Sean Sellwood, MD
Resident Physician
Corewell Health-East
Taylor, Michigan, United States
Saina Gowani, DO
Resident Physician
Corewell Health-East
Taylor, Michigan, United States
Melissa Mafiah, MD
Attending physician
Corewell Health-East
Taylor, Michigan, United States
Marchiafava-Bignami Disease
Case Description:
A 41-year-old male with a past medical history of alcoholic hepatitis and neuropathy secondary to chronic alcohol abuse presented from his neurologist’s office for significant jaundice, confusion, and motor dysfunction. Physical exam revealed bilateral foot drop with 2/5 Manual Muscle Testing on ankle dorsiflexion causing gait impairment. MRI brain showed demyelination of the corpus collosum with extension into the splenium, consistent with Marchiafava-Bignami Disease in the context of known alcohol use. The acute care course was complicated by confusion, hepatorenal syndrome requiring initiation of dialysis, and hypotension requiring midodrine, florinef, an abdominal binder, and leg compression wraps. He was admitted to the inpatient rehabilitation (IPR) unit for 20 days after prolonged hospitalization, in which a comprehensive treatment plan, including medical management and targeted rehabilitation therapies, was implemented to address these symptoms.
Discussions:
This case highlights the challenges of managing this complex condition and emphasizes the importance of a multimodal approach to meet a patient’s recovery goals in addition to managing the medical complexities. Rehabilitative efforts were challenging given labile blood pressures due to multiple medical complexities. Given his significant debility, he was was provided ankle-foot orthoses (AFO) and treated with electrical nerve stimulation with improvement in ankle dorsiflexion. He was taught sliding board transfers and discharged at the wheelchair level. Continued research and clinical advancements are essential to refine these strategies and enhance patient care.
Conclusions:
This case highlights the importance of a multidisciplinary approach, including physical therapy and occupational therapy, for patients with Marchiafava-Bignami Disease. Effective rehabilitation and treatment plans play a significant role in addressing the diverse needs of these patients and are crucial for improving functional outcomes and quality of life. Given the severity of this condition, early intervention and tailored treatment plans can help mitigate the disease's impact on cognitive impairment and motor functions.
