Teaching NeuroImages: Reversible widespread brain MRI lesions in Marchiafava-Bignami disease.

A 54-year-old woman with a history of alcoholism presented with stupor. Brain MRI disclosed extensive callosal and widespread extracallosal white matter and cortical lesions (figure) suggestive of MarchiafavaBignami disease (MBD). After 4 weeks of treatment with thiamine and corticosteroids, a complete resolution of brain MRI lesions along with a good clinical recovery was observed. In MBD, which is rare and frequently associated with alcoholism, brain MRI may show callosal, but also extracallosal, white matter and cortical lesions. In alcoholic MBD patients with impaired consciousness, rapid resolution of the widespread callosal, extracallosal, and cortical MRI lesions is highly unusual.