SHM Converge Scientific Abstract ePoster Gallery-Encephalopathy at Its Worst: A Case of Marchiafava-Bignami Disease

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This case describes a 64-year-old man with a 2-month history of worsening confusion and recurrent falls in the setting of long-standing heavy alcohol use and alcohol-related hepatic steatosis. He had recently reduced his intake from about three six-packs of beer daily to 10–13 beers daily and was followed by an addiction clinic. On presentation, he was disoriented, spoke about deceased family members, and believed he was in another state.<br /><br />Exam showed an unstable gait, bradykinesia, poor coordination with rapid alternating movements, decreased vibratory sensation, and a positive Romberg sign. Laboratory studies were largely unremarkable, including normal metabolic panel, liver tests, INR, ammonia, and negative ethanol level. CT head showed only global cerebral atrophy without acute findings, and CT chest/abdomen/pelvis revealed a distended bladder.<br /><br />He was initially thought to have a multifactorial gait disorder related to alcohol use, including cerebellar degeneration, peripheral neuropathy, or radiculopathy. He was started on CIWA monitoring plus thiamine, folic acid, and multivitamins, but his mental status continued to fluctuate. Neurology recommended MRI.<br /><br />MRI demonstrated global volume loss, thinning of the corpus callosum, and scattered T2/FLAIR hyperintensities along the corpus callosum, findings suggestive of Marchiafava-Bignami disease (MBD). MBD is a rare and often severe disorder, classically associated with chronic alcoholism and malnutrition, and can present with confusion, gait disturbance, seizures, apathy, psychosis, and other neurologic deficits. Diagnosis is now largely imaging-based.<br /><br />The patient was hospitalized for two weeks, stabilized with supportive care and vitamin supplementation, and discharged to a rehabilitation facility. The case highlights the importance of considering MBD in alcohol use patients with unexplained encephalopathy and gait dysfunction.

Asset Subtitle

Vyshnavi Kodali

Meta Tag

Author List Alejandra Perez-Chapman, Deepa Kumarjiguda, Kevin Ly, Monica Dzwonkowski, Vyshnavi Kodali

Category Clinical Vignettes

Concept Marchiafava-Bignami Disease

Concept Chronic Alcohol Use

Concept Altered Mental Status

Concept Corpus Callosum

Concept Malnutrition

Distinguished Non-Finalist

Presenter Organization Geisinger Medical Center

Presenting Author Vyshnavi Kodali

Track Adult

Keywords

Marchiafava-Bignami disease

chronic alcoholism

confusion

gait disturbance

MRI findings

corpus callosum

thiamine supplementation

encephalopathy

neurologic deficits

alcohol-related malnutrition

Marchiafava-Bignami Disease

Chronic Alcohol Use

Altered Mental Status

Corpus Callosum

Malnutrition