Magnetic Resonance Imaging in Marchiafava-Bignami Syndrome: A Cornerstone in Diagnosis and Prognosis

Table 1

Clinical forms of MBS and their differentials [1].

Clinical form of MBS	Predominant symptoms	Clinical differentials and their MRI findings
Acute MBS	Mental confusion, disorientation, neurocognitive deficits, and seizures	(1) Wernicke encephalopathy; Symmetric involvement of medial thalami, mammillary bodies, tectal plate, and periaqueductal grey matter; hypointense on T1WI; hyperintense on T2W and FLAIR images.; Few cases with cortical involvement restricted to motor and premotor areas.
Chronic MBS	Chronic dementia	(1) Alzheimer disease; Extreme hippocampal and medial temporal lobe atrophy, severe global atrophy in end-stage disease.; (2) Multi-infarct dementia; (i) Diffuse white matter disease with large confluent lesions (hypointense on T1WI and hyperintense on T2W and FLAIR images) affecting at least 25% of white matter, mainly in the periventricular regions.; (ii) Multiple lacunar infarcts in frontal white matter, thalami, and basal ganglia.; (iii) Strategic infarcts: involving Parieto-temporo-occipital association areas, angular gyrus (middle cerebral artery territory), paramedian thalamic, and inferior medial temporal lobe (posterior cerebral artery territory).; (3) Frontotemporal lobar degeneration (Pick’s) disease: Pronounced atrophy of frontal and/or temporal lobes.