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Marchiafava-Bignami or delirium ipoactive: a case report presentation
Thomas Fraccalini, Fabio Perotto, Luciano CARDINALE, Beatrice TAROZZO, Giorgio Garofalo, Cristina CIBIN, Davide Minniti, Giuseppe Maina et al.. Minerva Psychiatry, 2025-04-01
Topic: Risk, prevention and care in population studies
Marchiafava-Bignami disease (MBD) is a rare toxic-based demyelinating disease that affects the central nervous system. It is often associated with malnutrition and alcoholism. Clinically, it can manifest with pleomorphic pictures in which; however, neurological symptoms such as altered consciousness, dementia, dysarthria, pyramidal tract signs, seizures, ataxia, and signs of interhemispheric disconnection predominate. This pathology must be differentiated from Wernicke’s encephalopathy, multiple sclerosis, encephalitis, infectious leukoencephalopathy, paraneoplastic syndromes, cerebral stroke and dementias, both degenerative (Alzheimer’s disease, Pick’s fronto-temporal dementia), and secondary multi-infarct type. The diagnosis of MBD is performed with radiological criteria and depends on the MRI results of the hyperintensity of the corpus callosum in T2 sequences and T2 with fluid-attenuated inversion recovery, with or without extracallous lesions. Two clinical-radiological subtypes of MBD have been described, distinguishing between acute and chronic onset: type A and type B, with significant differences regarding the clinical course and prognosis. Type A is characterized by hyperintense T2 swelling of the entire corpus callosum on initial MRI; type B shows partial calloused lesions on MRI. The use of magnetic resonance imaging in diagnosis allowed early administration of parenteral treatment with thiamine and improved the prognosis of MBD from often fatal to less than 8% mortality. Administration of thiamine, within 14 days of symptom onset, has been shown to have statistically better results than delayed treatment. We present a clinical case of MBD diagnosed in a 74-year-old woman, who presented in a state of stupor-coma, following a hospitalization in Emergency Medicine for urinary tract infection. In this particular case, the use of MRI was able to discriminate MBD from hypokinetic delirium, which is very common in the population of elderly hospitalized for infectious status. Early diagnosis also allowed a rapid improvement in the patient’s condition which, if left undiagnosed, would have led inexorably to exitus.
Key findings
- It is often associated with malnutrition and alcoholism.
- The diagnosis of MBD is performed with radiological criteria and depends on the MRI results of the hyperintensity of the corpus callosum in T2 sequences and T2 with fluid-attenuated inversion recovery, with or without extracallous lesions.
- Two clinical-radiological subtypes of MBD have been described, distinguishing between acute and chronic onset: type A and type B, with significant differences regarding the clinical course and prognosis.
- Administration of thiamine, within 14 days of symptom onset, has been shown to have statistically better results than delayed treatment.
Why it matters
This case report describes Marchiafava-Bignami disease, a rare toxic-based demyelinating condition often linked to malnutrition and alcoholism that can cause dementia-like symptoms. It notes that this condition must be distinguished from degenerative dementias including Alzheimer's disease, and that MRI findings allow diagnosis.
Study details
- Evidence strengthLow
How this study scored 31/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Minerva Psychiatry) |
| Journal's citation record | 0 / 4 | Minerva Psychiatry: journal h-index 9 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 1 / 7 | Cited 2 times (OpenAlex, 2026-10-10) |
| Citations per year | 0 / 5 | 0.7 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 2 / 6 | Cited 1.1× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 1 / 6 | Cited by 1 other studies in this library |
| Still being cited | 0 / 4 | Cited 2 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 1 / 4 | Last-listed author Giovanni Volpicelli: h-index 5 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | University of Turin: institution h-index 903 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 5 institution(s) in 1 country |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 31 / 100 | — |
What each of these 20 components measures, and what this score is not →
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record's author list ends in “et al.”, so not every author is named. Check the citation against the original before you use it.
APA 7th
Fraccalini, T., Perotto, F., CARDINALE, L., TAROZZO, B., Garofalo, G., CIBIN, C., et al. (2025). Marchiafava-Bignami or delirium ipoactive: a case report presentation. Minerva Psychiatry. https://doi.org/10.23736/s2724-6612.24.02569-7
Vancouver
Fraccalini T, Perotto F, CARDINALE L, TAROZZO B, Garofalo G, CIBIN C, et al. Marchiafava-Bignami or delirium ipoactive: a case report presentation. Minerva Psychiatry. 2025. doi:10.23736/s2724-6612.24.02569-7.
BibTeX
@article{fraccalini2025-fbae8441,
author = {Fraccalini, Thomas and Perotto, Fabio and CARDINALE, Luciano and TAROZZO, Beatrice and Garofalo, Giorgio and CIBIN, Cristina and Minniti, Davide and Maina, Giuseppe and others},
title = {{Marchiafava-Bignami or delirium ipoactive: a case report presentation}},
journal = {Minerva Psychiatry},
year = {2025},
doi = {10.23736/s2724-6612.24.02569-7},
url = {https://doi.org/10.23736/s2724-6612.24.02569-7}
}
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