Cerebral microhemorrhage in Marchiafava–Bignami disease detected by susceptibility-weighted imaging

Abstract

Marchiafava-Bignami disease (MBD) is a rare alcohol-associated disorder. Clinical features include not only disturbed consciousness, dysarthria, tetraparesis, astasia-abasia, and symptoms of interhemispheric disconnection as initial symptoms but also cognitive deficits as clinical outcomes. The clinical significance of cerebral microhemorrhage (CMH) has been recognized in patients with cognitive deficits; however, the presence of CMH in patients with MBD has not been emphasized. The aim of the present study was to clarify the relationship between CMH and MBD. For this purpose, we report four patients with MBD, who showed asymmetrical hypointense areas in multiple cortico-subcortical regions on susceptibility-weighted imaging (SWI). All cases had a history of chronic alcohol abuse and symmetrical lesions in the entire corpus callosum. These patients' clinical symptoms included not only coma, dysarthria, and astasia-abasia as initial symptoms but also dementia as a clinical outcome. SWI showed asymmetrical hypointense areas in the multiple cortico-subcortical regions, indicating the presence of CMH. Compared with patients with normal cognitive function, demented patients showed higher severity of CMH. Our report would indicate that CMH is an important factor indicating the severity of dementia in patients with MBD.

Susceptibility-weighted imaging and quantitative susceptibility mapping in the brain

“…A key application of SWI is aiding the diagnosis of diseases involving cerebral vascular pathology. These changes include, for example, vascular malformations (e.g., arteriovenous malformations and cerebral cavernous malformations), restrictions in blood flow (e.g., developmental venous anomaly) and hemorrhages (caused by e.g., cerebral amyloid angiopathy, stroke, and traumatic injuries) (1,3,(75)(76)(77)(78)(79)(80)(81)(82)(83)(84)(85)(86)(87)(88)(89). In these cases, a common source of contrast is oxygenation-related susceptibility changes occurring in blood products (3).…”

Marchiafava-Bignami disease mimics motor neuron disease: case report

“…MBD is most frequently seen in middle-aged or elderly chronic alcoholic males [6-9,11]. MBD was first reported in 1903 by Marchiafava and Bignami, who originally described the symptoms in Italian men with increased consumption of inexpensively manufactured Chianti red wine [1].…”

“…In a report of an MR spectroscopic study, it was suggested that inflammatory reactions accompanying demyelination and micronecrosis and secondary axonal damage might occur in the acute stage of MBD [19]. Presence of cerebral microhemorrhage on susceptibility-weighted imaging was reportedly associated with cognitive dysfunction in MBD patients, and cytotoxic edema on DWI and the ADC map might predict poor outcome [8,11]. …”

“…Over 90% of the patients with MBD exhibited a poor prognosis [10]. However, MBD patients can recover completely with disappearance of the callosal and adjacent white matter lesions on serial MRI after adequate therapy in a few weeks to half a year [7,9,11,12]. MBD includes a variety of neurologic features such as seizures, confusion, and deterioration of consciousness, which can be difficult to differentiate from symptoms of other alcoholic neurological disorders [3].…”

An MRI review of acquired corpus callosum lesions

“…In the acute phase, reduced diffusion is often seen on diffusion-weighted imaging. Contrast enhancement can be occasionally seen in the acute phase, and sometimes slight haemorrhage can also occur inside the lesion 23. Less frequently, other brain structures including white matter tracts, cerebral cortex and middle cerebellar peduncles may be involved in MBD.…”