Marchiafava-Bignami disease, first described in 1903, is a rare condition characterized by demyelination of the corpus callosum seen in patients with chronic alcoholism or nutritional susceptibility. Magnetic resonance imaging (MRI) is currently the most sensitive diagnostic tool (Figure). A 24-year-old man, with a background of high level of alcohol abuse since he was 12, presented since last year behavioral and psychotic clinical manifestations characterized by elaborated visual and auditory delusions.

Figure Axial FLAIR image (Panel A, arrow) shows hyperintensity in the splenium of the corpus callosum. Sagittal T1-weighted image (Panel B, arrow) demonstrates the focal nature of this lesion. Three-dimensional fiber tracking of corpus callosum coregistered onto a parasagittal FLAIR image (Panel C) discloses a substantial decrease in fibers crossing through the splenium.