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Marchiafava-Bignami disease presenting as reversible coma.

Yixin Zhang¹, Kaleb Culpepper², Reshmi Mathew³

¹Internal Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, USA wendyz0411@gmail.com.

BMJ Case Reports

|April 5, 2022

Summary

Marchiafava-Bignami disease (MBD), a rare corpus callosum condition, can occur in non-alcoholic patients due to polysubstance misuse. Prompt thiamine and vitamin repletion can reverse severe neurological deficits.

Keywords:

Drugs misuse (including addiction)Medical management Neuroimaging Neurology (drugs and medicines)

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Area of Science:

Neurology
Neuroscience
Radiology

Background:

Marchiafava-Bignami disease (MBD) is a rare demyelinating disorder primarily affecting the corpus callosum and subcortical white matter.
Typically associated with chronic alcoholism, MBD is thought to result from B-complex vitamin deficiency, particularly thiamine.
Clinical presentations range widely, from cognitive impairment to coma, often with autonomic dysfunction.

Observation:

A case report of a 35-year-old male patient presenting with MBD.
The patient had a history of polysubstance misuse but no alcohol consumption.
The clinical course was marked by a persistent comatose state and autonomic instability.

Findings:

Brain MRI revealed characteristic findings indicative of MBD.
The patient received high-dose intravenous thiamine, vitamin C, and vitamin E.
Neurological improvement was observed within 48 hours, with the patient regaining consciousness and following commands.

Implications:

This case expands the known etiology of MBD beyond alcohol use.
Early recognition of MBD on brain MRI is critical for timely diagnosis and intervention.
Aggressive vitamin repletion, including thiamine, appears effective in treating MBD, even in non-alcoholic cases.