title: Acute Marchiafava-Bignami disease with selective involvement of the precentral cortex and splenium: a serial magnetic resonance imaging study.
abstract: BACKGROUND
  Marchiafava-Bignami disease (MBD) is defined pathologically as callosal degeneration associated with chronic alcoholism. We report a patient with MBD with acute lesions confined in the precentral cortex and splenium. Various magnetic resonance imaging (MRI) modalities were performed sequentially to elucidate the pathophysiology.
  
  
  METHODS
  A 52-year-old man with chronic alcoholism developed acute confusion and dysarthria. He improved incompletely with nutritional supplementation. Diffusion-weighted imaging MRI disclosed the presence of reversible lesions with low apparent diffusion coefficient values in the precentral cortex and splenium. Perfusion-weighted imaging revealed that the cerebral blood volume and flow decreased and subsequently increased, and the mean transit time and time to peak were persistently prolonged. On magnetic resonance spectroscopy, choline was initially normal and became elevated during the recovery period, whereas N-acetylaspartate was low initially and after the resolution of the lesion on conventional MRI.
  
  
  CONCLUSIONS
  The precentral cortex and splenium are the most vulnerable areas in acute MBD. The lesions have reversible restricted diffusivity and hypoperfusion. The magnetic resonance spectroscopy findings correlate well with the clinical status.
authors.affiliation: Department of Neurology, College of Medicine, Kangwon National University, Chuncheon-si, Kangwon-do, Republic of Korea.
authors.forename: Seung Hwan
authors.initials: SH
authors.lastname: Lee
authors.forename: Sam Soo
authors.initials: SS
authors.lastname: Kim
authors.forename: Sung Hun
authors.initials: SH
authors.lastname: Kim
authors.forename: Seo-Young
authors.initials: SY
authors.lastname: Lee
mesh_terms: D000437:Alcoholism / Q000150:complications / Q000473:pathology; D002540:Cerebral Cortex / Q000473:pathology*; D002560:Cerebrovascular Circulation / Q000502:physiology; D003337:Corpus Callosum / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D009682:Magnetic Resonance Spectroscopy / Q000379:methods; D008297:Male; D054319:Marchiafava-Bignami Disease / Q000209:etiology / Q000473:pathology*; D008875:Middle Aged