Reversible corpus callosum lesions in a patient with Marchiafava-Bignami disease: serial changes on MRI

Supratentorial profile of white matter microstructural integrity in recovering alcoholic men and women

BACKGROUND

Postmortem and in vivo studies consistently report degeneration of brain white matter in alcohol-dependent men and women. The full extent of the white matter involvement in uncomplicated alcoholism, however, is unknown, yet knowledge of the distribution of white matter degradation might provide clues to mechanisms underlying the pathology.

METHODS

To examine whether the white matter involvement is widespread or, alternatively, is regionally restricted in uncomplicated alcoholism, we used in vivo magnetic resonance diffusion tensor imaging (DTI) to quantify the microstructure of brain tissue. Accordingly, we acquired DTI data in 57 alcoholics (40 men, 17 women) who had been sober, on average, for 3 months and 74 demographically-matched control subjects (32 men, 42 women). Alcoholic men had consumed about twice as much alcohol in their lifetimes as the alcoholic women. Supratentorial white matter fractional anisotropy (FA), a DTI measure of intravoxel orientational coherence of tissue, was calculated across the full anterior-posterior extent of the brain in coronal sections, and a slice profile of the mean white matter FA was created for each subject. Group differences between alcoholics and control subjects were tested for each slice in three regions: the left and right hemispheres and a midsagittal sample; men and women were tested separately.

RESULTS

Alcoholic men and women each showed widespread FA deficits in all three regions relative to their gender-matched control subjects that were evident on a slice-by-slice basis. Furthermore, the number of slices showing FA deficits was significantly greater in the alcoholic men than women.

CONCLUSIONS

The widespread distribution of white matter deficits is in contrast to the highly regional-specific deficits seen in nutritional deficiency syndromes that can accompany alcoholism.

Marchiafava-Bignami disease: magnetic resonance imaging findings in corpus callosum and subcortical white matter

A case of Marchiafava-Bignami disease (MBD) is presented using magnetic resonance imaging (MRI). A patient with a long history of alcoholism developed a gait disturbance with involuntary movements at the lower extremities. MRI scans taken at the onset showed no particular abnormalities. He progressed to a coma 10 days later. MRI scans taken 20 days after the onset showed a focal lesion at the genu of the corpus callosum and he was diagnosed as having MBD. In addition, multiple lesions were observed in bilateral frontoparietal subcortical white matter. These lesions demonstrated similar intense MRI signals as the corpus callosum.