X-linked recessive bulbospinal neuronopathy: a report of ten cases

Familial bulbo-spinal muscular atrophy associated with testicular atrophy and sensory neuropathy (Kennedy-Alter-Sung syndrome). Autopsy case report of two brothers

Autopsy cases of two brothers with bulbo-spinal muscular atrophy associated with gynecomastia, testicular atrophy and sensory neuropathy are reported. The disease started with finger tremor, proximal muscle weakness and facial muscle twitching at the second and fourth decades, accompanied by bulbar signs and glove-stocking type sensory disturbance. Systemic neurogenic patterns and diminished sensory nerve action potential amplitudes were recorded by electrophysiological studies. A marked loss of myelinated fibers was noticed upon sural nerve biopsy. Gonadal hormone values were normal, except for elevated urinary estrogen. Postmortem examinations revealed a remarkable degeneration of the facial and hypoglossal nuclei, and the spinal cord motoneurons. The skeletal muscles and the tongue showed neurogenic muscular atrophy with fatty replacement. Testicular atrophy was prominent showing hyalinized seminiferous tubuli with nodular and diffuse Leydig cell hyperplasia, containing estrogen immunoreactive substance. These clinical and histological features seemed to be highly compatible with those of Kennedy-Alter-Sung type bulbo-spinal muscular atrophy. The involvement of sensory peripheral nerves, however, was a distinct feature of this family.

X-linked bulbo-spinal neuronopathy: a family study of three patients

The clinical features of two brothers and one nephew with X-linked recessive bulbo-spinal neuronopathy are described. The neurophysiological investigations and sural nerve biopsy, previously unreported, confirmed that both motor and sensory nerves are affected. Because of the genetic implications, the importance is stressed of recognising this disorder as a separate entity which should not be classified with the spinal muscular atrophies.

X-linked bulbo-spinal neuronopathy of late onset

Two cases of X-linked bulbo-spinal neuronopathy (BSN) of late onset are presented. An extensive review of the literature shows that, in addition to the signs of a chronic degeneration of brainstem and spinal neurons, other clinical features may also be present at the onset of the disease, or develop during its course. Some clinical, electrophysiological and anatomical data support the hypothesis that BSN is not purely a motoneuronopathy but also concerns sensory nerve.

X-linked bulbo-spinal neuronopathy of late onset: sporadic case

We describe a sporadic case of a rare form of X-linked bulbo-spinal neuronopathy (BSN) of late onset. This case emphasizes the importance of recognizing the sporadic cases of this X-recessive disease for genetic counselling.