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Marchiafava-Bignami disease presenting as reversible coma
  1. Yixin Zhang1,
  2. Kaleb Culpepper2,
  3. Reshmi Mathew1 and
  4. Luis CruzSaavedra2
  1. 1Internal Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, USA
  2. 2Neurology, UF Health Jacksonville, Jacksonville, Florida, USA
  1. Correspondence to Dr Yixin Zhang; wendyz0411{at}


Marchiafava-Bignami disease (MBD) is a rare demyelinating condition of the corpus callosum and subcortical white matter that is most commonly seen in alcoholic patients. The course of the disease varies with symptoms that range from dementia to complete coma; severe intermittent sympathetic storming with abnormal posturing is often reported in literature. It is presumably secondary to a deficiency of B complex vitamins, specifically thiamine and many patients have clinical improvement after repletion of B vitamins. We present a case of a 35-year-old man who developed MBD secondary to polysubstance misuse without history of alcohol use. His clinical course was complicated by persistent comatose state with autonomic dysfunction. After the administration of high-dose thiamine and vitamin C and E, the patient regained consciousness and was able to follow commands within 48 hours. Furthermore, this case showed recognising brain MRI findings for MBD is a crucial step in disease identification.

  • Neuroimaging
  • Neurology (drugs and medicines)
  • Medical management
  • Drugs misuse (including addiction)

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  • Contributors YZ and RM: Acquisition of data and drafting the manuscript. KC: Acquisition of imaging and annotation. LC: Drafting the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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