Acute Binge Alcohol Consumption Presenting With a Cytotoxic Lesion of the Corpus Callosum (CLOCC) in a Young, Healthy Filipino Male: A Case Report With Features Overlapping the Proposed Marchiafava-Bignami Disease Spectrum

Marchiafava-Bignami disease (MBD) is a rare toxic-metabolic encephalopathy characterized by corpus callosum involvement, classically associated with chronic alcoholism and malnutrition. Cytotoxic lesions of the corpus callosum (CLOCCs) represent a radiologic pattern that may occur in various metabolic, toxic, and infectious conditions and can mimic acute ischemic stroke. We report a 28-year-old previously healthy Filipino male who presented with an acute, remittent, and moderately severe bi-occipital headache following an episode of acute binge alcohol consumption. Systemic and neurological examinations were unremarkable. Cranial magnetic resonance imaging (MRI) revealed diffusion restriction in the splenium of the corpus callosum, initially interpreted as acute ischemic infarction, while magnetic resonance venography was normal. The patient was managed with antiplatelet therapy, citicoline, and analgesics. Extensive diagnostic evaluation, including transesophageal echocardiography, cranial computed tomography angiography, carotid duplex ultrasonography, 24-hour Holter monitoring, and cerebrospinal fluid analysis, yielded unremarkable results. Repeat cranial MRI performed 10 days after discharge demonstrated marked regression of the splenial lesion. The patient remained asymptomatic, with no neurological deficits, and was fully independent in activities of daily living. This case highlights an acute, reversible CLOCC triggered by binge alcohol consumption, presenting as a stroke mimic within the MBD spectrum. Recognition of this entity is essential to avoid misdiagnosis and unnecessary long-term antithrombotic therapy. To our knowledge, this represents the first locally documented case of this presentation in the Philippines.