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Kadam A, Toshniwal SS, Kinkar J, Kumar S, Acharya S. Exploring Marchiafava-Bignami Disease: A Rare Presentation in a Young Pregnant Female. Cureus 2024; 16:e61701. [PMID: 38975378 PMCID: PMC11226220 DOI: 10.7759/cureus.61701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Accepted: 06/04/2024] [Indexed: 07/09/2024] Open
Abstract
Marchiafava-Bignami disease (MBD) is uncommon and typically linked with persistent alcohol consumption; nevertheless, instances have been reported in non-alcoholic individuals with nutritional deficiencies. Depending on the severity, this condition may manifest as acute, subacute, or chronic neurological signs and symptoms, ranging from moderate dysarthria or mild disorientation to coma and death. We report a case of a 30-year-old, 14-week pregnant female who presented with complaints of persistent vomiting and loss of appetite. She was found to have achalasia cardia on upper GI endoscopy. Later, she developed confusion, irrelevant talks and her speech was incomprehensible. An MRI of the brain was done which showed features likely that of MBD. She was started high dose intravenous thiamine to which she responded brilliantly.
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Affiliation(s)
- Abhinav Kadam
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Saket S Toshniwal
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Jiwan Kinkar
- Department of Neurology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sunil Kumar
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sourya Acharya
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Hiraga A. Hand knob sign in Marchiafava-Bignami disease and Wernicke's encephalopathy. Neurol Sci 2024; 45:2903-2904. [PMID: 38265535 DOI: 10.1007/s10072-024-07345-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/19/2024] [Indexed: 01/25/2024]
Affiliation(s)
- Akiyuki Hiraga
- Department of Neurology, Chiba Rosai Hospital, 2-16 Tatsumidai-Higashi, Ichihara-shi, Chiba, 290-0003, Japan.
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Chalupczak N, Cole C, Lohala N. Marchiafava-Bignami Disease in a Patient With Polysubstance Use Disorder. Cureus 2024; 16:e59730. [PMID: 38841043 PMCID: PMC11151182 DOI: 10.7759/cureus.59730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2024] [Indexed: 06/07/2024] Open
Abstract
Marchiafava-Bignami disease (MBD) is a rare demyelinating disease associated with chronic alcohol use and/or malnutrition leading to vitamin deficiency. Clinical presentation is diverse and can range from mild neurological deficits of dysarthria and confusion to severe symptoms such as coma or even death. Diagnosis is made using imaging modalities including magnetic resonance imaging (MRI) and computed tomography (CT) with the rise in technological advances placing MRI as the most sensitive and specific imaging technology for diagnosis. Classic MBD imaging demonstrates demyelination and necrotic damage of the corpus callosum. While MBD is a well-documented neurologic complication of chronic alcoholism, its occurrence and presentation in the context of concurrent polysubstance abuse remain underexplored. We outline the case of a 27-year-old male with polysubstance use disorder presenting with subacute neurological deterioration and demyelination of the splenium of the corpus callosum.
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Affiliation(s)
- Natalia Chalupczak
- Chicago Medical School, Rosalind Franklin University of Medicine and Sciences, North Chicago, USA
| | - Connor Cole
- Internal Medicine, Ascension Saint Joseph Hospital, Chicago, USA
| | - Nita Lohala
- Internal Medicine, Ascension Saint Joseph Hospital, Chicago, USA
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Li H, Zeng M, Tang W. Marchiafava-Bignami disease(MBD) involving bilateral handknob area: neuroimages. Neurol Sci 2024; 45:369-372. [PMID: 37723370 DOI: 10.1007/s10072-023-07068-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 09/07/2023] [Indexed: 09/20/2023]
Abstract
Marchiafava-Bignami disease (MBD) is a metabolic disease of the nervous system. It mainly involves the Corpus callosum, but the handknob area is rarely involved. This article reports a MBD case involving the bilateral handknob area. The involvement of the bilateral handknob area contributes to the clinical presentation of convulsions of both hands. Through this case, more clinicians realize the bilateral handknob area involvement in MBD, which is helpful for the identification and diagnosis of MBD. To our knowledge, this is the first report on MBD involving the bilateral handknob area.
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Affiliation(s)
- He Li
- Neurology Department of First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, 250355, China
| | - MinLing Zeng
- The Third Clinical Medical College of the Three Gorges University, Gezhouba Central Hospital of Sinopharm, Yichang, 443002, China
| | - Wei Tang
- Dalian University Affiliated Xinhua Hospital, Shanghai, 16021, China.
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Waack A, Nandwani S, Ranabothu M, Ranabothu A, Vattipally V. Marchiafava-Bignami disease: Case presentation and radiological imaging. Radiol Case Rep 2023; 18:3922-3925. [PMID: 37663564 PMCID: PMC10473971 DOI: 10.1016/j.radcr.2023.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 09/05/2023] Open
Abstract
Marchiafava-Bignami disease (MBD) is a rare vitamin B deficiency classically associated with alcoholism. MBD damages the corpus callosum and presents with nonspecific neurological symptoms. Radiological imaging is critical for diagnosing MBD and commencing subsequent treatment, which often consists of vitamin B supplementation. We present a case of MBD in a 56-year-old male with alcohol use disorder, epilepsy, schizophrenia, post-traumatic stress disorder, and cardiovascular risk factors. The patient presented with general neurological symptoms, and there were several potential diagnoses to consider based on the patient's history. Radiological imaging was necessary for diagnosis. This case demonstrates the role radiological imaging plays in the workup of MBD.
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Affiliation(s)
- Andrew Waack
- University of Toledo College of Medicine and Life Sciences, 3000 Arlington Ave, Toledo, OH 43614 United States
| | - Swamroop Nandwani
- University of Toledo College of Medicine and Life Sciences, 3000 Arlington Ave, Toledo, OH 43614 United States
| | - Meghana Ranabothu
- University of Toledo College of Medicine and Life Sciences, 3000 Arlington Ave, Toledo, OH 43614 United States
| | - Akash Ranabothu
- Grand Valley State University College of Liberal Arts and Sciences, Mackinac Hall (MAK), 1 N Campus Dr, Allendale, MI 49401 United States
| | - Venkatramana Vattipally
- Advanced Radiology Services, P.C.3264 North Evergreen Drive NE, Grand Rapids, MI 49525 United States
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Abouibrahim M, Agarwal A, Ottih U, Ravendran K, Bista G, Zafar M, Hovagim G, Hacikurt K. Marchiafava-Bignami Disease: A Rare Association With Dysdiadochokinesia and Ataxic Gait. Cureus 2023; 15:e41492. [PMID: 37551251 PMCID: PMC10404341 DOI: 10.7759/cureus.41492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 08/09/2023] Open
Abstract
Marchiafava-Bignami disease (MBD) is a rare neurological disorder characterized by demyelination and necrosis of the corpus callosum. The non-specific signs and symptoms associated with MBD including dysarthria, impaired walking, pyramidal signs, primitive reflexes, seizures, incontinence, sensory symptoms, gaze palsies, and altered mental state result in a challenging diagnosis. Here, we report the case of a 64-year-old female presenting with dizziness, gait ataxia, and a history of recurrent falls for several months. Initial blood tests indicated anaemia, hypokalemia, hypomagnesemia, and mildly elevated inflammatory markers. Her presentation was initially attributed to a multifactorial aetiology, including a urinary tract infection, orthostatic hypotension, and electrolyte imbalances; however, on correction of reversible causes, her symptoms persisted. Moreover, further examination revealed right-hand dysdiadochokinesia. Subsequent brain MRI revealed fluid-attenuated inversion recovery hyperintensity within the corpus callosum and a right-sided pericallosal white matter hyperintensity. Neuro-radiology multidisciplinary team reported these findings consistent with MBD. Management with vitamin B supplementation was promptly initiated alongside alcohol cessation advice. She was also reviewed by physiotherapy teams. This case adds to the paucity of literature on MBD.
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Affiliation(s)
- Mahmoud Abouibrahim
- Internal Medicine, Conquest Hospital, East Sussex Healthcare NHS Trust, St. Leonards-on-Sea, GBR
| | - Ansh Agarwal
- Internal Medicine, Conquest Hospital, East Sussex Healthcare NHS Trust, St. Leonards-on-Sea, GBR
| | - Ugochinyere Ottih
- Internal Medicine, Conquest Hospital, East Sussex Healthcare NHS Trust, St. Leonards-on-Sea, GBR
| | - Kapilraj Ravendran
- General Surgery, East Sussex Healthcare NHS Trust, Brighton and Hove, GBR
- Medicine, Gradscape, London, GBR
- Medical School, Medical University of Sofia, Sofia, BGR
| | - Galaxy Bista
- Internal Medicine, Conquest Hospital, East Sussex Healthcare NHS Trust, St. Leonards-on-Sea, GBR
| | - Mansoor Zafar
- Gastroenterology, General Internal Medicine, Conquest Hospital, East Sussex Healthcare NHS Trust, St. Leonards-on-Sea, GBR
| | - Garabedyan Hovagim
- Neurology, Conquest Hospital, East Sussex Healthcare NHS Trust, St. Leonards-on-Sea, GBR
| | - Kadir Hacikurt
- Radiology, Conquest Hospital, East Sussex Healthcare NHS Trust, St. Leonards-on-Sea, GBR
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Azevedo FO, Neto A, Gama A, Subtil A, Fuertes R, Pereira C, Tavares J, Medinas RL, Silva AV, Dias S. Problemas ligados ao álcool em centros de emergência (PLACE)-People experiencing homelessness with alcohol-related problems in Lisbon's emergency shelters during the COVID-19 pandemic: a description and analysis of a harm reduction intervention. Front Psychol 2023; 14:1165322. [PMID: 37275696 PMCID: PMC10236796 DOI: 10.3389/fpsyg.2023.1165322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/10/2023] [Indexed: 06/07/2023] Open
Abstract
Introduction Alcohol-related problems disproportionally affect people experiencing homelessness. As the first wave of the COVID-2019 pandemic spread in 2020, a number of emergency shelters were opened in Lisbon. Increased difficulties in obtaining alcohol could have led to an increased incidence of alcohol withdrawal. Therefore, a low-threshold harm reduction intervention was introduced to these emergency shelters. This consisted of a fixed medication treatment, made available immediately for those with specific conditions, without the need for a medical evaluation or abstinence from alcohol, together with an offer of subsequent access to specialized addiction centers. The Problemas Ligados ao Álcool em Centros de Emergência (PLACE) study (alcohol-related problems in emergency shelters) is a retrospective mixed-methods observational study. It describes the demographic, health, and social characteristics of shelter users participating in the program and aims to evaluate the intervention as well as the experience of the patients, professionals, and decision-makers involved. Results A total of 69 people using shelters self-reported alcohol-related problems. Among them, 36.2% of the people accepted a pharmacological intervention, and 23.2% selected an addiction appointment. The take-up of the intervention was associated with better housing outcomes. A description of an individual's trajectory after leaving the shelter is provided. Discussion This study suggests that non-abstinence-focused interventions can be useful and well-tolerated in treating addiction in this population.
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Affiliation(s)
- Filipe Oliveira Azevedo
- Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Ana Neto
- Unidade de Alcoologia de Lisboa, Divisão para a Intervenção em Comportamentos Aditivos e Dependências, Associação Regional de Saúde, Instituto Público, Lisbon, Portugal
| | - Ana Gama
- Nova Escola Nacional de Saúde Pública, Public Health Research Centre, Comprehensive Health Research Center, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Ana Subtil
- Nova Escola Nacional de Saúde Pública, Public Health Research Centre, Comprehensive Health Research Center, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | | | | | - Raquel Luis Medinas
- Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Ana V. Silva
- Unidade de Alcoologia de Lisboa, Divisão para a Intervenção em Comportamentos Aditivos e Dependências, Associação Regional de Saúde, Instituto Público, Lisbon, Portugal
| | - Sónia Dias
- Nova Escola Nacional de Saúde Pública, Public Health Research Centre, Comprehensive Health Research Center, Universidade Nova de Lisboa, Lisbon, Portugal
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Melo E Silva JP, Soares Dionísio A, Barbosa Mateus D, Pais Silva F, Gonçalves Pereira J. From Chronic Alcohol Consumption to Coma: Report of an Uncommon Cause. Cureus 2023; 15:e36411. [PMID: 37090382 PMCID: PMC10115667 DOI: 10.7759/cureus.36411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 04/25/2023] Open
Abstract
Marchiafava-Bignami disease is a rare condition characterized by demyelination of the corpus callosum that can evolve into necrosis. It is associated with thiamine deficiency, chronic alcohol consumption, and less frequently, severe malnutrition. The diagnosis is based on clinical presentation - altered mental state and changes in a neurological examination - and on neuroimaging studies, especially magnetic resonance imaging. Treatment with parenteral thiamine is recommended. The authors present a case of a 50-year-old male, with chronic alcohol abuse and malnutrition, admitted to the hospital with an acute form of the Marchiafava-Bignami disease. An early diagnosis and treatment facilitated neurological and cognitive recovery.
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Affiliation(s)
| | - Antony Soares Dionísio
- Internal Medicine Department, Centro Hospitalar de Lisboa Ocidental - Hospital São Francisco Xavier, Lisboa, PRT
| | | | - Filipa Pais Silva
- Intensive Care Unit Department, Hospital de Vila Franca de Xira, Vila Franca de Xira, PRT
| | - João Gonçalves Pereira
- Intensive Care Unit Department, Hospital de Vila Franca de Xira, Vila Franca de Xira, PRT
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Castro I, Cardoso J, Esteves C, Figueiredo A. Marchiafava-Bignami Disease: Report of a Subacute Case. Cureus 2023; 15:e34692. [PMID: 36909031 PMCID: PMC9995083 DOI: 10.7759/cureus.34692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 02/09/2023] Open
Abstract
Marchiafava-Bignami disease (MBD) is rare and often associated with chronic alcohol consumption; however, cases have been described in non-alcoholic patients with nutritional deficits. This disease manifests itself through an array of neurological signs and symptoms, from mild dysarthria or mild confusion to coma and death, and can present acutely, subacutely, or chronically, depending on their severity. The evolution of imaging technology makes magnetic resonance imaging (MRI) the gold standard for the diagnosis of this disease, although computed tomography (CT) scan is usually in the first line owing to its greater availability. The main feature for the diagnosis of MBD by brain MRI is the identification of areas of demyelination and necrosis of the corpus callosum. We report a 55-year-old male with subacute neurological deterioration whose MRI demonstrated atrophy and demyelination of the corpus callosum.
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Affiliation(s)
- Ivo Castro
- Department of Internal Medicine, Hospital Distrital de Santarém, Santarém, PRT
| | - João Cardoso
- Department of Internal Medicine, Hospital Distrital de Santarém, Santarém, PRT
| | - Cristina Esteves
- Department of Internal Medicine, Hospital Distrital de Santarém, Santarém, PRT
| | - Adelaide Figueiredo
- Department of Internal Medicine, Hospital Distrital de Santarém, Santarém, PRT
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