A Rare Case Of Sub-Acute Form Of Marchiafava-Bignami Disease Presenting Predominantly With Psychotic Symptoms

Objective: The objective is to present a rare case of sub-acute form of Marchiafava-Bignami disease presenting with psychosis, minimal cognitive impairment and no clinical neurological signs. Methods: This is a case report of a patient with Marchiafava-Bignami disease presenting to a tertiary care psychiatric hospital in Singapore. A review of the literature of the condition is also presented. Results: The patient presented with prominent psychotic symptoms in the context of chronic alcohol abuse. He also had minimal cognitive impairment and clinically no neurological signs. A working diagnosis of alcohol induced psychotic disorder was made. His psychotic symptoms seemed to be resistant to treatment with antipsychotic medications initially and this led to further investigation by MRI scan of brain which revealed atrophy of corpus callosum and no other significant abnormalities. His psychotic symptoms gradually improved with treatment. He is now placed in an intermediate care setting in the hospital while waiting for a suitable community placement. Conclusions: It is rare for Marchiafava-Bignami disease to present with prominent psychotic symptoms with minimal cognitive impairment and no neurological signs clinically. In patients with a history of chronic alcohol abuse presenting with psychotic disorder, Marchiafava-Bignami disease should be suspected as a diagnostic possibility.

Histomorphological features of pancreas and liver in chronic alcoholics - an analytical study in 390 autopsy cases.

Introduction: Chronic pancreatitis and liver disease are two conditions that commonly co-exist in chronic alcoholics with variable incidences. Aim: To evaluate frequency pancreatitis in patients with a history of chronic alcohol abuse. Materials and Methods: A total of 390 autopsies over 11 year’s period were included in the study. Gross and microscopic assessment of liver and pancreas were performed. Available clinical and laboratory parameters were recorded. Results: Age ranged from 22 to 65 years with a mean age of 45.32 years. All 390 consecutive patients included in the study were males. Majority of the patients had primarily presented with alcohol related liver diseases whereas few had presented with features of pancreatitis. Micronodular cirrhosis was present in 292 cases. Features of chronic pancreatitis were observed in 42 cases and 8 of these cases had associated changes of acute hemorrhagic pancreatitis. Prevalence of pancreatitis was more in cirrhotics as compared to non-cirrhotics, and acute pancreatitis was mostly seen in non-cirrhotics. Dominant pattern of fi brosis was perilobular followed by periductal, intralobular and diffuse. Conclusion: Chronic pancreatitis as evidence by the presence of parenchymal fi brosis was more frequently observed in alcoholic cirrhosis cases than that in non-cirrhotic alcoholic liver disease, thereby suggesting common underlying pathobiology in the development of fi brosis in liver as well as in pancreas.

Syndrome of malnutrition-inflammation complex in chronic alcoholics.

Several studies have reported elevated serum ferritin levels in patients of chronic alcohol abuse. We hypothesized that serum ferritin may be acting as a marker of acute phase reactant, reflecting the inflammatory status of patients of chronic alcohol abuse, rather than as a marker of iron overload . Hence we correlated serum ferritin levels with interleukin 6 (IL-6), interleukin 1 (IL-1) and tumor necrosis factor alpha (TNF -α ) which are markers of inflammation. Serum ferritin and IL-6 levels were significantly elevated at the time of admission. The elevation of IL-6 correlated well with the increase in ferritin levels (r=0.78, p<0.01). Serum iron levels were not significantly different before and after abstinence from alcohol. We also speculated that the inflammatory status was associated with the malnutrition that is observed in alcohol abuse. Therefore we studied serum total protein, albumin, prealbumin and transferrin levels as markers of nutrition in patients of chronic alcohol abuse. Serum levels of all these nutritional parameters increased significantly after 8 weeks of abstinence from alcohol and were accompanied by reduced levels of ferritin and IL-6. Hence it is possible that a malnutrition inflammation complex like syndrome exists in patients of alcohol abuse.