Marchiafava-Bignami disease (MBD) is a rare disease with only a few reports worldwide. To describe clinical features and identify difficulties in the treatment of alcohol-related MBD, we performed a retrospective study of 21 MBD inpatients at a hospital in Southwest China. The interquartile range (IQR) for age was 53-66, with a mean age of 59 years. The IQR for drinking duration was 30-40, with a mean drinking length of 35.5 years. Cognitive impairment and unconsciousness were the most common symptoms (n=13, [61.9%]). Consciousness disorders, delirium, irritability, and ataxia are more prevalent in type A MBD patients; seizures, cognitive impairment, and limb weakness are more common in type B MBD patients. Routine blood and biochemical tests in alcoholic MBD patients may demonstrate orthocytic hypochromic anaemia and impaired liver function. Patients' uric acid (UA), potassium, and sodium levels may be normal. Eight patients received thiamine, while one received steroids. The average stay was 15 days. At the time of discharge, there had been no deaths. One patient died six months after being discharged, while another died two years afterwards. Indeed, MBD is a rare alcohol-related disorder with a variety of clinical symptoms. With thiamine treatment, prognosis is positive.