Marchiafava Bignami Disease Potentially Complicating Normal Pressure Hydrocephalus

Abstract

Marchiafava-Bignami disease (MBD) is a rare disorder of demyelination or necrosis of the corpus callo- sum. Mainly, MBD is associated with alcohol and malnutrition. We report a 60-year-old woman with no history of alcohol consumption or malnutrition who had MBD as a possible complication of normal pres- sure hydrocephalus (NPH). The patient presented with a 2-month history of progressive gait unsteadi- ness, urinary incontinence, and forgetfulness, for which the patient underwent ventriculoperitoneal shunt surgery with remarkable improvement. Magnetic resonance imaging (MRI) demonstrated hyperintensity in the body and splenium of corpus callosum when she was brought to the hospital again with rapid dete- rioration of her mental ststus. It might be postulated that cerebrospinal fluid (CSF) tumor necrosis factor- alpha (TNF-α) might have contributed to the development of MBD although not measured in this patient, given that TNF-α, as a proinflammatory cytokine mediating demyelinating process have been found in be increased in the CSF of NPH.