1
|
Cerebellar Ataxia in Children: A Clinical and MRI Approach to the Differential Diagnosis. Top Magn Reson Imaging 2018; 27:275-302. [PMID: 30086112 DOI: 10.1097/rmr.0000000000000175] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
: The cerebellum has long been recognized as a fundamental structure in motor coordination. Structural cerebellar abnormalities and diseases involving the cerebellum are relatively common in children. The not always specific clinical presentation of ataxia, incoordination, and balance impairment can often be a challenge to attain a precise diagnosis. Continuous advances in genetic research and moreover the constant development in neuroimaging modalities, particularly in the field of magnetic resonance imaging, have promoted a better understanding of cerebellar diseases and led to several modifications in their classification in recent years. Thorough clinical and neuroimaging investigation is recommended for proper diagnosis. This review outlines an update of causes of cerebellar disorders that present clinically with ataxia in the pediatric population. These conditions were classified in 2 major groups, namely genetic malformations and acquired or disruptive disorders recognizable by neuroimaging and subsequently according to their features during the prenatal and postnatal periods.
Collapse
|
2
|
Razi SM, Gupta AK, Gupta DC, Gutch M, Gupta KK, Usman SI. Cerebrotendinous xanthomatosis (a rare lipid storage disorder): a case report. J Med Case Rep 2016. [PMID: 27094915 DOI: 10.1186/s13256‐016‐0882‐y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cerebrotendinous xanthomatosis is a very rare autosomal recessive lipid storage disorder affecting bile acid biosynthesis. It is manifested by subtle neurological and non-neurological symptoms due to abnormal tissue lipid deposition. Diagnosis is usually delayed but early diagnosis and replacement therapy can prevent devastating neurological sequelae. CASE PRESENTATION We present a case of a 25-year-old Asian Indian woman who presented with gait difficulty, fusiform swellings of bilateral tendo-Achilles and infrapatellar tendons, along with history of bilateral cataract surgery 1 year earlier. The diagnosis was made on the basis of clinical, biochemical, imaging, and histopathological analysis and replacement therapy was started. CONCLUSIONS The peculiarity of the present case is the absence of any neurological manifestations which are usually the early clues to the diagnosis of cerebrotendinous xanthomatosis. The present case report emphasizes the fact that early age bilateral cataracts along with bilateral tendo-Achilles xanthomas can be early pointers toward the diagnosis of cerebrotendinous xanthomatosis.
Collapse
Affiliation(s)
- Syed Mohd Razi
- Department of Endocrinology, Lala Lajpat Rai Memorial Medical College, Garh Raod, Meerut, 250004, Uttar Pradesh, India.
| | - Abhinav Kumar Gupta
- Department of Endocrinology, Lala Lajpat Rai Memorial Medical College, Garh Raod, Meerut, 250004, Uttar Pradesh, India
| | - Deepak Chand Gupta
- Department of Endocrinology, Lala Lajpat Rai Memorial Medical College, Garh Raod, Meerut, 250004, Uttar Pradesh, India
| | - Manish Gutch
- Department of Endocrinology, Lala Lajpat Rai Memorial Medical College, Garh Raod, Meerut, 250004, Uttar Pradesh, India
| | - Keshav Kumar Gupta
- Department of Endocrinology, Lala Lajpat Rai Memorial Medical College, Garh Raod, Meerut, 250004, Uttar Pradesh, India
| | - Syeda Iqra Usman
- Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, 202002, Uttar Pradesh, India
| |
Collapse
|
3
|
Razi SM, Gupta AK, Gupta DC, Gutch M, Gupta KK, Usman SI. Cerebrotendinous xanthomatosis (a rare lipid storage disorder): a case report. J Med Case Rep 2016; 10:103. [PMID: 27094915 PMCID: PMC4837582 DOI: 10.1186/s13256-016-0882-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 03/22/2016] [Indexed: 01/22/2023] Open
Abstract
Background Cerebrotendinous xanthomatosis is a very rare autosomal recessive lipid storage disorder affecting bile acid biosynthesis. It is manifested by subtle neurological and non-neurological symptoms due to abnormal tissue lipid deposition. Diagnosis is usually delayed but early diagnosis and replacement therapy can prevent devastating neurological sequelae. Case presentation We present a case of a 25-year-old Asian Indian woman who presented with gait difficulty, fusiform swellings of bilateral tendo-Achilles and infrapatellar tendons, along with history of bilateral cataract surgery 1 year earlier. The diagnosis was made on the basis of clinical, biochemical, imaging, and histopathological analysis and replacement therapy was started. Conclusions The peculiarity of the present case is the absence of any neurological manifestations which are usually the early clues to the diagnosis of cerebrotendinous xanthomatosis. The present case report emphasizes the fact that early age bilateral cataracts along with bilateral tendo-Achilles xanthomas can be early pointers toward the diagnosis of cerebrotendinous xanthomatosis.
Collapse
Affiliation(s)
- Syed Mohd Razi
- Department of Endocrinology, Lala Lajpat Rai Memorial Medical College, Garh Raod, Meerut, 250004, Uttar Pradesh, India.
| | - Abhinav Kumar Gupta
- Department of Endocrinology, Lala Lajpat Rai Memorial Medical College, Garh Raod, Meerut, 250004, Uttar Pradesh, India
| | - Deepak Chand Gupta
- Department of Endocrinology, Lala Lajpat Rai Memorial Medical College, Garh Raod, Meerut, 250004, Uttar Pradesh, India
| | - Manish Gutch
- Department of Endocrinology, Lala Lajpat Rai Memorial Medical College, Garh Raod, Meerut, 250004, Uttar Pradesh, India
| | - Keshav Kumar Gupta
- Department of Endocrinology, Lala Lajpat Rai Memorial Medical College, Garh Raod, Meerut, 250004, Uttar Pradesh, India
| | - Syeda Iqra Usman
- Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, 202002, Uttar Pradesh, India
| |
Collapse
|
4
|
Abstract
This is a case of an adult male with history of motor difficulties, speech, and behavioral problems since early childhood found to have progressive spastic paraparesis, impaired vibration and proprioception, and gait instability. His medical history included bilateral cataracts status post surgical removal at the age of 30, cholelithiasis status post cholecystectomy at age 45, and high cholesterol levels.
Collapse
|
5
|
Esmaeeli Nieh S, Madou MRZ, Sirajuddin M, Fregeau B, McKnight D, Lexa K, Strober J, Spaeth C, Hallinan BE, Smaoui N, Pappas JG, Burrow TA, McDonald MT, Latibashvili M, Leshinsky-Silver E, Lev D, Blumkin L, Vale RD, Barkovich AJ, Sherr EH. De novo mutations in KIF1A cause progressive encephalopathy and brain atrophy. Ann Clin Transl Neurol 2015; 2:623-35. [PMID: 26125038 PMCID: PMC4479523 DOI: 10.1002/acn3.198] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 03/04/2015] [Indexed: 12/30/2022] Open
Abstract
Objective To determine the cause and course of a novel syndrome with progressive encephalopathy and brain atrophy in children. Methods Clinical whole-exome sequencing was performed for global developmental delay and intellectual disability; some patients also had spastic paraparesis and evidence of clinical regression. Six patients were identified with de novo missense mutations in the kinesin gene KIF1A. The predicted functional disruption of these mutations was assessed in silico to compare the calculated conformational flexibility and estimated efficiency of ATP binding to kinesin motor domains of wild-type (WT) versus mutant alleles. Additionally, an in vitro microtubule gliding assay was performed to assess the effects of de novo dominant, inherited recessive, and polymorphic variants on KIF1A motor function. Results All six subjects had severe developmental delay, hypotonia, and varying degrees of hyperreflexia and spastic paraparesis. Microcephaly, cortical visual impairment, optic neuropathy, peripheral neuropathy, ataxia, epilepsy, and movement disorders were also observed. All six patients had a degenerative neurologic course with progressive cerebral and cerebellar atrophy seen on sequential magnetic resonance imaging scans. Computational modeling of mutant protein structures when compared to WT kinesin showed substantial differences in conformational flexibility and ATP-binding efficiency. The de novo KIF1A mutants were nonmotile in the microtubule gliding assay. Interpretation De novo mutations in KIF1A cause a degenerative neurologic syndrome with brain atrophy. Computational and in vitro assays differentiate the severity of dominant de novo heterozygous versus inherited recessive KIF1A mutations. The profound effect de novo mutations have on axonal transport is likely related to the cause of progressive neurologic impairment in these patients.
Collapse
Affiliation(s)
- Sahar Esmaeeli Nieh
- Department of Neurology, University of California San Francisco, California, 94158
| | - Maura R Z Madou
- Department of Neurology, University of California San Francisco, California, 94158
| | - Minhajuddin Sirajuddin
- Department of Cellular and Molecular Pharmacology and the Howard Hughes Medical Institute, University of California San Francisco, California ; Cardiovascular Biology and Diseases, Institute of Stem Cell Biology and Regenerative Medicine, NCBS-TIFR Bangalore, India
| | - Brieana Fregeau
- Department of Neurology, University of California San Francisco, California, 94158
| | | | - Katrina Lexa
- Department of Pharmaceutical Chemistry, University of California San Francisco San Francisco, California
| | - Jonathan Strober
- Department of Neurology, University of California San Francisco, California, 94158
| | - Christine Spaeth
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center Cincinnati, Ohio
| | - Barbara E Hallinan
- Division of Neurology, Cincinnati Children's Hospital Medical Center Cincinnati, Ohio
| | | | - John G Pappas
- Department of Pediatrics, Clinical Genetic Services, NYU School of Medicine New York, New York
| | - Thomas A Burrow
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center Cincinnati, Ohio ; Department of pediatrics, University of Cincinnati School of Medicine Cincinnati, Ohio
| | - Marie T McDonald
- Section of Medical Genetics, Department of Pediatrics, Duke University Durham, North Carolina
| | - Mariam Latibashvili
- Department of Neurology, University of California San Francisco, California, 94158 ; University of California San Diego, California
| | - Esther Leshinsky-Silver
- Molecular Genetics Laboratory, and Metabolic-Neurogenetic Service, Wolfson Medical Center and Sackler Medical School, Tel Aviv University Tel Aviv, Israel
| | - Dorit Lev
- Institute of Medical Genetics and Metabolic Neurogenetic Service, Wolfson Medical Center and Sackler Medical School, Tel Aviv University Tel Aviv, Israel
| | - Luba Blumkin
- Pediatric Neurology Unit and Metabolic Neurogenetic Service, Wolfson Medical Center, Holon and Sackler Medical School, Tel Aviv University Tel Aviv, Israel
| | - Ronald D Vale
- Department of Cellular and Molecular Pharmacology and the Howard Hughes Medical Institute, University of California San Francisco, California
| | - Anthony James Barkovich
- Department of Radiology and Biomedical Imaging, University of California San Francisco, California
| | - Elliott H Sherr
- Department of Neurology, University of California San Francisco, California, 94158
| |
Collapse
|
6
|
Ezgu F, Krejci P, Li S, de Sousa C, Graham JM, Hansmann I, He W, Porpora K, Wand D, Wertelecki W, Schneider A, Wilcox WR. Phenotype-genotype correlations in patients with Marinesco-Sjögren syndrome. Clin Genet 2013; 86:74-84. [PMID: 23829326 DOI: 10.1111/cge.12230] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Revised: 07/02/2013] [Accepted: 07/02/2013] [Indexed: 12/17/2022]
Abstract
Marinesco-Sjögren syndrome (MSS; MIM 248800) is an autosomal recessive disorder characterized by congenital cerebellar ataxia, early cataracts, developmental delay, myopathy and short stature. Alterations in the gene SIL1 cause MSS in some patients with typical findings. In this study, molecular investigations including sequencing of the SIL1 gene, western blotting and microscopic investigations in fibroblast cultures were carried out in a cohort of 15 patients from 14 unrelated families, including the large, inbred family reported by Superneau et al., having the clinical features of MSS to provide insights into the pathophysiology of the disorder. A total of seven different mutations were found in eight of the patients from seven families. The mutations caused loss of the BIP-associated protein (BAP) protein in four patients by western blot. Novel clinical features such as dental abnormalities, iris coloboma, eczema and hormonal abnormalities were noticed in some patients, but there was no clear way to distinguish those with and without SIL1 mutations. Cultured fibroblasts contained numerous cytoplasmic inclusion bodies, similar to those identified in the brain of the whoozy mouse in five unrelated patients, three with and two without SIL1 mutations, suggesting some SIL1 negative patients share a common cellular pathogenesis with those who are SIL1 positive.
Collapse
Affiliation(s)
- F Ezgu
- Medical Genetics Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Pediatric Metabolic Disorders and Pediatric Genetics, Gazi University Faculty of Medicine, Ankara, Turkey
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Horvers M, Anttonen AK, Lehesjoki AE, Morava E, Wortmann S, Vermeer S, van de Warrenburg BP, Willemsen MA. Marinesco-Sjögren syndrome due to SIL1 mutations with a comment on the clinical phenotype. Eur J Paediatr Neurol 2013; 17:199-203. [PMID: 23062754 DOI: 10.1016/j.ejpn.2012.09.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 09/07/2012] [Accepted: 09/15/2012] [Indexed: 12/21/2022]
Abstract
BACKGROUND Marinesco-Sjögren syndrome is an autosomal recessive cerebellar ataxia, characterised by cerebellar ataxia, myopathy, cataracts and intellectual disability, due to mutations in the SIL1 gene. METHODS The clinical features and two novel SIL1 mutations of four Dutch patients with Marinesco-Sjögren syndrome are described and compared to the literature on genetically proven Marinesco-Sjögren patients. RESULTS The core phenotype of this syndrome appears homogeneous, but: [1] cataract can develop later than the motor and cognitive signs; [2] myopathy is an early feature that seems progressive during the course of the disease; [3] serum creatine kinase is normal or only mildly elevated; [4] peripheral neuropathy is absent; and [5] a variable degree of intellectual disability is present in most Marinesco-Sjögren patients. CONCLUSIONS Because the late appearance of some hallmarks and the uncertainty as to whether incomplete phenotypes occur, SIL1 mutation analysis is helpful early in the diagnostic work-up of children with suspected inherited ataxias.
Collapse
Affiliation(s)
- M Horvers
- Department of Paediatric Neurology, Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, PO Box 9101, 6500HB Nijmegen, The Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
8
|
Orcesi S, Tonduti D, Uggetti C, Larizza D, Fazzi E, Balottin U. New case of 4H syndrome and a review of the literature. Pediatr Neurol 2010; 42:359-64. [PMID: 20399393 DOI: 10.1016/j.pediatrneurol.2010.01.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Revised: 10/02/2009] [Accepted: 01/25/2010] [Indexed: 10/19/2022]
Abstract
Different pathologic processes (especially demyelination, hypomyelination, and combinations of these) may underlie leukoencephalopathies. Leukoencephalopathies pose a particular diagnostic problem when they occur in children. To seek associated, non-neurologic signs is of fundamental importance in hypomyelinating leukoencephalopathies, because these can help clarify the diagnostic picture. Two new types of leukoencephalopathy have emerged, one classified as ataxia, delayed dentition, and hypomyelination, and the other as hypomyelination with hypogonadotropic hypogonadism and hypodontia. Initially described as distinct entities, they were recently brought together in the Online Mendelian Inheritance in Man database under a single code. However, the literature describes only two patients with the characteristics of both these clinical pictures. We present the extended clinical and neuroradiologic follow-up of a patient with ataxia, delayed dentition, and hypomyelination, as well as hypogonadotropic hypogonadism. This patient reinforces the idea that the two syndromes should actually be considered the same disorder, and prompted us to conduct a critical review of the literature on disorders in which hypomyelinating leukoencephalopathy is associated with cerebellar atrophy or hypogonadism.
Collapse
Affiliation(s)
- Simona Orcesi
- Department of Child Neurology and Psychiatry, IRCCS C. Mondino Institute of Neurology Foundation, 27100 Pavia, Italy.
| | | | | | | | | | | |
Collapse
|
9
|
Eriguchi M, Mizuta H, Kurohara K, Fujitake J, Kuroda Y. Identification of a new homozygous frameshift insertion mutation in the SIL1 gene in 3 Japanese patients with Marinesco–Sjögren syndrome. J Neurol Sci 2008; 270:197-200. [DOI: 10.1016/j.jns.2008.02.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2007] [Revised: 02/05/2008] [Accepted: 02/07/2008] [Indexed: 10/22/2022]
|
10
|
Sakai K, Tada M, Yonemochi Y, Nakajima T, Onodera O, Takahashi H, Kakita A. Marinesco-Sjögren syndrome with atrophy of the brain stem tegmentum and dysplastic cytoarchitecture in the cerebral cortex. Neuropathology 2008; 28:541-6. [PMID: 18410272 DOI: 10.1111/j.1440-1789.2008.00884.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Marinesco-Sjögren syndrome (MSS) is a progressive multisystem disease with autosomal recessive inheritance characterized by cataracts, mental retardation, and cerebellar ataxia. Recently, two causative genes for MSS, SIL1 and SARA2, have been identified. On the other hand, the histopathologic features of the CNS in this syndrome have not yet been clarified in detail. We report here the features of an autopsy case of MSS with progressive myopathy, in which atrophy of the cerebellum and brain stem tegmentum, retinal degeneration, and dysplastic cytoarchitecture in the cerebral cortex were evident. An elder brother of the patient showed quite similar symptoms, implying an autosomal recessive mode of inheritance. However, we detected no mutations in the available genes. This case appears to represent an unusual example of MSS manifesting widespread developmental anomaly and neuronal degeneration in the CNS.
Collapse
Affiliation(s)
- Kenji Sakai
- Department of Pathology, Brain Research Institute, University of Niigata, Niigata, Japan.
| | | | | | | | | | | | | |
Collapse
|
11
|
Review of cases presenting with microcephaly and bilateral congenital cataract in a paediatric cataract clinic. Eye (Lond) 2007; 22:273-81. [DOI: 10.1038/sj.eye.6702958] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
|
12
|
Fogel BL, Perlman S. Clinical features and molecular genetics of autosomal recessive cerebellar ataxias. Lancet Neurol 2007; 6:245-57. [PMID: 17303531 DOI: 10.1016/s1474-4422(07)70054-6] [Citation(s) in RCA: 178] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Among the hereditary ataxias, autosomal recessive spinocerebellar ataxias comprise a diverse group of neurodegenerative disorders. Clinical phenotypes vary from predominantly cerebellar syndromes to sensorimotor neuropathy, ophthalmological disturbances, involuntary movements, seizures, cognitive dysfunction, skeletal anomalies, and cutaneous disorders, among others. Molecular pathogenesis also ranges from disorders of mitochondrial or cellular metabolism to impairments of DNA repair or RNA processing functions. Diagnosis can be improved by a systematic approach to the categorisation of these disorders, which is used to direct further, more specific, biochemical and genetic investigations. In this Review, we discuss the clinical characteristics and molecular genetics of the more common autosomal recessive ataxias and provide a framework for assessment and differential diagnosis of patients with these disorders.
Collapse
Affiliation(s)
- Brent L Fogel
- Department of Neurology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, 90095, USA
| | | |
Collapse
|
13
|
Mahjneh I, Anttonen AK, Somer M, Paetau A, Lehesjoki AE, Somer H, Udd B. Myopathy is a prominent feature in Marinesco-Sjögren syndrome: A muscle computed tomography study. J Neurol 2005; 253:301-6. [PMID: 16151599 DOI: 10.1007/s00415-005-0983-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2005] [Revised: 06/19/2005] [Accepted: 07/05/2005] [Indexed: 12/15/2022]
Abstract
BACKGROUND Marinesco-Sjögren syndrome (MSS) is an autosomal recessive multiorgan disorder showing clinical and genetic heterogeneity. The key features of MSS include cerebellar ataxia, early bilateral cataracts, delayed motor development, and varying degrees of mental retardation. Patients with a subtype of MSS with myoglobinuria and neuropathy have been linked to chromosome 18qter, and recently a locus for classical MSS has been localized on chromosome 5q31. OBJECTIVES To determine the importance of myopathy in this disorder apart from the CNS based disability and to establish the pattern of muscle involvement and degree of its severity. METHODS Muscle computed tomography (CT) investigations were carried out in nine Finnish MSS patients homozygous for markers around the MSS locus on chromosome 5q31. RESULTS Patients with severe clinical disability showed severe and generalized muscle degeneration. Muscle CT findings in patients with relatively severe clinical picture were characterized by severe involvement of the posterior thoracic and pelvic muscles, and almost all thigh muscles. In the legs the peronei and posterior compartment muscles were severely degenerated. The group of patients with moderate severity of disease showed the same pattern of involved muscle, albeit with lower degree of muscle degeneration. CONCLUSIONS Patients with MSS linked to chromosome 5q31 have a severe progressive myopathy, the extent of which may remain largely unrecognized because of the CNS involvement.
Collapse
Affiliation(s)
- Ibrahim Mahjneh
- Dept. of Neurology, Pietasaari Hospital PL 23, 68601 Pietasaari, Finland.
| | | | | | | | | | | | | |
Collapse
|