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

ABSTRACT

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.