Encephalopathy, MRIs and Thiamine Supplementation

August 7, 2020

An MRI is a helpful diagnostic tool for patients presenting with encephalopathy, which is damage or disease that affects the brain. For patients subsequently diagnosed with Marchiafava-Bignami Disease (MBD), thiamine supplementation can significantly reduce mortality.

This was according to a case reported presented at the July Grand Rounds lecture provided by the College of Community Health Sciences. The case report and presentation, “Thiamine and encephalopathy: A case report of Marchiafava-Bignami Disease,” were prepared by Drs. Stephanie Kinsley and Jordan Pharris, resident physicians of The University of Alabama Tuscaloosa Family Medicine Residency Program, which is operated by the College.

Kinsley and Pharris cared for a hospitalized patient in March admitted to emergency department with slurred speech, confusion, difficulty with balance and who was undernourished. The patient had a history of high blood pressure, malnutrition, anemia, chronic back pain and heavy alcohol use.

Pharris said the patient’s laboratory work and scans were “unremarkable, but an MRI showed (lesions) in the corpus callosum and bilateral frontal lobes (of the brain). Inflammatory markers were increased. It was such a distinctive finding on the MRI.”

The MRI findings indicated MBD, a toxic disorder of the central nervous system associated with chronic alcoholism and malnutrition. It is a rare disorder, with only 250 reported cases worldwide.

Kinsley and Pharris said thiamine deficiency is a contributing factor for development of MBD. Thiamine deficiency leads to impaired glucose metabolism, which leads to neurotransmitter changes in the body. Diagnosis by MRI allows for early initiation of thiamine supplementation and an improved prognosis for MBD from frequently fatal to a mortality of less than 8%.

“Use of MRI has drastically improved the outcome,” Kinsley said. “In the past, this diagnosis was typically made postmortem.”

After thiamine supplementation, the patient no longer had slurred speech and was able to walk with the help of a walker. The patient was discharged from the hospital to an inpatient facility for physical therapy and counseling for nutrition and alcohol use.

“Improvement was dramatic after the thiamine supplementation,” Kinsley said.