[Interhemispheric disconnection, Balint's syndrome and persistent anarthria: Marchifava-Bignami disease with white...

A 37-year-old alcoholic right-handed man developed a complex neuropsychological picture following a mild head injury and a severe confusional state. Prominent features were Balint's syndrome, signs of interhemispheric deconnection, and speech disorders with anarthria and dysprosody. Iterative CT scans showed pathognomonic hypodensities of the genu and splenium of corpus callosum, confirmative of Machiafava-Bignami disease. After a two years follow-up, a favourable outcome was observed despite haemmoragic transformation of bilateral necrotic lesions of the parietal white matter, an exceptional neuropathological fact. This case is demonstrative of the possibility of articulate speech impairment when lesions of both corpus callosum and subcortical white matter are present. It also raises several aetiopathogenic problems which are discussed.