1
|
Scaravilli A, Tranfa M, Pontillo G, Brais B, De Michele G, La Piana R, Saccà F, Santorelli FM, Synofzik M, Brunetti A, Cocozza S. A Review of Brain and Pituitary Gland MRI Findings in Patients with Ataxia and Hypogonadism. CEREBELLUM (LONDON, ENGLAND) 2024; 23:757-774. [PMID: 37155088 DOI: 10.1007/s12311-023-01562-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 05/10/2023]
Abstract
The association of cerebellar ataxia and hypogonadism occurs in a heterogeneous group of disorders, caused by different genetic mutations often associated with a recessive inheritance. In these patients, magnetic resonance imaging (MRI) plays a pivotal role in the diagnostic workflow, with a variable involvement of the cerebellar cortex, alone or in combination with other brain structures. Neuroimaging involvement of the pituitary gland is also variable. Here, we provide an overview of the main clinical and conventional brain and pituitary gland MRI imaging findings of the most common genetic mutations associated with the clinical phenotype of ataxia and hypogonadism, with the aim of helping neuroradiologists in the identification of these disorders.
Collapse
Affiliation(s)
- Alessandra Scaravilli
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini 5, 80131, Naples, Italy
| | - Mario Tranfa
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini 5, 80131, Naples, Italy
| | - Giuseppe Pontillo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini 5, 80131, Naples, Italy
- Department of Electrical Engineering and Information Technology (DIETI), University of Naples "Federico II", Naples, Italy
| | - Bernard Brais
- Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, Montreal, Canada
| | - Giovanna De Michele
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Roberta La Piana
- Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, Montreal, Canada
| | - Francesco Saccà
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | | | - Matthis Synofzik
- German Center for Neurodegenerative Diseases (DZNE), Tubingen, Germany
- Division Translational Genomics of Neurodegenerative Diseases, Center for Neurology and Hertie Institute for Clinical Brain Research, University of Tübingen, Otfried-Müller-Strasse 27, 72076, Tubingen, Germany
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini 5, 80131, Naples, Italy
| | - Sirio Cocozza
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini 5, 80131, Naples, Italy.
| |
Collapse
|
2
|
Lyon E, Temple-Smolkin RL, Hegde M, Gastier-Foster JM, Palomaki GE, Richards CS. An Educational Assessment of Evidence Used for Variant Classification: A Report of the Association for Molecular Pathology. J Mol Diagn 2022; 24:555-565. [PMID: 35429647 DOI: 10.1016/j.jmoldx.2021.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/12/2021] [Accepted: 12/10/2021] [Indexed: 11/25/2022] Open
Abstract
The Association for Molecular Pathology Variant Interpretation Testing Among Laboratories (VITAL) Working Group convened to evaluate the Standards and Guidelines for the Interpretation of Sequence Variants implementation into clinical practice, identify problematic classification rules, and define implementation challenges. Variants and associated clinical information were provided to volunteer respondents. Participant variant classifications were compared with intended consensus-derived classifications of the Working Group. The 24 variant challenges received 1379 responses; 1119 agreed with the intended response (81%; 95% CI, 79% to 83%). Agreement ranged from 44% to 100%, with 16 challenges (67%; 47% to 82%) reaching consensus (≥80% agreement). Participant classifications were also compared to a calculated interpretation of the ACMG Guidelines using the participant-reported criteria as input. The 24 variant challenges had 1368 responses with specific evidence provided and 1121 (82%; 80% to 84%) agreed with the calculated interpretation. Agreement for challenges ranged from 63% to 98%; 15 (63%; 43% to 79%) reaching consensus. Among 81 individual participants, 32 (40%; 30% to 50%) reached agreement with at least 80% of the intended classifications and 42 (52%; 41% to 62%) with the calculated classifications. This study demonstrated that although variant classification remains challenging, published guidelines are being utilized and adapted to improve variant calling consensus. This study identified situations where clarifications are warranted and provides a model for competency assessment.
Collapse
Affiliation(s)
- Elaine Lyon
- The Variant Interpretation Testing Among Laboratories (VITAL) Working Group of the Clinical Practice Committee, Association for Molecular Pathology (AMP), Rockville, Maryland; HudsonAlpha Institute for Biotechnology, Huntsville, Alabama
| | | | - Madhuri Hegde
- The Variant Interpretation Testing Among Laboratories (VITAL) Working Group of the Clinical Practice Committee, Association for Molecular Pathology (AMP), Rockville, Maryland; Global Genetics Laboratory, PerkinElmer Genomics, Pittsburgh, Pennsylvania
| | - Julie M Gastier-Foster
- The Variant Interpretation Testing Among Laboratories (VITAL) Working Group of the Clinical Practice Committee, Association for Molecular Pathology (AMP), Rockville, Maryland; Departments of Pediatrics and Pathology/Immunology, Baylor College of Medicine, Houston, Texas; Pathology Department, Texas Children's Hospital, Houston, Texas; Department of Pathology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Glenn E Palomaki
- The Variant Interpretation Testing Among Laboratories (VITAL) Working Group of the Clinical Practice Committee, Association for Molecular Pathology (AMP), Rockville, Maryland; Department of Pathology and Laboratory Medicine, Women & Infants Hospital and the Alpert Medical School at Brown University, Providence, Rhode Island
| | - C Sue Richards
- The Variant Interpretation Testing Among Laboratories (VITAL) Working Group of the Clinical Practice Committee, Association for Molecular Pathology (AMP), Rockville, Maryland; Department of Molecular and Medical Genetics and Knight Diagnostic Laboratories, Oregon Health & Science University, Portland, Oregon.
| |
Collapse
|
3
|
Alves CAPF, Goldstein A, Teixeira SR, Martin-Saavedra JS, de Barcelos IP, Fadda G, Caschera L, Kidd M, Gonçalves FG, McCormick EM, Falk MJ, Zolkipli-Cunningham Z, Vossough A, Zuccoli G. Involvement of the Spinal Cord in Primary Mitochondrial Disorders: A Neuroimaging Mimicker of Inflammation and Ischemia in Children. AJNR Am J Neuroradiol 2021; 42:389-396. [PMID: 33384291 PMCID: PMC7872189 DOI: 10.3174/ajnr.a6910] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 09/25/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND PURPOSE Little is known about imaging features of spinal cord lesions in mitochondrial disorders. The aim of this research was to assess the frequency, imaging features, and pathogenic variants causing primary mitochondrial disease in children with spinal cord lesions. MATERIALS AND METHODS This retrospective analysis included patients seen at Children's Hospital of Philadelphia between 2000 and 2019 who had a confirmed diagnosis of a primary (genetic-based) mitochondrial disease and available MR imaging of the spine. The MR imaging included at least both sagittal and axial fast spin-echo T2-weighted images. Spine images were independently reviewed by 2 neuroradiologists. Location and imaging features of spinal cord lesions were correlated and tested using the Fisher exact test. RESULTS Of 119 children with primary mitochondrial disease in whom MR imaging was available, only 33 of 119 (28%) had available spine imaging for reanalysis. Nineteen of these 33 individuals (58%) had evidence of spinal cord lesions. Two main patterns of spinal cord lesions were identified: group A (12/19; 63%) had white ± gray matter involvement, and group B (7/19; 37%) had isolated gray matter involvement. Group A spinal cord lesions were similar to those seen in patients with neuromyelitis optica spectrum disorder, multiple sclerosis, anti-myelin oligodendrocyte glycoprotein-IgG antibody disease, and leukoencephalopathy with brain stem and spinal cord involvement and lactate elevation. Group B patients had spinal cord findings similar to those that occur with ischemia and viral infections. Significant associations were seen between the pattern of lesions (group A versus group B) and the location of lesions in cervical versus thoracolumbar segments, respectively (P < .01). CONCLUSIONS Spinal cord lesions are frequently observed in children with primary mitochondrial disease and may mimic more common causes such as demyelination and ischemia.
Collapse
Affiliation(s)
- C A P F Alves
- From the Division of Neuroradiology, Department of Radiology (C.A.P.F.A., S.R.T., J.S.M.S., L.C., F.G.G., A.V., G.Z.)
| | - A Goldstein
- Division of Human Genetics, Department of Pediatrics (A.G., E.M.M., M.J.F., Z.Z.-C.), Mitochondrial Medicine Frontier Program
- Pediatrics (A.G., M.J.F., Z.Z.-C.) University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - S R Teixeira
- From the Division of Neuroradiology, Department of Radiology (C.A.P.F.A., S.R.T., J.S.M.S., L.C., F.G.G., A.V., G.Z.)
| | - J S Martin-Saavedra
- From the Division of Neuroradiology, Department of Radiology (C.A.P.F.A., S.R.T., J.S.M.S., L.C., F.G.G., A.V., G.Z.)
| | - I P de Barcelos
- Division of Human Genetics (I. P.d.B.), Department of Pediatrics, Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - G Fadda
- Departments of Neurology (G.F.)
| | - L Caschera
- From the Division of Neuroradiology, Department of Radiology (C.A.P.F.A., S.R.T., J.S.M.S., L.C., F.G.G., A.V., G.Z.)
- Neuroradiology Unit (L.C.), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, Milan, Italy
| | - M Kidd
- Centre for Statistical Consultation (M.K.), University of Stellenbosch, South Africa
| | - F G Gonçalves
- From the Division of Neuroradiology, Department of Radiology (C.A.P.F.A., S.R.T., J.S.M.S., L.C., F.G.G., A.V., G.Z.)
| | - E M McCormick
- Division of Human Genetics, Department of Pediatrics (A.G., E.M.M., M.J.F., Z.Z.-C.), Mitochondrial Medicine Frontier Program
| | - M J Falk
- Division of Human Genetics, Department of Pediatrics (A.G., E.M.M., M.J.F., Z.Z.-C.), Mitochondrial Medicine Frontier Program
- Pediatrics (A.G., M.J.F., Z.Z.-C.) University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Z Zolkipli-Cunningham
- Division of Human Genetics, Department of Pediatrics (A.G., E.M.M., M.J.F., Z.Z.-C.), Mitochondrial Medicine Frontier Program
- Pediatrics (A.G., M.J.F., Z.Z.-C.) University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - A Vossough
- From the Division of Neuroradiology, Department of Radiology (C.A.P.F.A., S.R.T., J.S.M.S., L.C., F.G.G., A.V., G.Z.)
| | - G Zuccoli
- From the Division of Neuroradiology, Department of Radiology (C.A.P.F.A., S.R.T., J.S.M.S., L.C., F.G.G., A.V., G.Z.)
- The Program for the Study of Neurodevelopment in Rare Disorders (G.Z.), Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| |
Collapse
|
4
|
Finsterer J. Double Trouble from
POLG1
and
CLCN1
Variants with Intrafamilial Phenotypic Heterogeneity. Mov Disord Clin Pract 2020; 7:575-576. [DOI: 10.1002/mdc3.12962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 02/19/2020] [Indexed: 11/09/2022] Open
|
5
|
Finsterer J. POLG1-related phenotypes are heterogeneous and progressive due to secondary mtDNA maintenance defects. Int J Neurosci 2020; 130:1282-1283. [PMID: 32065548 DOI: 10.1080/00207454.2020.1731506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Josef Finsterer
- Krankenanstalt Rudolfstiftung, Messerli Institute, Vienna, Austria
| |
Collapse
|
6
|
Tabarki B, Hakami W, Alkhuraish N, Tlili-Graies K, Alfadhel M. Spinal Cord Involvement in Pediatric-Onset Metabolic Disorders With Mendelian and Mitochondrial Inheritance. Front Pediatr 2020; 8:599861. [PMID: 33520891 PMCID: PMC7841137 DOI: 10.3389/fped.2020.599861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/24/2020] [Indexed: 01/31/2023] Open
Abstract
Previous reviews have described the features of brain involvement in pediatric-onset metabolic disorders with Mendelian and mitochondrial inheritance, but only a few have focused on spinal cord abnormalities. An increasing number of metabolic disorders with Mendelian and mitochondrial inheritance in children with predominant spinal cord involvement has been recognized. Spinal cord involvement may be isolated or may occur more frequently with brain involvement. Timely diagnosis and occasional genetic counseling are needed for timely therapy. Therefore, clinicians must be aware of the clinical, laboratory, and radiographic features of these disorders. In this review, we describe pediatric-onset metabolic disorders with Mendelian and mitochondrial inheritance and predominant spinal cord involvement. Furthermore, we provide an overview of these conditions, including background information and examples that require rapid identification, focusing on treatable conditions; that would be catastrophic if they are not recognized.
Collapse
Affiliation(s)
- Brahim Tabarki
- Division of Pediatric Neurology, Department of Pediatrics, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Wejdan Hakami
- Division of Pediatric Neurology, Department of Pediatrics, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Nader Alkhuraish
- Division of Neuroradiology, Department of Radiology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Kalthoum Tlili-Graies
- Division of Neuroradiology, Department of Radiology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Majid Alfadhel
- Medical Genomics Research Department, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.,Genetics and Precision Medicine Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, King Abdullah Specialist Children's Hospital, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| |
Collapse
|
7
|
Finsterer J, Zarrouk-Mahjoub S. Involvement of the Spinal Cord in Mitochondrial Disorders. J Neurosci Rural Pract 2019; 9:245-251. [PMID: 29725177 PMCID: PMC5912032 DOI: 10.4103/jnrp.jnrp_446_17] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
This review aims at summarising and discussing the current status concerning the clinical presentation, pathogenesis, diagnosis, and treatment of spinal cord affection in mitochondrial disorders (MIDs). A literature search using the database Pubmed was carried out by application of appropriate search terms and their combinations. Involvement of the spinal cord in MIDs is more frequent than anticipated. It occurs in specific and non-specific MIDs. Among the specific MIDs it has been most frequently described in LBSL, LS, MERRF, KSS, IOSCA, MIRAS, and PCH and only rarely in MELAS, CPEO, and LHON. Clinically, spinal cord involvement manifests as monoparesis, paraparesis, quadruparesis, sensory disturbances, hypotonia, spasticity, urinary or defecation dysfunction, spinal column deformities, or as transverse syndrome. Diagnosing spinal cord involvement in MIDs requires a thoroughly taken history, clinical exam, and imaging studies. Additionally, transcranial magnetic stimulation, somato-sensory-evoked potentials, and cerebro-spinal fluid can be supportive. Treatment is generally not at variance compared to the underlying MID but occasionally surgical stabilisation of the spinal column may be necessary. It is concluded that spinal cord involvement in MIDs is more frequent than anticipated but may be missed if cerebral manifestations prevail. Spinal cord involvement in MIDs may strongly determine the mobility of these patients.
Collapse
Affiliation(s)
- Josef Finsterer
- Department of Neurology, Krankenanstalt Rudolfstiftung, Vienna, Austria
| | - Sinda Zarrouk-Mahjoub
- Pasteur Institute of Tunis, University of Tunis El Manar and Genomics Platform, Pasteur Institute of Tunis, Tunis, Tunisia
| |
Collapse
|
8
|
Finsterer J, Zarrouk-Mahjoub S. Mitochondrial multiorgan disorder syndrome score generated from definite mitochondrial disorders. Neuropsychiatr Dis Treat 2017; 13:2569-2579. [PMID: 29062232 PMCID: PMC5638572 DOI: 10.2147/ndt.s149067] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Mitochondrial disorders (MIDs) frequently present as mitochondrial multiorgan disorder syndrome (MIMODS) at onset or evolve into MIMODS during the course. This study aimed to find which organs and/or tissues are most frequently affected by MIMODS, which are the most frequent abnormalities within an affected organ, whether there are typical MIMODS patterns, and to generate an MIMODS score to assess the diagnostic probability for an MID. METHODS This is a retrospective evaluation of clinical, biochemical, and genetic investigations of adult patients with definite MIDs. A total of 36 definite MID patients, 19 men and 17 women, aged 29-82 years were included in this study. The diagnosis was based on genetic testing (n=21), on biochemical investigations (n=17), or on both (n=2). RESULTS The number of organs most frequently affected was 4 ranging from 1 to 9. MIMODS was diagnosed in 97% of patients. The organs most frequently affected were the muscle (97%), central nervous system (CNS; 72%), endocrine glands (69%), heart (58%), intestines (55%), and peripheral nerves (50%). The most frequent CNS abnormalities were leukoencephalopathy, prolonged visually evoked potentials, and atrophy. The most frequent endocrine abnormalities included thyroid dysfunction, short stature, and diabetes. The most frequent cardiac abnormalities included arrhythmias, systolic dysfunction, and hypertrophic cardiomyopathy. The most frequent MIMODS patterns were encephalomyopathy, encephalo-myo-endocrinopathy, and encepalo-myo-endocrino-cardiopathy. The mean ± 2SD MIMODS score was 35.97±27.6 (range =11-71). An MIMODS score >10 was regarded as indicative of an MID. CONCLUSION Adult MIDs manifest as MIMODS in the vast majority of the cases. The organs most frequently affected in MIMODS are muscles, CNS, endocrine glands, and heart. An MIMODS score >10 suggests an MID.
Collapse
|