Marchiafava Bignami disease
Chronic alcoholic with altered sensorium, ataxia, restricted eye movements and short term memory loss.
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Symmetric T2 and T2 FLAIR hyperintense areas with facilitated diffusion is seen involving bilateral corona radiata, crus cerebri, splenium of corpus callosum, periaqueductal grey matter, mammillary bodies. Symmetric T1 hyperintense signals seen in bilateral globus pallidi. None of these areas show appreciable gadolinium T1 enhancement. No acute infarct. No intra axial or extra axial hemorrhage.
Malnutrition / malabsorption in chronic alcoholics and secondary vitamin B deficiency can result in a spectrum of neurologic disorders as thiamine is an important component of multiple basic functions - co factor in cellular respiration, ATP production, glutamate synthesis and myelin sheath maintenance. The symmetric involvement of both cerebral hemispheres weighs heavily in favor of Wernicke encephalopathy rather than any other form of demyelination. The symmetric involvement of splenium of corpus callosum favors Marchiafava Bignami disease.
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