Marchiafava–Bignami Disease in a Chronic Alcohol User: A Case Report Emphasizing Early Diagnosis and Multidisciplinary Management

Year 2025, Volume: 11 Issue: 3, 250 - 256, 30.08.2025

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Abstract

Diagnosing acute neurological deficits in chronic alcohol users is challenging due to atypical presentations and incomplete histories. Marchiafava–Bignami disease (MBD) is a rare disorder characterized by demyelination and necrosis of the corpus callosum, often extending to adjacent white matter. A 36‐year‐old male presented to the emergency department with sudden-onset speech disturbance and word-finding difficulty that began one day prior. Later that evening, he developed nausea, vomiting, imbalance, and hand tremors. The patient had a 10-year history of chronic alcohol use and recent illicit alcohol consumption. Brain magnetic resonance imaging (MRI) revealed diffusion restriction in the corpus callosum and posterior parietal white matter, while contrast-enhanced images showed no pathological enhancement. Laboratory studies indicated elevated homocysteine, normal vitamin B12 levels, and thrombocytopenia. Although an infectious process was initially considered, the absence of fever and normal leukocyte counts led to a preliminary diagnosis of MBD. The patient was admitted to neurology and treated with intravenous thiamine (100 mg daily) and aggressive hydration for 10 days. Following treatment, significant improvement was observed in speech, balance, nausea, and vomiting, although hand tremors persisted. Suspected alcohol withdrawal prompted psychiatric consultation and subsequent treatment. Follow-up imaging and Electroencephalography (EEG) revealed resolution of abnormalities, and the patient was discharged with only mild tremor and minimal dysarthria. This case emphasizes that rare conditions such as MBD should be considered in the differential diagnosis of acute neurological deficits in chronic alcohol users. Early recognition and prompt treatment, with diffusion-weighted MRI serving as a key diagnostic tool, are essential for minimizing permanent neurological damage.

Keywords

Marchiafava–Bignami disease , alcohol dependence , encephalopathy , corpus callosum , thiamine

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