in demyelination and necrosis. 1,2 The main pathophysiology revolves around chronic alcoholism with resultant hypovitaminosis, alteration in the neurotransmitter activity and oxidative injury. The clinical presentation of the disease encompasses a wide range of symptoms ranging from reduced consciousness, emotional and psychotic symptoms, depression and apathy, aggression, seizures, hemiparesis, ataxia, and apraxia. 1 The disease can present in 3 stages - acute, subacute and chronic form. 3,4 However, if left untreated, these patients may land in coma as well. The gold standard investigation is magnetic resonance imaging (MRI) brain which may show typical features of restricted diffusion in the corpus callosum and helpful in appropriate clinical setting to guide in early diagnosis. 4,5 A relatively accepted treatment for this condition is intravenous thiamine (vitamin B1) infusion. Some authors suggest usage of high dose steroids, folic acid, and amantadine in the treatment protocol. Our patient is a 57-year-old alcoholic who presented with acute confusion and showed DWI abnormalities in corpus callosum and periventricular white matter. CASE REPORT A 57-year-old chronic alcoholic presented to our hospital acutely in a state of confusion, with disorientation and aphasia. Patient had been consuming alcohol for almost 25 years. We obtained the history from the patient’s relative. There was no prior history of sensory or motor deficit, memory loss or previous similar episodes. On examination, patient was hemodynamically stable. CNS examination revealed 1 Department of Radiology, Global Hospitals and Health City, Chennai, Tamil Nadu, India 2 Department of Surgery, SRM Medical College, Kattangulathur, Chennai, Tamil Nadu, India Received: 19 October 2022 Accepted: 26 October 2022 *Correspondence: Dr. Sriram Jaganathan, E-mail: sriramj.ach@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Marchiafava-Bignami Disease (MBD) is a rare neurodegenerative disease usually associated with chronic alcoholism characterized by demyelination and necrosis of the corpus callosum. Here, we report a 57-year-old patient who presented to our hospital with acute aphasia, disorientation and altered mental state. Diffusion weighted imaging (DWI) magnetic resonance imaging (MRI) revealed areas of restricted diffusion in the corpus callosum, bilateral periventricular white matter and right cerebellar peduncle. Given that the patient was a chronic alcoholic, a diagnosis of Marchiafava-Bignami disease was made. Supportive management with intravenous Thiamine and multivitamins was offered. The patient improved clinically after one week of treatment and a repeat DWI MRI revealed complete resolution of the abnormalities. It is imperative to diagnose MBD promptly and distinguish this from other neurological manifestations related to chronic alcoholism. An early diagnosis can aid in a better outcome and faster recovery. Keywords: Chronic alcoholism, Corpus callosum, Demyelination, Intravenous thiamine DOI: https://dx.doi.org/10.18203/2320-6012.ijrms20222887