A Rare Case of Marchiafava-Bignami Disease Mimicking as Wernicke's Encephalopathy

Abstract

 Aim: This case report aims to highlight the diagnostic challenges and management of Marchiafava-Bignami Disease (MBD) in alcohol-dependent patients, emphasizing the role of MRI in differentiating MBD from Wernicke's Encephalopathy (WE) and the importance of early, high-dose thiamine supplementation for improved outcomes. Introduction: Marchiafava-Bignami Disease (MBD) is a rare neurological disorder characterized by demyelination and necrosis of the corpus callosum, often associated with chronic alcohol use and malnutrition. First described in 1903, MBD typically presents with nonspecific symptoms such as confusion, ataxia, and cognitive deficits, making it difficult to distinguish from other alcohol-related conditions like Wernicke's Encephalopathy (WE). Neuroimaging, particularly MRI, plays a pivotal role in diagnosing MBD by revealing characteristic lesions in the corpus callosum. Early intervention with high-dose thiamine and supportive care is critical for improving patient outcomes. Materials and Methods: A 33-year-old male with chronic alcohol dependence presented with memory loss, diplopia, and ataxia. Initial tests revealed acute pancreatitis and elevated liver enzymes. Suspecting WE, standard thiamine was administered with limited improvement. Brain MRI was performed, revealing T2 hyperintensity in the corpus callosum, leading to an MBD diagnosis. Treatment was escalated to high-dose thiamine (1500 mg/day) and folic acid, alongside supportive care. Results: The patient demonstrated gradual clinical improvement within a week of high-dose thiamine and supportive care, achieving normal neurological function at follow-up. MRI findings, showing T2 hyperintensity in the corpus callosum, were crucial in confirming MBD and guiding effective treatment. Conclusion: MBD should be suspected in alcohol-dependent patients with unusual neurological symptoms, particularly if treatment fails. Early MRI diagnosis and aggressive thiamine supplementation are essential for positive outcomes, emphasizing the need for timely intervention and accurate diagnostic tools.