SHM Converge Scientific Abstract ePoster Gallery-Case of Marchiafava Bignami Disease

Pdf Summary

This case describes a 28-year-old woman with heavy alcohol use disorder who presented with rapidly worsening mental status and gait instability. She had recently been treated for presumed Wernicke’s encephalopathy with IV thiamine and folate, but her neurologic status then deteriorated again, progressing from slowed speech and flat affect to mutism while still following commands. She also had poor hygiene, diffuse hyperpigmentation, and significant nutritional risk factors, including alcohol use and weight loss.<br /><br />Workup during the current admission revealed MRI findings consistent with Marchiafava-Bignami disease: restricted diffusion and FLAIR hyperintensities involving the corpus callosum, including the genu, rostrum, and splenium, with extension into periventricular white matter. This rare disorder is associated with chronic alcoholism and malnutrition and is caused by toxic-metabolic demyelination and necrosis of the corpus callosum. Because its presentation overlaps with other neurologic disorders, diagnosis can be delayed.<br /><br />The patient also had a complex medical background, including newly diagnosed systemic lupus erythematosus and prior positive autoimmune testing. Her treatment included a high-dose steroid burst, IVIG for five days, IV thiamine, folic acid, and penicillin G, along with supportive measures such as sensory stimulation, a windowed room, and family interaction with music.<br /><br />By discharge, she remained somewhat apathetic but was able to communicate in short answers and was transferred to inpatient rehabilitation with a PEG tube still in place. At one-month rheumatology follow-up, she had improved communication, was eating by mouth after PEG removal, and reported persistent memory gaps and balance problems but overall felt better.<br /><br />Key lessons from this case are that Marchiafava-Bignami disease should be suspected in patients with alcohol use disorder who worsen or fail to improve after standard Wernicke’s treatment, MRI corpus callosum abnormalities are an important clue, and early multidisciplinary care can support meaningful recovery.

Asset Subtitle

Katherine L. Ripley

Meta Tag

Author List Abu Baker Sheikh, Eva Angeli, Katherine L. Ripley

Category Clinical Vignettes

Concept Marchiafava-Bignami Disease

Concept Alcohol Use Disorder

Concept Malnutrition

Concept Corpus Callosum

Concept Wernicke Encephalopathy

Distinguished Non-Finalist

Presenter Organization University of New Mexico

Presenting Author Katherine L. Ripley

Track Adult

Keywords

Marchiafava-Bignami disease

alcohol use disorder

Wernicke encephalopathy

corpus callosum

MRI restricted diffusion

malnutrition

toxic-metabolic demyelination

mutism

intravenous thiamine

systemic lupus erythematosus

Marchiafava-Bignami Disease

Alcohol Use Disorder

Malnutrition

Corpus Callosum

Wernicke Encephalopathy