A 54-year old woman with subacute encephalopathy

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Presentation transcript:

A 54-year old woman with subacute encephalopathy Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology

Vignette A 54-year old woman with a history of alcoholism presented with stupor after 10 days of confusion followed by somnolence. Brain MRI disclosed callosal and widespread extracallosal white matter and cortical lesions (figure). After four weeks of treatment with thiamine and corticosteroids, a complete resolution of brain MRI lesions along with a good clinical recovery was observed. Dujmovic et al. © 2014 American Academy of Neurology

Imaging Figure. T2-weighted (T2W), fluid-attenuated inversion recovery (FLAIR) and diffusion-weighted (DWI) brain MRI images in Marchiafava-Bignami disease A-C: Corpus callosum hyperintensity and diffuse swelling with extensive extracallosal hyperintense white matter lesions; D: bilateral cortical and white matter hyperintensity involving splenium of the corpus callosum. Dujmovic et al. © 2014 American Academy of Neurology

Reversible widespread brain MRI lesions in Marchiafava-Bignami disease In Marchiafava-Bignami disease (MBD) , which is rare and frequently associated with alcoholism, brain MRI may show callosal, but also extracallosal white matter and cortical lesions. In alcoholic MBD patients with impared consciousness, rapid resolution of the widespread callosal, extracallosal and cortical MRI lesions is highly unusual. References 1. Hillbom M, Saloheimo P, Fujioka S, Wszolek ZK, Juvela S, Leone MA. Diagnosis and management of Marchiafava-Bignami disease: a review of CT/MRI confirmed cases. J Neurol Neurosurg Psychiatry 2014;85:168-173. 2. Ménégon P, Sibon I, Pachai C, Orgogozo JM, Dousset V. Marchiafava-Bignami disease: diffusion-weighted MRI in corpus callosum and cortical lesions. Neurology 2005;65:475-477. Dujmovic et al. © 2014 American Academy of Neurology