Coexistence of Marchiafava–Bignami disease, Wernicke encephalopathy and central pontine myelinolysis in a patient with chronic alcoholism

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We reported a 59-year-old man with a history of chronic alcoholism who presented with acute onset of confusion, dysarthria and ataxia. Magnetic resonance imaging (MRI) showed typical features of Marchiafava–Bignami disease, Wernicke encephalopathy, central pontine myelinolysis with mamillary bodies atrophy, extensive lesions involving the corpus callosum, periaqueductal gray matter and central pons. Diffusion-weighted images displayed restricted diffusion in the corpus callosum. These disease entities were rare; all had strong association with alcoholism. His clinical conditions improved dramatically after thiamine supplement. Although coexistence of these entities had been reported, we believe that this is the first report demonstrating the imaging features of these entities in the same patient on MRI.