Reversible “ears of the lynx” sign in Marchiafava–Bignami disease

A 51-year-old man with a history of ongoing severe alcohol abuse presented with subacute impaired consciousness. On admission, Glasgow coma scale was 4/15 in the absence of focal neurological deficit. Brain MRI showed FLAIR hyperintensities in the entire corpus callosum, the forceps minor, and the adjacent prefrontal white matter fibers (Figs. 1, 2). The splenium was strongly hyperintense on DWI and hypointense on ADC map, whereas the genu, the forceps minor, and the prefrontal white matter showed moderate DWI and ADC hyperintensities (Figs. 1, 2). Electroencephalography showed generalized slowing. CSF analysis was normal. The patient was intubated and mechanically ventilated. A diagnosis of Marchiafava–Bignami disease (MBD) was made, and high-dose vitamin B complex (including intravenous thiamine 500 mg/d for 3 weeks) was started. 8 days later, MRI showed complete reversibility of the genu, the forceps minor, and the prefrontal signal changes on FLAIR, DWI, and ADC map, whereas the radiological abnormalities persisted in the posterior part of the corpus callosum (Figs. 1, 2). The patient was extubated 2 weeks later and regained normal consciousness. Progressive improvement of his clinical state was observed, in the presence, however, of severe and persisting cognitive deficit. We interpreted the reversible genu, forceps minor, and prefrontal signal changes as vasogenic edema, whereas the posterior corpus callosum abnormalities corresponded probably to irreversible cytotoxic edema leading to cystic necrosis (observed in the posterior corpus callosum on MRI 2 months later; images not shown). …