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Marchiafava-Bignami Disease
Computed Tomograghic Scan, 99mTc HMPAO-SPECT, and FLAIR MRI Findings in a Patient With Subcortical Aphasia, Alexia, Bilateral Agraphia, and Left-handed Deficit of Constructional Ability
Franco Ferracci, MD;
Fernando Conte, MD;
Manrico Gentile, MD;
Rosamaria Candeago, MD;
Luciano Foscolo, MD;
Matteo Bendini, MD;
Giuliano Fassetta, MD
Arch Neurol. 1999;56:107-110.
Objectives To report and discuss the neuropsychological deficits and neuroimaging findings in a patient with probable Marchiafava-Bignami disease.
Design and Method A right-handed woman with chronic alcoholism demonstrated mutism, impaired comprehension of spoken language, alexia, and right-handed agraphia. The syndrome of interhemispheric disconnection was manifested by left-handed deficit of constructional ability and agraphia. The patient underwent brain computed tomographic scans, technetium 99 hexylmethylpropylene amineoxime–single photon emission computed tomography, and magnetic resonance imaging (MRI) that also included fluid attenuated inversion recovery images.
Setting Clinical neurology department.
Results The patient's symptoms were related to scattered lesions of the corpus callosum and to extensive symmetrical lesions of the centrum semiovale. Only the lat-ter were detected by computed tomographic scans. Results of single photon emission computed tomography did not show areas of focal hypoperfusion. Results of fast spin-echo MRI showed all lesions were hyperintense in T1-weighted images and hypointense in T2-weighted images. Fluid attenuated inversion recovery images revealed that periventricular lesions had a hypointense core surrounded by a hyperintense rim; callosal lesions were still hyperintense.
Conclusions We believe that our patient's symptoms are due to the discontinuous affection of the corpus callosum and to the bilateral cutting of the outflow from the cortex. The MRI findings may be interpreted as indicating central necrosis and peripheral demyelination of periventricular lesions and demyelination of the corpus callosum. The combined use of fast spin echo and fluid attenuated inversion recovery MRI reproduced with more accuracy than fast spin echo MRI alone some features of Marchiafava-Bignami disease known from observations at autopsy.
From the Departments of Neurology (Drs Ferracci, Conte, Gentile, Candeago, and Fassetta), and Radiology (Drs Foscolo and Bendini), Ospedale di Belluno, Belluno, Italy.
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