Chronic Alcoholic Toxic Cerebral Encephalopathy manifested as Acute Marchiafava-Bignami Disease: a case report

Abstract Background: Marchiafava-Bignami Disease (MBD) is a alcohol-related disorder, its acute form is rather rare that is characterized by acute edema and demyelination of the corpus callosum, manifested as severe disorder of consciousness like coma, which can be accompanied by an increase in muscle tone. Case presentation: We report a 57-year-old man with a 40-year history of chronic and heavy alcohol abuse who progressively developed bilateral lower limb weakness and slurred speech for 3 days. On admission, neurological examination revealed abnormal mental status and cognitive deficits. His left nasolabial groove appeared shallow. The muscle power of the bilateral upper and lower limbs was only grade 4+ with lead-pipe rigidity of muscle. Deep tendon reflexes in the lower limbs were increased, and babinski reflexes were positive bilaterally ，and negative Hoffmann reflexes and the forced grasp reflex . He was diagnosed with erosive gastritis two years ago without any treatment. The immediate brain computed tomography(CT) showed hypodensity in the genu and splenium of the corpus callosum, which suggested an acute cerebrovascular disease, however, the laboratory tests were almost normal except for decreased serum level of folic acid (7.63mmol/L; normal range 11.8-56.2mmol/L), and MRI revealed bilateral hyperintensity on T2 , T2 FLAIR and DWI in the entire corpus callosum, with corresponding hypointensity on ADC images . Based on his medical history, physical examination, and imaging features, the definitive diagnosis of acute MBD was reasonable. But after nearly 5 months of treatment, the symptoms did not relieve significantly, which could be attributed to entire callosal lesion etc. Conclusions: MBD is mainly caused by chronic alcoholism. MRI findings, especially the DWI sequence, are critical for the early diagnosis of MBD in the acute stage, which prevent disease progression from irreversible callosal lesion.