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Kozić DB, Petrović I, Svetel M, Pekmezović T, Ragaji A, Kostić VS. Reversible lesions in the brain parenchyma in Wilson's disease confirmed by magnetic resonance imaging: earlier administration of chelating therapy can reduce the damage to the brain. Neural Regen Res 2015; 9:1912-6. [PMID: 25558242 PMCID: PMC4281431 DOI: 10.4103/1673-5374.145360] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2014] [Indexed: 12/01/2022] Open
Abstract
The aim of this study was to evaluate the resolution of brain lesions in patients with Wilson's disease during the long-term chelating therapy using magnetic resonance imaging and a possible significance of the time latency between the initial symptoms of the disease and the introduction of this therapy. Initial magnetic resonance examination was performed in 37 patients with proven neurological form of Wilson's disease with cerebellar, parkinsonian and dystonic presentation. Magnetic resonance reexamination was done 5.7 ± 1.3 years later in 14 patients. Patients were divided into: group A, where chelating therapy was initiated < 24 months from the first symptoms and group B, where the therapy started ≥ 24 months after the initial symptoms. Symmetry of the lesions was seen in 100% of patients. There was a significant difference between groups A and B regarding complete resolution of brain stem and putaminal lesions (P = 0.005 and P = 0.024, respectively). If the correct diagnosis and adequate treatment are not established less than 24 months after onset of the symptoms, irreversible lesions in the brain parenchyma could be expected. Signal abnormalities on magnetic resonance imaging might therefore, at least in the early stages, represent reversible myelinolisis or cytotoxic edema associated with copper toxicity.
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Affiliation(s)
- Duško B Kozić
- Diagnostic Imaging Center, Institute of Oncology, School of Medicine, University of Novi Sad, Put Doktora Goldmana 4, 21204 Sremska Kamenica, Serbia
| | - Igor Petrović
- Institute of Neurology Clinical Centre of Serbia, School of Medicine, University of Belgrade, Dr Subotića 6, 11000, Belgrade, Serbia
| | - Marina Svetel
- Institute of Neurology Clinical Centre of Serbia, School of Medicine, University of Belgrade, Dr Subotića 6, 11000, Belgrade, Serbia
| | - Tatjana Pekmezović
- Institute of Epidemiology, School of Medicine, University of Belgrade, Dr Subotića 6, 11000, Belgrade, Serbia
| | - Aleksandar Ragaji
- Diagnostic Imaging Center, Institute of Oncology, School of Medicine, University of Novi Sad, Put Doktora Goldmana 4, 21204 Sremska Kamenica, Serbia
| | - Vladimir S Kostić
- Institute of Neurology Clinical Centre of Serbia, School of Medicine, University of Belgrade, Dr Subotića 6, 11000, Belgrade, Serbia
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Effect of liver transplantation on brain magnetic resonance imaging pathology in Wilson disease: a case report. Neurol Neurochir Pol 2013; 47:393-7. [PMID: 23986430 DOI: 10.5114/ninp.2013.36763] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The authors present a case report of a 28-year-old patient with hepatic, but no neurological, signs of Wilson disease, with pathological changes in both the globi pallidi and caudate found with routine brain magnetic resonance imaging (MRI). The patient was recommended for liver transplantation by hepatologists, and during the two years of observation after liver transplantation, MRI brain abnormalities due to Wilson disease completely regressed. On the basis of this case, the authors present an argument for the prognostic significance of brain MRI in Wilson disease as well as current recommendations concerning liver transplantation in Wilson disease.
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Burgos A, Bermejo PE. [Neurological complications of Wilson's disease]. Med Clin (Barc) 2011; 137:419-23. [PMID: 21596401 DOI: 10.1016/j.medcli.2011.02.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2010] [Revised: 02/20/2011] [Accepted: 02/22/2011] [Indexed: 11/25/2022]
Affiliation(s)
- Aurora Burgos
- Servicio de Aparato Digestivo, Hospital Universitario La Paz, Madrid, España
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Sinha S, Taly AB, Prashanth LK, Ravishankar S, Arunodaya GR, Vasudev MK. Sequential MRI changes in Wilson's disease with de-coppering therapy: a study of 50 patients. Br J Radiol 2007; 80:744-9. [PMID: 17709362 DOI: 10.1259/bjr/48911350] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Wilson's disease (WD) is clinically and radiologically a dynamic disorder. However, there is a paucity of studies involving sequential MRI changes in this disease with or without therapy This study looked at serial MRI changes and their clinical correlate in patients with WD The severity of MRI changes using 1.5 T MRI in 50 patients with WD was graded based on alteration in signal intensity of focal lesions and atrophy. Details of clinical manifestations, Schwab and England Activities of daily living (MSEADL) score, Neurological Symptom Score (NSS) and Chu staging were recorded. Clinical severity and disability scores were correlated with MRI scores using SPSS v10 The mean age at onset of illness and diagnosis was 12.8+/-5.6 years and 14.4+/-6.0 years, respectively. At the time of first MRI, patients had been treated for 49.0+/-77.3 months. At a follow-up of 24.2+/-12.2 months, clinically 36 patients had improved, 9 remained the same and 5 had worsened. Serial imaging revealed an improvement in MRI parameters in 35 patients, no significant changes in 10, worsening in 4 and an admixture of resolving and evolving changes in 1. The overall MRI score improved from 8.2+/-5.7 to 5.9+/-6.6. There was an improvement in measures of disability and impairment in all: Chu stage, 11.5+/-0.7 to 1.3+/-0.6; MSEADL score (%), 79.7+/-27.6 to 88.0+/-25.4; NSS, 10.6+/-11.2 to 8.0+/-11.6, with good clinico-radiological correlation. Patients with extensive changes, white-matter involvement and severe diffuse atrophy had a poor prognosis In conclusion, the majority of patients with WD showed variable improvement in clinical and MRI features when treated.
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Affiliation(s)
- S Sinha
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India.
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Autti T, Joensuu R, Aberg L. Decreased T2 signal in the thalami may be a sign of lysosomal storage disease. Neuroradiology 2007; 49:571-8. [PMID: 17334752 DOI: 10.1007/s00234-007-0220-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2006] [Accepted: 01/23/2007] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Lysosomal disorders are rare and are caused by genetically transmitted lysosomal enzyme deficiencies. A decreased T2 signal in the thalamus has occasionally been reported. AIMS Because the finding of bilateral abnormal signal intensity of the thalamus on T2-weighted images has not been systematically reviewed, and its value as a diagnostic tool critically evaluated, we carried out a systematic review of the literature. METHODS Articles in English with 30 trios of keywords were collected from PubMed. Exclusion criteria were lack of conventional T2-weighted images in the protocol and not being a human study. Finally, 111 articles were included. The thalamus was considered affected only if mentioned in the text or in the figure legends. RESULTS Some 117 patients with various lysosomal diseases and five patients with ceruloplasmin deficiency were reported to have a bilateral decrease in T2 signal intensity. At least one article reported a bilateral decrease in signal intensity of the thalami on T2-weighted images in association with GM1 and GM2 gangliosidosis and with Krabbe's disease, aspartylglucosaminuria, mannosidosis, fucosidosis, and mucolipidosis IV. Furthermore, thalamic alteration was a consistent finding in several types of neuronal ceroid lipofuscinosis (NCL) including CLN1 (infantile NCL), CLN2 (classic late infantile NCL), CLN3 (juvenile NCL), CLN5 (Finnish variant late infantile NCL), and CLN7 (Turkish variant late infantile NCL). CONCLUSION A decrease in T2 signal intensity in the thalami seems to be a sign of lysosomal disease.
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Affiliation(s)
- Taina Autti
- Helsinki Medical Imaging Center, Helsinki University Central Hospital, P.O. Box 340, 00029-HUS, Helsinki, Finland.
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Brami-Zylberberg F, Méary E, Oppenheim C, Gobin-Metteil MP, Delvat D, De Montauzan-Rivière I, Frédy D, Meder JF. Atteintes bilatérales des noyaux gris chez l’adulte. ACTA ACUST UNITED AC 2005; 86:281-93. [PMID: 15908868 DOI: 10.1016/s0221-0363(05)81357-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Several diseases may cause non-specific MR signal abnormalities of the bilateral basal ganglia and thalami. As such, diagnosis of the underlying etiology may be difficult to achieve at imaging. In this review, we will present interpretative guidelines based on clinical data (mode of presentation, previous history, clinical symptoms, and evolution) and imaging data (type of signal abnormalities, location of lesions, and associated abnormalities). The main categories of diseases causing MR signal abnormalities of the bilateral basal ganglia and thalami in adults are reviewed: toxic, metabolic, vascular, tumoral, infectious and inflammatory diseases.
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Affiliation(s)
- F Brami-Zylberberg
- Département d'Imagerie Morphologique et Fonctionnelle, Centre Hospitalier Sainte-Anne, 1 rue Cabanis, 75674 Paris cedex 14.
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Affiliation(s)
- Jonathan D Gitlin
- Edward Mallincroft Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
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Abstract
Six patients having Wilson's disease were studied with diffusion MRI in order to characterize cerebral lesions. Diffusion MRI was obtained using the spin-echo, echo-planar sequence with a gradient strength of 30 mT/m. The trace protocol was used in the axial imaging plane. Heavily diffusion-weighted (b=1000s/mm(2)) images, and the ADC (apparent diffusion coefficient) values from automatically generated ADC maps were studied. The ADC values of the normal brain parenchyma were available in 17 age-matched cases for comparison (ADC values, 0.85+/-0.11 x 10(-3)mm(2)/s). In Wilson's disease two distinct diffusion MRI patterns were observed by quantitative evaluations of the ADC maps; cytotoxic edema-like (ADC values, 0.52+/-0.03 x 10(-3)mm(2)/s), and vasogenic edema-like (ADC values, 1.42+/-0.17 x 10(-3)mm(2)/s) patterns. Diffusion imaging appears to be a promising sequence to evaluate the changes in the brain tissue in Wilson's disease at least by revealing two different patterns.
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Affiliation(s)
- R N Sener
- Department of Radiology, Ege University Hospital, Bornova, Izmir 35100, Turkey.
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Bono W, Moutie O, Benomar A, Aïdi S, el Alaoui-Faris M, Yahyaoui M, Chkili T. [Wilson's disease. Clinical presentation, treatment and evolution in 21 cases]. Rev Med Interne 2002; 23:419-31. [PMID: 12064213 DOI: 10.1016/s0248-8663(02)00589-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE Wilson's disease is characterized by neuropsychiatric symptoms with frequent extrapyramidal and intellectual presentations. They have an insidious evolution that leads to a late diagnosis and less therapeutic effectiveness in the advanced forms. METHODS We report 21 cases of Wilson's disease with neurological complications, emphasizing clinical semiology, diagnostic means and problems of the therapeutics in our country. RESULTS The average age at the beginning of the disease was 17.6 years, with a female prevalence (8/13). The signs at first were mostly all neurological (71.4%), then psychiatric (19%) or hepatic (19%). The most common neurological signs were dystonia of members (81%), dysarthria (76%), tremors (76%) or disorders of motoricity (71.4%). Sometimes there were sialorrhea or disorders of the handwriting. The Kayser-Fleischer ring was present in 19 patients. Eighteen patients had clinical and/or biological hepatic involvement. The diagnosis was confirmed by biochemical examinations, which found a low rate of copper in blood, a sinking rate of ceruloplasmin and a very high rate of urinary copper. The cerebral computer tomography shows a cortical and/or subcortical atrophy (37%), and/or a low density of the central grey cores (35%). The treatment was based on D-penicillamine and/or zinc sulfate, according to the availability of the drugs. The evolution was favourable among 18 patients (85%) and not good in 42.8% of the cases. Six of the first patients had poor evolution after many years of follow-up. Finally, only 12 patients (57%) had a very good outcome. The family investigation made among 17 patients revealed 13 family cases. The only predictive factor of a poor evolution was the therapeutic noncompliance (P = 0.006). CONCLUSIONS The neurological presentations are traditional during the Wilson's disease, but are often ignored. We must suspect the disease in children when faced with disorders of handwriting or school failures and in the adult, when faced with neurological symptoms in a patient having a hepatic disease. We must not hesitate to consider it even given purely psychiatric signs, and we had better know to seek the neurological ones.
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Affiliation(s)
- W Bono
- Service de neurologie, hôpital des spécialités, CHU Ibn Sina, Rabat, Maroc.
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Giagheddu M, Tamburini G, Piga M, Tacconi P, Giagheddu A, Serra A, Siotto P, Satta L, Demelia L, Marrosu F. Comparison of MRI, EEG, EPs and ECD-SPECT in Wilson's disease. Acta Neurol Scand 2001; 103:71-81. [PMID: 11227135 DOI: 10.1034/j.1600-0404.2001.103002071.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The purpose of this study is to evaluate the efficiency of a few methodologies in detecting anatomo-functional brain abnormalities in patients with Wilson's disease. MATERIALS AND METHODS Twenty-three patients with Wilson's disease underwent almost simultaneously brain magnetic resonance imaging (MRI), computerized electroencephalography (EEG), multimodal evoked potentials (EPs) and ECD single photon computerized tomography (SPECT) evaluation. The clinical picture was of the neurologic type in 8 patients and of the hepatic type in 15. RESULTS MRI was abnormal in 7 patients with neurological manifestations. The EPs proved pathologic in 7 neurologically symptomatic patients and in 4 cases with hepatic form. These results agree with those reported in other case studies. The EEG records were abnormal only in 3 cases. Nevertheless, the most interesting finding of this study is the particular frequency (86%) of diffuse or focal decrease of ECD uptake shown by brain SPECT. CONCLUSION We highlight the use of this interesting procedure in the therapeutic monitoring of this disease.
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Affiliation(s)
- M Giagheddu
- Clinica Neurologica, Policlinico Universitario, Universita degli Studi di Cagliari, Italy
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Frucht S, Sun D, Schiff N, Eidelberg D, Gilliam TC. Arm tremor secondary to Wilson's disease. Mov Disord 1998; 13:351-3. [PMID: 9539354 DOI: 10.1002/mds.870130227] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- S Frucht
- Department of Neurology and Neurosciences, New York Hospital/Cornell Medical Center, NY, USA
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