Is every sharply defined, symmetrical, necrotic-demyelinating lesion in the corpus callosum an actual manifestation of Marchiafava-Bignami disease?

Neuroimaging of a 75-year-old lady demonstrated the characteristic pathological features of the Marchiafava-Bignami disease (MBD), which develops usually in chronic alcoholics. The onset of the neurological symptoms and signs were abrupt and similar to those seen in common ischemic vascular lesions. Our patient denied that she had consumed alcoholic beverage during her life. Laboratory results showed her liver enzymes were not elevated and a subsequent abdominal ultrasound examination revealed no liver pathology. The attack responded fairly well to anti-ischemic therapy and a complete recovery was observed within a week. In this sense, her pathology cannot be considered as a true MBD in spite of the presence of the CT and MRI findings of MBD. Our case seems to show that the CT and MRI findings in MBD are not specific because new imaging procedures reveal edematous, necrotic lesions that may have the appearance of MBD.