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Marchiafava-Bignami disease

Marchiafava-Bignami disease (MBD) is a rare CNS disorder. It is usually seen in the context of alcoholism and malnutrition (originally described in Italian alcoholic patients) 5 . The condition classically involves the corpus callosum with necrosis and demyelination. 

Epidemiology

MBD is in most instances seen in chronic alcoholics, and as such the epidemiology reflects this demographic, with middle-aged to elderly male patients (40-60 years of age) being most commonly affected 2

Clinical presentation

The clinical presentation of MBD can vary and patients often present with non specific clinical features such as motor or cognitive disturbances, a hemispheric disconnection syndrome and / or seizures.

Pathology

The disease is attributed to a deficiency in vitamin B complex, and results in necrosis and demyelination of the corpus callosum

Histology

Histologically, the myelin loss may be striking and may be accompanied by axonal degeneration 5.

Radiographic features

Prior to the advent of cross-sectional imaging, the diagnosis was only limited to post mortem examination and only the acute variety was diagnosed. 

Marchiafava-Bignami disease typically begins in the body of the corpus callosum and later involves the genu and then splenium 2. It classically involves the central layers with relative sparing of the dorsal and ventral extremes (which may be seen as a sandwich sign on sagittal MRI imaging). 

CT
  • may typically show hypo-attenuating regions in the corpus callosum.
  • in exceptional situations of haemorrhage, these regions may turn into iso or hyper attenuating 3.
MRI

Corpus callosum may appear oedematous in the acute phase and atrophic in the chronic phase.

  • T1 - may show hypo intense foci in corpus callosum in the acute phase. 
  • T2 -  
    • acute phase: hyper-intensities in the corpus callosum in the correct clinical setting may aid to the diagnosis
    • sub acute phase: may show hypointense focal lesions (likely as a result of haemosiderin) 3-4
  • MR spectroscopy - the NAA / Cr ratio may show a progressive decrease to a minimum level after the 1st few months followed by a partial recovery after around 11 months 3.

Treatment and prognosis

Administration of vitamin B complex results in improvement in many patients, although some do not recover and may die of the disease 2

Differential diagnosis

General imaging differential considerations include

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