Marchiafawa bignami disease possibly related to consumption of a locally brewed alcoholic beverage: Report of two cases
Mr. ABC, a 57-year-old male patient from low socio-economic status from rural area with history of chronic alcohol abuse since 35 years, gradually increasing to 4-5 (400-500 ml) pouches of Mahuwa Daru over 2 hours daily in the evening. Patient never abstained. Patient was forced to stop alcohol by relatives for financial and health reasons, the following day he developed tremors and sleep impairment and on third day he was found disoriented in disheveled state with fecal and urinary incontinence by the coworkers and was admitted. General examination showed malnourishment and thickening of post-auricular and ulnar nerve. Vital signs were normal. Mental state examination showed disorientation. Pupillary reactions were symmetrical. There were no lateralizing deficits and no signs of meningeal irritation. Laboratory tests showed a normal haemogram, liver and renal function tests and serum electrolytes. Patient was started on Inj Thiamine 100 mg and anti withdrawal line of management. He had four episodes of seizures over three days of admission. His EEG was normal. His MRI-Brain showed hyper intense signal intensities involving genu, body and splenium of corpus callosum on T2W and FLAIR []. Patient gradually improved. On 20th day he was symptom free, MSE was clear, MMSE was 30/30 and was discharged and advised to follow up. After one month he resumed his work. Patient did not follow up in OPD for further evaluation.