Callosal dementia: behavioral disorders related to centro and extrapontinemyelinolysis

We report the behavioral symptoms presented by a 57-year-old man as the fir st sign of a Marchiafava-Bignami syndrome and by a 44-year-old woman with c entro and extrapontine myelinolysis. These observations define a clinical e ntity, that we named callosal dementia characterized by: 5) fronto-limbic s igns with coarse interjections, repetitive and antisocial behavior, alterna tion of lack of incitation and agitation; 6) elements of a Balint syndrome (suggestive of a posterior callosal involvement), with a pseudo-hallucinate d look and a gaze apraxia; 7) signs of callosal dysconnection and; signs of adjacent white matter involvement, with paucity of vocal and facial expres sion modulation. Early recognition of these features of callosat dementia m ay be very helpful for diagnosis of suspected myelinolysis, leading to a mo re careful research of clinical signs of callosal dysconnection and prompti ng neuroimaging with MRI. A rapid confirmation of the diagnosis may prevent progression to centro or extrapontine myelinolysis, that may sometimes sti ll be lethal, by adequate supportive measures (slow correction of electroly tes imbalance, correction of deficiencies, total alcohol withdrawal).