2012 Volume 16 Issue 1 Pages 64-69
[Introduction] Marchiafava-Bignami disease (MBD) is a unique disorder caused by alcohol abuse or malnutrition with symptoms such as disturbance of consciousness and convulsion due to lesions in the corpus callosum. Here we report a case where a patient with MBD achieved a full transition from nasogastric tube to oral feeding through swallowing and dysphagia rehabilitation.
[Case] A 46-year-old woman was transported to a hospital by ambulance due to disturbance of consciousness. Magnetic resonance images of the brain revealed areas of high signal intensity in the corpus callosum. She was diagnosed with MBD given a history of alcohol abuse. Detailed testing of feeding and swallowing functions was initiated upon her transfer to another hospital 2 months after the onset.
[Treatment course] Irritation symptoms and impaired orofacial function were observed. Video-endoscopy (VE) of the pharynx during deglutition revealed pharyngeal contamination. Tube feeding was continued while the patient underwent indirect training, which included orofacial function training and oral care. VE confirmed the absence of aspiration. Direct training was initiated once the patient was able to ingest jelly with some assistance. Food was gradually transitioned from jelly to mashed foods based on re-evaluations. She was eventually able to revert to oral feeding; no aspiration pneumonia developed. With the improvement in feeding and swallowing functions, Functional Independence Measure scores that represent independence level of patient also improved in both cognition and mobility categories.
[Conclusion] Comprehensive rehabilitation aimed at improving oral feeding performance led to improvements in ADL as well as feeding and swallowing functions in a patient with MBD. Feeding and swallowing impairments must not be overlooked during the course of MBD treatment. Our findings suggest that patient outcomes can be improved by responding appropriately to these impairments.
