Rapidly Resolving Nonalcoholic Marchiafava-Bignami Disease in the Setting of Malnourishment After Gastric Bypass Surgery

Abstract

Objectives. We describe a rare case of nonalcoholic Marchiafava-Bignami disease (MBD) in the setting of malnourishment after gastric bypass. Methods. A 44-year-old nonalcoholic Caucasian woman with malnutrition after gastric bypass presented with 2 weeks of weakness. The patient acutely became stuporous. Brain magnetic resonance imaging showed lesions in the corpus callosum and internal capsules consistent with MBD. After 10 days of treatment, the patient had resolution of her encephalopathy with return to baseline mental function, with radiological improvement. Results. MBD is a rare neurological disorder seen in alcoholics and can rapidly progress to coma or death. Our patient was successfully treated with a regimen typically used in alcoholics. We discuss the relevant literature supporting this regimen. Conclusions. This case demonstrates that since the pathophysiological etiology of the disease is malnutrition, MBD patients can be effectively treated with this regimen regardless of the underlying cause.

A rare neurological manifestation of a malnourished alcohol-dependent acute pancreatitis patient with Marchiafava–Bignami disease

“…MBD occurs in patients with chronic alcoholism and, occasionally, in < 10% of all MBD patients [ 5 ], in malnourished non-alcoholics. Although necrosis or demyelination of the corpus callosum is specific for MBD, a pathophysiological mechanism explaining its particular vulnerability remains uncertain.…”

Marchiafava Bignami Disease: A Rare Neurological Complication of Long-Term Alcohol Abuse

“…When hyperintense lesions are observed on diffusion-weighted imaging (DWI) in the early stages, cytotoxic edema is suggested as a potential underlying mechanism, while necrosis and demyelination may be involved in the later stages [ 11 ]. Other possible etiology includes callosal myelinolysis as a consequence of ketoacidosis brought on by alcoholism or diabetes mellitus [ 12 ] and non-alcoholic malnourishment as a result of gastric bypass surgery [ 13 ]. Various non-alcoholic illnesses like sepsis, sickle cell disease, carbon monoxide poisoning, cerebral malaria, and cardiac cancer surgery have all been linked to it [ 14 , 15 ].…”

A patient with Marchiafava–Bignami disease type A transported by ambulance with impaired consciousness and malnutrition was successfully treated after early diagnosis by MRI

“…1 Disease onset is reported to occur mainly in people with poor nutritional status and heavy alcohol consumption; however, alcohol is not the sole cause as some cases have occurred in nonalcoholic patients. 2,3 As mentioned above, MBD is caused by a combination of factors; however, as it is a rare disorder of unknown pathophysiology, the addition of knowledge regarding its clinical and neuroradiological findings toward future clarification of its pathophysiology is essential.…”