Abstract
Marchiafava-Bignami disease (MBD), Wernicke encephalopathy (WE) and alcoholic polyneuropathy (AP) are distinct diseases and all have strong relationship with chronic alcoholism. A 70-year-old male who had altered mentality and ataxia of both lower limbs and had past history of WE 3 years previously admitted with 6 months history of impaired walking. He also had a symptom of altered sensorium by impaired consciousness for 2 days. In brain magnetic resonance imaging, the body, splenium of corpus callosum and bilateral frontal cortex were involved. The patient was diagnosed with MBD on the basis of the clinical features and the brain imaging findings. The electrodiagnostic findings implied demyelinating neuropathy in all extremities. He failed to recover his mentality and the function of the limbs remained poor finishing several treatment options including medications and physical therapy. The poor prognosis of this patient is thought to be associated with cortical involvement of MBD. We reported this very rare case who was affected by 3 distinct diseases of MBD, AP, and WE as complications of chronic alcohol abuse. Moreover, the case was relevant to a rare clinical presentation of MBD with cortical involvement which was associated with poor prognosis.