A Rare Case of Marchiafava-Bignami Disease With Reversible Splenial Lesion

Individuals with a history of chronic alcohol consumption can develop Marchiafava-Bignami disease (MBD), a rare neurological disorder that is thought to occur secondary to thiamine deficiency and alcohol-induced brain damage. It is characterized by the toxic demyelination and necrosis of the corpus callosum. We report the case of a 42-year-old man who developed acute-onset altered sensorium and irrelevant speech output associated with ataxia. The clinical presentation raised a suspicion of MBD, although it was not a top differential diagnosis initially. Magnetic resonance imaging revealed significant demyelination of the splenium of the corpus callosum, confirming the suspicion and prompting immediate intervention aimed at addressing both the neurological manifestations and the possible underlying thiamine deficiency. Relevant history of significant alcohol consumption further supported this diagnosis. Following the initiation of thiamine supplementation and supportive care, the patient exhibited gradual improvement in neurological function, eventually leading to a complete clinical recovery and resolution of radiological findings, suggestive of the type B spectrum of the disease. This report highlights the importance of clinical evaluation and neuroimaging in the diagnosis, treatment, and prognostic stratification of patients with MBD.