IMPORTANT: We currently have a number of bugs related to image cropping and are actively trying to resolve them. In the meantime, we have disabled cropping. Apologies for any inconvenience. Stay informed: radiopaedia.org/chat

Marchiafava Bignami disease

Case contributed by Varun Babu
Diagnosis almost certain

Presentation

Chronic alcoholic with altered sensorium, ataxia, restricted eye movements and short term memory loss.

Patient Data

Age: 55 years
Gender: Male
mri

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. 

Case Discussion

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.

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.