Marchiafawa bignami disease possibly related to consumption of a locally brewed alcoholic beverage: Report of two cases
Mr. A, 39-year-old married Hindu male from low socioeconomic class and urban background, a known case of chronic alcoholism, brought by wife and uncle with 3-month history of forgetfulness in form of forgetting his way back home, whether bath was taken, where he kept the things. It was progressive in nature affecting his daily routine and socio-occupational life. He used to consume locally made alcohol called Mahuwa Daru occasionally one pouch (100 ml) since 8 years, gradually increasing to one to two pouches three times a day since last one and half year. There is history of withdrawal symptoms in form of tremors, insomnia and irritability in past. No history of any other psychiatric illness. There is family history of alcohol dependence in father.\nPatient was first taken to physician. His routine investigations were normal. MRI showed abnormal signal intensity with restricted diffusion in corpus callosum with demyelination in genu and splenium. He was treated for withdrawal and discharged. Patient restarted alcohol after discharge.\nPatient was referred to our hospital for fitness. He was admitted. Last consumption was day prior to admission and he developed tremors next day. Routine investigations and neurological examination were normal. MMSE was 21/30. He was started on anti-withdrawal line of management with Inj. Thiamine (100 mg) OD, Tab. Multivitamin BD and Tab. Lorazepam 10 mg in divided doses. Repeat MRI brain showed hyper intense signal alterations involving posterior body and splenium, as well as anterior body and genu of the corpus callosum. This represent progressive demyelination and necrosis of the corpus callosum []. All these characteristic findings confirmed the diagnosis of MBD.