Table 1 Differential diagnostic possibilities
From: A fatal case of acute Marchiafava-Bignami disease complicated by acute abdomen– a case report
Marchiafava-Bignami disease (MBD) | Wernicke encephalopathy (WE) | Metabolic enchephalitis | Infective diseases (meningitis, enchephalitis) | Stuctural leasion | Toxication (opioid, carbon-monoxide) | |
|---|---|---|---|---|---|---|
Cause | Alcohol abuse | Alcohol abuse, malnutrition, hyperemesis, malabsorption, inadequate dietary intake, increased metabolic requirement, dialysis patients | Septic state, hepatic (ammonia elevated), uremic (urea elevated), electrocyte abnormalities (natrium, calcium), hypoglycemia, hyperglycemia, hypoxic | Bacterial, viral, fungal infections | Stroke, hemorrhage, traumatic injuries | Opioid overdose, CO toxication |
Implication | Thiamin deficiency | Thiamin deficiency | Oedema, neurotransmitter disturbance | Altered blood-brain permeability, inflammatory cytokines | Structural damage of the brain | Opioid overdose, Increased carboxyhemoglobin |
Symptoms | Acute: seizures, confusion, altered mental state, coma Subacut and chronic: interhemispheric disconnection syndrome, ataxia, dysarthria, behavioral issues, hallucination, progressive dementia | Confusion, ataxia, ocular abnormalities | Irritability, apathy, lethargy, confusion, agitation, coma | Diffuse muscle weakness, polyneuropathy, fever, stiff neck, severe headache, nausea, coma | Seizure, motor deficit, sensory deficit, ataxia, dizziness, agnosia, aphasia, dysarthria, headache, homonymous hemianopia, diplopia, nausea, coma | Opioid: decreased mental status, respiratory rate, tidal volume, vowel sounds and miotic pupils CO: headache, nausea, dizziness, drowsiness, vomiting, caught, confusion, shortness of breath, syncope |
Clinical presentation | Variety of symptoms, severe symptoms, improve slowly | Characteristic symptoms, moderate symptoms, resolve within weeks | Confusion, coma with deviation in blood gas or laboratory results. History of vomiting, diarrhoea, bad medicine compliance. Positive meningeal signs | Infection, elevated infection markers, fever with confusion, sudden onset | Gradual and progression or abrubt onset | Opioid: Mental state between euphoria and coma CO: Fire victims, flu-like symtoms, unexplained altered mental status |
Affecting brain areas | In subtype A: the whole corpus callosum affected In subtype B: partial part of the corpus callosum affected | Medial thalamic nuclei, tectal plate, mammillary bodies, periaqueductal gray matter | Not specific | Not specific | Specific | Not specific |
Diagnosis | Laboratory, brain imaging, clinical sympthoms | Laboratory, brain imaging, clinical sympthoms | Blood gas, laboratory | Lumbar punction, Electroenc-ephalography | CT, MRI | Opioid: Laboratory CO: COHg measurement |
Therapy | Thiamine, folate, vitamin B complex, high-dose corticosteroids, amantidine, nutritional support, cessation of alcohol consumption | Thiamine, glucose infusion, nutritional support, cessation of alcohol | Treating the underlying deviation | Infection control | Thrombolysis, neurosurgeon intervention | Opioid: Antidotum, supportive therapy CO: High-flow oxygen |
Outcome | Slow and complete recovery, or terminal illness | Complete recovery, or progression to Korsakoff syndrome | Varying from the cause of the problem, may be reversible | May be reversible | May be reversible | Opioid: May be reversible or fatal due respiratory arrest CO: Complete recovery or late neurocognitive impairment |