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Washington University Experience | METABOLIC | Alcoholism - Overview | Marchiafava-Bignami Disease | 1A0 Case 1 History
Case 1 History ---- The decedent was a 54 year old female, with a past medical history of obstructive sleep apnea, COPD, bilateral DVT, seizures (remote), alcoholism, and alcoholic encephalopathy. The patient was reported to be in her usual state of health, talking and eating independently, when she had sudden onset of aphasia and tonic movements of RUE and LLE. She was unable to answer questions or follow commands but was negative for acute stroke by MRI and showed an old L frontal stroke. She was later noted to have a clinical seizure (head and eye deviation to left with head twitching). EEG showed moderate generalized slowing with left temporal sharp waves, consistent with metabolic encephalopathy. During a scan for pulmonary embolism, she became bradycardic and was transferred to the MICU. Brain MRI showed a persistent area of mild restricted diffusion and slight decreased FLAIR hyperintensity in the splenium of the corpus callosum which was suggestive of nutritional deficiencies or a metabolic disturbance. She developed increased oxygen demand and CXR showed bilateral patchy opacities concerning for aspiration event. Care was redirected and the patient expired. The patient was found to have alcoholic cerebellar degeneration, diffuse cortical neuron loss thought to be Morel's laminar sclerosis but no changes in the mamillary bodies. This case is not the most compelling pathologic example of Marchiafava-Bignami disease but does show callosal pathology in the appropriate clinical setting and I have included it.
