1
|
Bonkowsky JL, Healey B, Sacks NC, McLin R, Cyr PL, Sawyer EK, Stephen CD, Eichler F. Burden of illness and mortality in men with Adrenomyeloneuropathy: a retrospective cohort study. Orphanet J Rare Dis 2024; 19:270. [PMID: 39020416 PMCID: PMC11253437 DOI: 10.1186/s13023-024-03276-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 07/01/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND Adrenomyeloneuropathy (AMN) is a neurodegenerative disease phenotype of X-linked adrenoleukodystrophy (ALD), resulting in progressive myeloneuropathy causing spastic paraparesis, sensory ataxia, and bowel/bladder symptoms. We conducted a retrospective cohort study using two large administrative databases to characterize mortality and the burden of illness in adult men with AMN in the US. RESULTS Healthcare resource use was assessed using a national commercial insurance claims database (2006-2021). Males with AMN ages 18-64 years and no evidence of cerebral ALD or other peroxisomal disorders were included and 1:4 matched on demographic characteristics to individuals without AMN. All study participants were followed for as long as observable. Patients with AMN were also identified in the Medicare Limited Dataset (2017-2022); mortality and age at death were compared with all Medicare enrollees. We identified 303 commercially insured men with AMN. Compared with non-AMN, individuals with AMN had significantly more inpatient hospital admissions (0.44 vs. 0.04 admissions/patient/year), outpatient clinic (8.88 vs. 4.1 visits/patient/year), outpatient hospital (5.33 vs. 0.99 visits/patient/year), and home healthcare visits (4.66 vs. 0.2 visits/patient/year), durable medical equipment claims (0.7 vs. 0.1 claims/patient/year), and prescription medication fills (18.1 vs. 5.4 fills/patient/year) (all p < 0.001). Average length-of-stay per hospitalization was also longer in AMN (8.88 vs. 4.3 days; p < 0.001). Rates of comorbidities were significantly more common in AMN compared to controls, including peripheral vascular disease (4.6% vs. 0.99%), chronic pulmonary disease (6.3% vs. 2.6%), and liver disease (5.6% vs. 0.88%), all p < 0.001. Among individuals age < 65 with Medicare disability coverage, mortality rates were 5.3x higher for adult AMN males (39.3% vs. 7.4%) and the age at death significantly younger (47.0 ± 11.3 vs. 56.5 ± 7.8 years), both p < 0.001. Among Medicare beneficiaries ages ≥ 65 mortality rates were 2.2x higher for men with AMN vs. those without AMN (48.6% vs. 22.4%), p < 0.001. CONCLUSION AMN imposes a substantial and underrecognized health burden on men, with higher healthcare utilization, greater medical comorbidity, higher mortality rates, and younger age at death.
Collapse
Affiliation(s)
- Joshua L Bonkowsky
- Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, UT, USA
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Bridget Healey
- PRECISION AQ, 133 Federal St.,10th Floor, Boston, MA, 02110, USA
- Ontada, Boston, MA, USA
| | - Naomi C Sacks
- PRECISION AQ, 133 Federal St.,10th Floor, Boston, MA, 02110, USA
- HEORStrategies, A Division of ToxStrategies Inc, Boston, MA, USA
| | - Ronaé McLin
- PRECISION AQ, 133 Federal St.,10th Floor, Boston, MA, 02110, USA
| | - Philip L Cyr
- PRECISION AQ, 133 Federal St.,10th Floor, Boston, MA, 02110, USA.
| | | | - Christopher D Stephen
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Florian Eichler
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
2
|
Armangue T, Whitehead MT, Tonduti D, Farina L, Tavasoli AR, Vossough A, Bennett ML, Vaia Y, Bernard G, Salsano E, Mercimek-Andrews S, Waldman A, Vanderver A. Brainstem Chipmunk Sign: A Diagnostic Imaging Clue across All Subtypes of Alexander Disease. AJNR Am J Neuroradiol 2024; 45:769-772. [PMID: 38697787 PMCID: PMC11288593 DOI: 10.3174/ajnr.a8220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/01/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND AND PURPOSE While classic brain MR imaging features of Alexander disease have been well-documented, lesional patterns can overlap with other leukodystrophies, especially in the early stages of the disease or in milder phenotypes. We aimed to assess the utility of a new neuroimaging sign to help increase the diagnostic specificity of Alexander disease. MATERIALS AND METHODS A peculiar bilateral symmetric hyperintense signal on T2-weighted images affecting the medulla oblongata was identified in an index patient with type I Alexander disease. Subsequently, 5 observers performed a systematic MR imaging review for this pattern by examining 55 subjects with Alexander disease and 74 subjects with other leukodystrophies. Interobserver agreement was assessed by the κ index. Sensitivity, specificity, and receiver operating characteristic curves were determined. RESULTS The identified pattern was present in 87% of subjects with Alexander disease and 14% of those without Alexander disease leukodystrophy (P < .001), 3 with vanishing white matter, 4 with adult polyglucosan body disease, and 3 others. It was found equally in both type I and type II Alexander disease (28/32, 88% versus 18/21, 86%; P = .851) and in subjects with unusual disease features (2/2). Sensitivity (87.3%; 95% CI, 76.0%-93.7%), specificity (86.5%; 95% CI, 76.9%-92.5%), and interobserver agreement (κ index = 0.82) were high. CONCLUSIONS The identified pattern in the medulla oblongata, called the chipmunk sign due to its resemblance to the face of this rodent, is extremely common in subjects with Alexander disease and represents a diagnostic tool that can aid in early diagnosis, especially in subjects with otherwise atypical MR imaging findings and/or clinical features.
Collapse
Affiliation(s)
- Thaís Armangue
- From the Neuroimmunology Program (T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clinic, University of Barcelona, Barcelona, Spain
- Neurology Department (T.A.), Neuroimmunology Unit, Sant Joan de Deu Children's Hospital, University of Barcelona, Barcelona, Spain
| | - Matthew T Whitehead
- Department of Radiology (M.T.W., A.Vossough), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine (M.T.W., A.Vossough, A.W., A.Vanderver), University of Pennsylvania, Philadelphia, Pennsylvania
| | - Davide Tonduti
- Unit of Pediatric Neurology (D.T., Y.V.), Center for Diagnosis and Treatment of Leukodystrophies, V. Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Laura Farina
- Neuroimaging Laboratory (L.F.), IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Ali Reza Tavasoli
- Department of Neurology (A.R.T.), Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neurology (A.R.T.), Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, Arizona
| | - Arastoo Vossough
- Department of Radiology (M.T.W., A.Vossough), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine (M.T.W., A.Vossough, A.W., A.Vanderver), University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mariko L Bennett
- Division of Neurology (M.L.B., Y.V., A.W., A.Vanderver), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ylenia Vaia
- Unit of Pediatric Neurology (D.T., Y.V.), Center for Diagnosis and Treatment of Leukodystrophies, V. Buzzi Children's Hospital, University of Milan, Milan, Italy
- Division of Neurology (M.L.B., Y.V., A.W., A.Vanderver), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Geneviève Bernard
- Departments of Neurology and Neurosurgery, Pediatrics, and Human Genetics (G.B.), McGill University, Montreal, Quebec, Canada
- Department of Specialized Medicine (G.B.), Division of Medical Genetics, McGill University Health Centre, Montreal, Quebec, Canada
- Child Health and Human Development Program (G.B.), Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Ettore Salsano
- Unit of Rare Neurological Diseases (E.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Saadet Mercimek-Andrews
- Department of Medical Genetics (S.M.-A.), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- The Hospital for Sick Children (S.M.-A.), Toronto, Ontario, Canada
| | - Amy Waldman
- Perelman School of Medicine (M.T.W., A.Vossough, A.W., A.Vanderver), University of Pennsylvania, Philadelphia, Pennsylvania
- Division of Neurology (M.L.B., Y.V., A.W., A.Vanderver), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Adeline Vanderver
- Perelman School of Medicine (M.T.W., A.Vossough, A.W., A.Vanderver), University of Pennsylvania, Philadelphia, Pennsylvania
- Division of Neurology (M.L.B., Y.V., A.W., A.Vanderver), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| |
Collapse
|
3
|
Chaer LER, de Mendonça JM, Del Negro MC, Titze-de-Almeida R, Nogueira NPB, Provetti PM, de Paula Brandão PR, de Carvalho Bispo DD, Ferreira GB, Faber I, Cavalcante TB, Adoni T, Mazzeu JF, von Glehn F. Differential diagnosis between multiple sclerosis and leukodystrophies - A scoping review. J Neurol Sci 2024; 459:122969. [PMID: 38507990 DOI: 10.1016/j.jns.2024.122969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 02/01/2024] [Accepted: 03/13/2024] [Indexed: 03/22/2024]
Abstract
Multiple Sclerosis (MS) is an autoimmune demyelinating disease of the central nervous system (CNS) characterized by damage to the myelin sheaths of oligodendrocytes. Currently, there is no specific biomarker to identify the disease; however, a diagnostic criterion has been established based on patient's clinical, laboratory, and imaging characteristics, which assists in identifying this condition. The primary method for diagnosing MS is the McDonald criteria, first described in 2001 and revised in the years 2005, 2012, and 2017. These criteria have been continuously reviewed to enhance specificity and sensitivity in the diagnosis of MS, thereby reducing errors in its differential diagnosis. An important differential diagnosis that shares overlapping features with MS, mainly the progressive forms, are leukodystrophies with demyelination as underlying pathology. Leukodystrophies comprise a rare group of genetically determined disorders that lead to either demyelination or hypomyelination of the central nervous system that can result neuroimaging changes as well as clinical findings similar to those observed in MS. Thus, systematic evaluation encompassing clinical presentation, neuroimaging findings, and laboratory metrics proves indispensable for a differential diagnosis. As such, this study aimed to establish, clearly and objectively, the similarities and differences between MS and the main demyelinating leukodystrophies. The study analyzed the parameters of the McDonald criteria, including clinical, laboratory, and magnetic resonance imaging aspects, as found in patients with leukodystrophies through scoping literature review. The data were compared with the determinations of the revised 2017 McDonald criteria to facilitate the differential diagnosis of these diseases in clinical practice.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Ingrid Faber
- School of Medicine, University of Brasilia, Brasilia, Brazil
| | | | | | | | - Felipe von Glehn
- School of Medicine, University of Brasilia, Brasilia, Brazil; Neuroimmunology Unit, Institute of Biology, University of Campinas, Campinas, Brazil.
| |
Collapse
|
4
|
Thakkar RN, Patel D, Kioutchoukova IP, Al-Bahou R, Reddy P, Foster DT, Lucke-Wold B. Leukodystrophy Imaging: Insights for Diagnostic Dilemmas. Med Sci (Basel) 2024; 12:7. [PMID: 38390857 PMCID: PMC10885080 DOI: 10.3390/medsci12010007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/09/2023] [Accepted: 12/13/2023] [Indexed: 02/24/2024] Open
Abstract
Leukodystrophies, a group of rare demyelinating disorders, mainly affect the CNS. Clinical presentation of different types of leukodystrophies can be nonspecific, and thus, imaging techniques like MRI can be used for a more definitive diagnosis. These diseases are characterized as cerebral lesions with characteristic demyelinating patterns which can be used as differentiating tools. In this review, we talk about these MRI study findings for each leukodystrophy, associated genetics, blood work that can help in differentiation, emerging diagnostics, and a follow-up imaging strategy. The leukodystrophies discussed in this paper include X-linked adrenoleukodystrophy, metachromatic leukodystrophy, Krabbe's disease, Pelizaeus-Merzbacher disease, Alexander's disease, Canavan disease, and Aicardi-Goutières Syndrome.
Collapse
Affiliation(s)
- Rajvi N. Thakkar
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Drashti Patel
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | | | - Raja Al-Bahou
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Pranith Reddy
- College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, USA
| | - Devon T. Foster
- College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, 1600 SW Archer Rd., Gainesville, FL 32610, USA
| |
Collapse
|
5
|
Garg D, Agarwal A, Garg A, Srivastava AK. Adult-onset Leukodystrophy due to TMEM63A Variant Presenting with Rapidly Progressive Dementia with Parkinsonism. Ann Indian Acad Neurol 2024; 27:105-107. [PMID: 38495226 PMCID: PMC10941901 DOI: 10.4103/aian.aian_694_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 11/22/2023] [Accepted: 11/29/2023] [Indexed: 03/19/2024] Open
Affiliation(s)
- Divyani Garg
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ayush Agarwal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Garg
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | | |
Collapse
|
6
|
Pasquetti D, Gazzellone A, Rossi S, Orteschi D, L’Erario FF, Concolino P, Minucci A, Dionisi-Vici C, Genuardi M, Silvestri G, Chiurazzi P. Triple Genetic Diagnosis in a Patient with Late-Onset Leukodystrophy and Mild Intellectual Disability. Int J Mol Sci 2023; 25:495. [PMID: 38203665 PMCID: PMC10778870 DOI: 10.3390/ijms25010495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/20/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
We describe the complex case of a 44-year-old man with polycystic kidney disease, mild cognitive impairment, and tremors in the upper limbs. Brain MRI showed lesions compatible with leukodystrophy. The diagnostic process, which included clinical exome sequencing (CES) and chromosomal microarray analysis (CMA), revealed a triple diagnosis: autosomal dominant polycystic kidney disease (ADPKD) due to a pathogenic variant, c.2152C>T-p.(Gln718Ter), in the PKD1 gene; late-onset phenylketonuria due to the presence of two missense variants, c.842C>T-p.(Pro281Leu) and c.143T>C-p.(Leu48Ser) in the PAH gene; and a 915 Kb duplication on chromosome 15. Few patients with multiple concurrent genetic diagnoses are reported in the literature; in this ADPKD patient, genome-wide analysis allowed for the diagnosis of adult-onset phenylketonuria (which would have otherwise gone unnoticed) and a 15q11.2 duplication responsible for cognitive and behavioral impairment with incomplete penetrance. This case underlines the importance of clinical genetics for interpreting complex results obtained by genome-wide techniques, and for diagnosing concurrent late-onset monogenic conditions.
Collapse
Affiliation(s)
- Domizia Pasquetti
- Section of Genomic Medicine, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Medical Genetics Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
| | - Annalisa Gazzellone
- Section of Genomic Medicine, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Medical Genetics Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
| | - Salvatore Rossi
- Department of Neurosciences, Faculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Neurology Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
| | - Daniela Orteschi
- Section of Genomic Medicine, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Medical Genetics Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
| | - Federica Francesca L’Erario
- Section of Genomic Medicine, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Medical Genetics Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
| | - Paola Concolino
- Departmental Unit of Molecular and Genomic Diagnostics, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
| | - Angelo Minucci
- Departmental Unit of Molecular and Genomic Diagnostics, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
| | - Carlo Dionisi-Vici
- Division of Metabolic Diseases, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy
| | - Maurizio Genuardi
- Section of Genomic Medicine, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Medical Genetics Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
| | - Gabriella Silvestri
- Department of Neurosciences, Faculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Neurology Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
| | - Pietro Chiurazzi
- Section of Genomic Medicine, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Medical Genetics Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
| |
Collapse
|
7
|
Van den Borre E, Cypers G, Vanhoenacker P, Dekeyzer S. Case 318: Adult Polyglucosan Body Disease. Radiology 2023; 309:e220598. [PMID: 37906012 DOI: 10.1148/radiol.220598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
HISTORY A 72-year-old man sought care for a cognitive deterioration over the past 5 years. There was a documented decline in his performance on the Mini-Mental State Examination (30 of 30 in 2016, 23 of 30 in 2021), with mainly episodic memory impairment. A more detailed history revealed a gait problem, paresthesia in both feet, and nocturnal urinary frequency. Clinical examination findings were suggestive of a length-dependent polyneuropathy. In addition, a right-sided Babinski sign was noted. Electromyography and a nerve conduction study corroborated a peripheral axonal sensorimotor neuropathy. MRI of the brain was performed.
Collapse
Affiliation(s)
- Eline Van den Borre
- From the Department of Neurology, Onze-Lieve-Vrouwziekenhuis vzw, Moorselbaan 164, 9300 Aalst, Belgium (E.V.d.B., G.C.); Department of Radiology, Universitair Ziekenhuis Gent, Gent, Belgium (P.V.); and Department of Radiology, Universitair Ziekenhuis Antwerpen, Edegem, Belgium (S.D.)
| | - Gert Cypers
- From the Department of Neurology, Onze-Lieve-Vrouwziekenhuis vzw, Moorselbaan 164, 9300 Aalst, Belgium (E.V.d.B., G.C.); Department of Radiology, Universitair Ziekenhuis Gent, Gent, Belgium (P.V.); and Department of Radiology, Universitair Ziekenhuis Antwerpen, Edegem, Belgium (S.D.)
| | - Piet Vanhoenacker
- From the Department of Neurology, Onze-Lieve-Vrouwziekenhuis vzw, Moorselbaan 164, 9300 Aalst, Belgium (E.V.d.B., G.C.); Department of Radiology, Universitair Ziekenhuis Gent, Gent, Belgium (P.V.); and Department of Radiology, Universitair Ziekenhuis Antwerpen, Edegem, Belgium (S.D.)
| | - Sven Dekeyzer
- From the Department of Neurology, Onze-Lieve-Vrouwziekenhuis vzw, Moorselbaan 164, 9300 Aalst, Belgium (E.V.d.B., G.C.); Department of Radiology, Universitair Ziekenhuis Gent, Gent, Belgium (P.V.); and Department of Radiology, Universitair Ziekenhuis Antwerpen, Edegem, Belgium (S.D.)
| |
Collapse
|
8
|
Oliveira DAD, Araújo LC, Paiva ARBD, Melo ESD. Adult-onset Alexander disease with brainstem and cervical cord enhancing lesions. Pract Neurol 2023; 23:414-417. [PMID: 37474302 DOI: 10.1136/pn-2023-003761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2023] [Indexed: 07/22/2023]
Abstract
Leukodystrophies are a group of genetic diseases with diverse clinical features and prominent involvement of the central nervous system white matter. We describe a 27-year-old man who presented with a progressive neurological disease, and striking involvement of the brainstem and symmetrical white matter lesions on MR scanning. Having excluded several other causes of leukodystrophy, we confirmed Alexander disease when a genetic panel showed a probable pathogenic variant in GFAP: p.Leu359Pro. Clinicians should suspect Alexander disease in people with a progressive neurological motor decline who has pyramidal and bulbar signs and compatible neuroimaging.
Collapse
Affiliation(s)
| | | | - Anderson Rodrigues Brandão de Paiva
- Neurogenetics Unit, Neurology Department, Universidade de São Paulo Hospital das Clínicas, Sao Paulo, Brazil
- Rare diseases department, Mendelics Genomic Analysis, Sao Paulo, Brazil
| | - Eduardo Sousa de Melo
- Department of Neurology, Hospital das Clínicas UFPE / EBSERH, Recife, Brazil
- Neurology, Universidade Federal de Pernambuco, Recife, Brazil
| |
Collapse
|
9
|
Suthar PP, Jhaveri M, Mafraji M. Case 317: Adult-Onset Leukoencephalopathy with Axonal Spheroids and Pigmented Glia. Radiology 2023; 308:e220790. [PMID: 37750775 DOI: 10.1148/radiol.220790] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
HISTORY A 44-year-old previously healthy man with a 9-month history of progressive cognitive decline, depression, urinary incontinence, and inability to perform tasks of daily living presented to the emergency department with worsening cognitive and neuropsychiatric symptoms. He had become more distressed, and his family noticed him departing the house without closing doors, leaving water faucets running, and sending his children to school on Sundays. History taken from the patient's wife revealed that his brother had passed away in his late 30s after a slowly progressing functional and cognitive decline over the course of 5 years. No further detailed family history could be obtained. The review of systems was negative; he had no prior medical, psychiatric, or surgical history; and he denied any history of recent travel, camping, hiking, or vaccination. The patient was not taking any dietary supplements, nor was he taking any over-the-counter or prescription medication. Examination revealed vital signs were within normal limits. Neurocognitive assessment revealed a conscious, coherent, and alert patient with impaired memory and concentration. He showed poor attention, depressed mood, and restricted affect. He was unable to spell the word world forward, nor was he able to understand a request to spell it backward. The rest of the physical and neurologic examination revealed no abnormalities. Extensive laboratory work-up was conducted and included the following: toxicology screening; screening for HIV-1, HIV-2, and syphilis treponemal antibodies; COVID-19 polymerase chain reaction; and measurement of B1 and B12 levels. The results of screening were negative. Cerebrospinal fluid (CSF) assays, including CSF oligoclonal bands and CSF flow cytometry, revealed values within normal limits. CT of the brain without intravenous contrast material was performed in the emergency department to rule out acute intracranial abnormality. Multiplanar multisequence MRI of the brain without and with intravenous contrast material was ordered for further assessment. CT images of chest, abdomen, and pelvis were unremarkable (images not shown).
Collapse
Affiliation(s)
- Pokhraj Prakashchandra Suthar
- From the Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, 1653 W Congress Pkwy, Chicago, IL 60612
| | - Miral Jhaveri
- From the Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, 1653 W Congress Pkwy, Chicago, IL 60612
| | - Mustafa Mafraji
- From the Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, 1653 W Congress Pkwy, Chicago, IL 60612
| |
Collapse
|
10
|
Li Y, Xu J, Xu Y, Li C, Wu Y, Liu Z. Clinical, genetic, and molecular characteristics in a central-southern Chinese cohort of genetic leukodystrophies. Ann Clin Transl Neurol 2023; 10:1556-1568. [PMID: 37434390 PMCID: PMC10502626 DOI: 10.1002/acn3.51845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/06/2023] [Accepted: 06/25/2023] [Indexed: 07/13/2023] Open
Abstract
OBJECTIVE Leukodystrophies are a diverse group of rare inherited disorders that affect the white matter of the central nervous system with a wide phenotypic spectrum. We aimed to characterize the clinical and genetic features of leukodystrophies in a central-southern Chinese cohort. METHODS A cohort of 16 Chinese probands with leukodystrophy was recruited and performed genetic analysis by targeted panels or whole-exome sequencing. Further functional analysis of identified mutations in the colony stimulating factor 1 receptor (CSF1R) gene was explored. RESULTS A total of eight pathogenic variants (3 novel, 5 documented) were identified in genes including AARS2, ABCD1, CSF1R, and GALC. Common symptoms of leukodystrophy such as cognitive decline, behavioral symptoms, bradykinesia, and spasticity were observed in mutation carriers as well as other rare features (e.g., seizure, dysarthric, and vision impairment). Overexpressing CSF1R mutants p.M875I and p.F971Sfs*7 in vitro showed pronounced cleavage CSF1R and suppressed protein expression, respectively, and reduced transcripts of both mutants were observed. CSF1 treatment revealed deficient and suppressed CSF1R phospho-activation with the mutants. In contrast to the plasma membrane and endoplasmic reticulum (ER) localized wild-type CSF1R, M875I mutant showed much less membrane association and greater detainment in the ER, whereas F971Sfs*7 mutation led to aberrant non-ER localization. Both mutations caused suppressed cell viability, which was partially resulted from deficient/suppressed CSF1R-ERK signaling. INTERPRETATION In summary, our findings expand the mutation spectrum of these genes in leukodystrophies. Supported by in vitro validation of the pathogenicity of heterozygous CSF1R mutations, our data also provide insights into the pathogenic mechanisms of CSF1R-related leukodystrophy.
Collapse
Affiliation(s)
- Yingjie Li
- Department of Neurology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- Department of Medical Genetics, School of Basic Medicine, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Jiaming Xu
- Department of Neurology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Yan Xu
- Department of Neurology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Chuanzhou Li
- Department of Medical Genetics, School of Basic Medicine, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Yan Wu
- Department of Neurology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Zhijun Liu
- Department of Neurology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| |
Collapse
|
11
|
Wong-Valenzuela EI, San Juan D, Santos Zambrano J, Camacho Molina A, Morales-Morales MA, Lopez-Landa A. Recurrent Ischemic Strokes due to Monogenic COL4A1 Mutation: The First Case Report from Latin America. Case Rep Genet 2023; 2023:6614837. [PMID: 37681221 PMCID: PMC10482535 DOI: 10.1155/2023/6614837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 08/09/2023] [Accepted: 08/16/2023] [Indexed: 09/09/2023] Open
Abstract
Introduction. Monogenic mutations as the cause of recurrent ischemic cerebral small-vessel disease with leukodystrophy are rare. COL4A1 gene mutations are a relatively new etiology of cerebrovascular lesions in young adults; however, any patient has been reported from Latin America. Case Presentation. We presented a Mexican young female with leukodystrophy and recurrent stroke secondary to COL4A1 monogenic mutation. Discussion/Conclusion. COL4A1 monogenic mutations are associated with cerebral small-vessel disease and other systemic manifestations. To date, there is little evidence to justify the treatment and prevention of recurrent strokes in patients with this mutation.
Collapse
Affiliation(s)
| | - Daniel San Juan
- Epilepsy Clinic, Instituto Nacional de Neurologia y Neurocirugia, Mexico City, Mexico
| | | | - Alejandra Camacho Molina
- Rare Diseases National Program, Institute for Social Security and Services for State Workers, Mexico City, Mexico
| | | | | |
Collapse
|
12
|
Morel H, Bailly L, Urbanczyk C, Hervé D, Berroir S, Le Bouc R, Levy R, Meyer M, Aloui C, Tournier-Lasserve E, Mathey G. Extension of the Clinicoradiologic Spectrum of Newly Described End-Truncating LAMB1 Variations. Neurol Genet 2023; 9:e200069. [PMID: 37063705 PMCID: PMC10096279 DOI: 10.1212/nxg.0000000000200069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 02/14/2023] [Indexed: 04/18/2023]
Abstract
Objectives To refine the clinical spectrum of a very recently identified phenotype associated with LAMB1 end-truncating pathogenic variations. Methods Detailed clinical, neuropsychological, and MRI investigation of 6 patients from 2 unrelated families segregating end-truncating LAMB1 variations. Results All patients harbored a LAMB1 end-truncating pathogenic variation. The specific association of a hippocampal type episodic memory dysfunction and a diffuse leukoencephalopathy was observed in all 4 patients aged older than 50 years, slightly worsening over time in 2 patients with several years of follow-up. Additional unspecific neurologic symptoms are reported, such as episodes of numbness, language troubles, or faintness in these 4 patients and the 2 younger ones. Discussion The association of an extensive leukoencephalopathy with an episodic memory dysfunction of the hippocampal type is strongly suggestive of a LAMB1 end-truncating variation in adults older than 50 years. Early cognitive complaints and imaging abnormalities might exist decades before. Additional transient manifestations can be observed, and this association should lead to LAMB1 screening to avoid unnecessary invasive investigations.
Collapse
Affiliation(s)
- Hélène Morel
- Université de Paris (H.M., D.H., C.A., E.T.-L.), INSERM UMR 1141 NeuroDiderot; AP-HP (H.M., E.T.-L.), Service de Génétique Moléculaire Neurovasculaire, Hôpital Saint-Louis; Reference Centre for Rare or Early-Onset Dementias (L.B., R.L.B., R.L.), IM2A, Département de Neurologie, AP-HP - Hôpital Pitié-Salpêtrière, Paris; Centre Hospitalier Départemental La Roche-Sur-Yon (C.U.), Service de Neurologie, La Roche-Sur-Yon; AP-HP (D.H.), CERVCO, Centre de Neurologie Vasculaire Translationnelle, Hôpital Lariboisière; Service de Neurologie (S.B.), Centre Hospitalier Alpes Leman, Contamine sur Arve; and Service de Neurologie (M.M., G.M.), Centre Hospitalier Regional Universitaire de Nancy, France
| | - Laurent Bailly
- Université de Paris (H.M., D.H., C.A., E.T.-L.), INSERM UMR 1141 NeuroDiderot; AP-HP (H.M., E.T.-L.), Service de Génétique Moléculaire Neurovasculaire, Hôpital Saint-Louis; Reference Centre for Rare or Early-Onset Dementias (L.B., R.L.B., R.L.), IM2A, Département de Neurologie, AP-HP - Hôpital Pitié-Salpêtrière, Paris; Centre Hospitalier Départemental La Roche-Sur-Yon (C.U.), Service de Neurologie, La Roche-Sur-Yon; AP-HP (D.H.), CERVCO, Centre de Neurologie Vasculaire Translationnelle, Hôpital Lariboisière; Service de Neurologie (S.B.), Centre Hospitalier Alpes Leman, Contamine sur Arve; and Service de Neurologie (M.M., G.M.), Centre Hospitalier Regional Universitaire de Nancy, France
| | - Cédric Urbanczyk
- Université de Paris (H.M., D.H., C.A., E.T.-L.), INSERM UMR 1141 NeuroDiderot; AP-HP (H.M., E.T.-L.), Service de Génétique Moléculaire Neurovasculaire, Hôpital Saint-Louis; Reference Centre for Rare or Early-Onset Dementias (L.B., R.L.B., R.L.), IM2A, Département de Neurologie, AP-HP - Hôpital Pitié-Salpêtrière, Paris; Centre Hospitalier Départemental La Roche-Sur-Yon (C.U.), Service de Neurologie, La Roche-Sur-Yon; AP-HP (D.H.), CERVCO, Centre de Neurologie Vasculaire Translationnelle, Hôpital Lariboisière; Service de Neurologie (S.B.), Centre Hospitalier Alpes Leman, Contamine sur Arve; and Service de Neurologie (M.M., G.M.), Centre Hospitalier Regional Universitaire de Nancy, France
| | - Dominique Hervé
- Université de Paris (H.M., D.H., C.A., E.T.-L.), INSERM UMR 1141 NeuroDiderot; AP-HP (H.M., E.T.-L.), Service de Génétique Moléculaire Neurovasculaire, Hôpital Saint-Louis; Reference Centre for Rare or Early-Onset Dementias (L.B., R.L.B., R.L.), IM2A, Département de Neurologie, AP-HP - Hôpital Pitié-Salpêtrière, Paris; Centre Hospitalier Départemental La Roche-Sur-Yon (C.U.), Service de Neurologie, La Roche-Sur-Yon; AP-HP (D.H.), CERVCO, Centre de Neurologie Vasculaire Translationnelle, Hôpital Lariboisière; Service de Neurologie (S.B.), Centre Hospitalier Alpes Leman, Contamine sur Arve; and Service de Neurologie (M.M., G.M.), Centre Hospitalier Regional Universitaire de Nancy, France
| | - Stéphane Berroir
- Université de Paris (H.M., D.H., C.A., E.T.-L.), INSERM UMR 1141 NeuroDiderot; AP-HP (H.M., E.T.-L.), Service de Génétique Moléculaire Neurovasculaire, Hôpital Saint-Louis; Reference Centre for Rare or Early-Onset Dementias (L.B., R.L.B., R.L.), IM2A, Département de Neurologie, AP-HP - Hôpital Pitié-Salpêtrière, Paris; Centre Hospitalier Départemental La Roche-Sur-Yon (C.U.), Service de Neurologie, La Roche-Sur-Yon; AP-HP (D.H.), CERVCO, Centre de Neurologie Vasculaire Translationnelle, Hôpital Lariboisière; Service de Neurologie (S.B.), Centre Hospitalier Alpes Leman, Contamine sur Arve; and Service de Neurologie (M.M., G.M.), Centre Hospitalier Regional Universitaire de Nancy, France
| | - Raphaël Le Bouc
- Université de Paris (H.M., D.H., C.A., E.T.-L.), INSERM UMR 1141 NeuroDiderot; AP-HP (H.M., E.T.-L.), Service de Génétique Moléculaire Neurovasculaire, Hôpital Saint-Louis; Reference Centre for Rare or Early-Onset Dementias (L.B., R.L.B., R.L.), IM2A, Département de Neurologie, AP-HP - Hôpital Pitié-Salpêtrière, Paris; Centre Hospitalier Départemental La Roche-Sur-Yon (C.U.), Service de Neurologie, La Roche-Sur-Yon; AP-HP (D.H.), CERVCO, Centre de Neurologie Vasculaire Translationnelle, Hôpital Lariboisière; Service de Neurologie (S.B.), Centre Hospitalier Alpes Leman, Contamine sur Arve; and Service de Neurologie (M.M., G.M.), Centre Hospitalier Regional Universitaire de Nancy, France
| | - Richard Levy
- Université de Paris (H.M., D.H., C.A., E.T.-L.), INSERM UMR 1141 NeuroDiderot; AP-HP (H.M., E.T.-L.), Service de Génétique Moléculaire Neurovasculaire, Hôpital Saint-Louis; Reference Centre for Rare or Early-Onset Dementias (L.B., R.L.B., R.L.), IM2A, Département de Neurologie, AP-HP - Hôpital Pitié-Salpêtrière, Paris; Centre Hospitalier Départemental La Roche-Sur-Yon (C.U.), Service de Neurologie, La Roche-Sur-Yon; AP-HP (D.H.), CERVCO, Centre de Neurologie Vasculaire Translationnelle, Hôpital Lariboisière; Service de Neurologie (S.B.), Centre Hospitalier Alpes Leman, Contamine sur Arve; and Service de Neurologie (M.M., G.M.), Centre Hospitalier Regional Universitaire de Nancy, France
| | - Mylène Meyer
- Université de Paris (H.M., D.H., C.A., E.T.-L.), INSERM UMR 1141 NeuroDiderot; AP-HP (H.M., E.T.-L.), Service de Génétique Moléculaire Neurovasculaire, Hôpital Saint-Louis; Reference Centre for Rare or Early-Onset Dementias (L.B., R.L.B., R.L.), IM2A, Département de Neurologie, AP-HP - Hôpital Pitié-Salpêtrière, Paris; Centre Hospitalier Départemental La Roche-Sur-Yon (C.U.), Service de Neurologie, La Roche-Sur-Yon; AP-HP (D.H.), CERVCO, Centre de Neurologie Vasculaire Translationnelle, Hôpital Lariboisière; Service de Neurologie (S.B.), Centre Hospitalier Alpes Leman, Contamine sur Arve; and Service de Neurologie (M.M., G.M.), Centre Hospitalier Regional Universitaire de Nancy, France
| | - Chaker Aloui
- Université de Paris (H.M., D.H., C.A., E.T.-L.), INSERM UMR 1141 NeuroDiderot; AP-HP (H.M., E.T.-L.), Service de Génétique Moléculaire Neurovasculaire, Hôpital Saint-Louis; Reference Centre for Rare or Early-Onset Dementias (L.B., R.L.B., R.L.), IM2A, Département de Neurologie, AP-HP - Hôpital Pitié-Salpêtrière, Paris; Centre Hospitalier Départemental La Roche-Sur-Yon (C.U.), Service de Neurologie, La Roche-Sur-Yon; AP-HP (D.H.), CERVCO, Centre de Neurologie Vasculaire Translationnelle, Hôpital Lariboisière; Service de Neurologie (S.B.), Centre Hospitalier Alpes Leman, Contamine sur Arve; and Service de Neurologie (M.M., G.M.), Centre Hospitalier Regional Universitaire de Nancy, France
| | - Elisabeth Tournier-Lasserve
- Université de Paris (H.M., D.H., C.A., E.T.-L.), INSERM UMR 1141 NeuroDiderot; AP-HP (H.M., E.T.-L.), Service de Génétique Moléculaire Neurovasculaire, Hôpital Saint-Louis; Reference Centre for Rare or Early-Onset Dementias (L.B., R.L.B., R.L.), IM2A, Département de Neurologie, AP-HP - Hôpital Pitié-Salpêtrière, Paris; Centre Hospitalier Départemental La Roche-Sur-Yon (C.U.), Service de Neurologie, La Roche-Sur-Yon; AP-HP (D.H.), CERVCO, Centre de Neurologie Vasculaire Translationnelle, Hôpital Lariboisière; Service de Neurologie (S.B.), Centre Hospitalier Alpes Leman, Contamine sur Arve; and Service de Neurologie (M.M., G.M.), Centre Hospitalier Regional Universitaire de Nancy, France
| | - Guillaume Mathey
- Université de Paris (H.M., D.H., C.A., E.T.-L.), INSERM UMR 1141 NeuroDiderot; AP-HP (H.M., E.T.-L.), Service de Génétique Moléculaire Neurovasculaire, Hôpital Saint-Louis; Reference Centre for Rare or Early-Onset Dementias (L.B., R.L.B., R.L.), IM2A, Département de Neurologie, AP-HP - Hôpital Pitié-Salpêtrière, Paris; Centre Hospitalier Départemental La Roche-Sur-Yon (C.U.), Service de Neurologie, La Roche-Sur-Yon; AP-HP (D.H.), CERVCO, Centre de Neurologie Vasculaire Translationnelle, Hôpital Lariboisière; Service de Neurologie (S.B.), Centre Hospitalier Alpes Leman, Contamine sur Arve; and Service de Neurologie (M.M., G.M.), Centre Hospitalier Regional Universitaire de Nancy, France
| |
Collapse
|
13
|
Nagree MS, Rybova J, Kleynerman A, Ahrenhoerster CJ, Saville JT, Xu T, Bachochin M, McKillop WM, Lawlor MW, Pshezhetsky AV, Isaeva O, Budde MD, Fuller M, Medin JA. Spinal muscular atrophy-like phenotype in a mouse model of acid ceramidase deficiency. Commun Biol 2023; 6:560. [PMID: 37231125 DOI: 10.1038/s42003-023-04932-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/12/2023] [Indexed: 05/27/2023] Open
Abstract
Mutations in ASAH1 have been linked to two allegedly distinct disorders: Farber disease (FD) and spinal muscular atrophy with progressive myoclonic epilepsy (SMA-PME). We have previously reported FD-like phenotypes in mice harboring a single amino acid substitution in acid ceramidase (ACDase), P361R, known to be pathogenic in humans (P361R-Farber). Here we describe a mouse model with an SMA-PME-like phenotype (P361R-SMA). P361R-SMA mice live 2-3-times longer than P361R-Farber mice and have different phenotypes including progressive ataxia and bladder dysfunction, which suggests neurological dysfunction. We found profound demyelination, loss of axons, and altered sphingolipid levels in P361R-SMA spinal cords; severe pathology was restricted to the white matter. Our model can serve as a tool to study the pathological effects of ACDase deficiency on the central nervous system and to evaluate potential therapies for SMA-PME.
Collapse
Affiliation(s)
- Murtaza S Nagree
- Department of Medical Biophysics, University of Toronto, Toronto, M5G 1L7, ON, Canada
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Jitka Rybova
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Annie Kleynerman
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | | | - Jennifer T Saville
- Genetics and Molecular Pathology, SA Pathology at Women's and Children's Hospital, and Adelaide Medical School, University of Adelaide, Adelaide, SA, 5006, Australia
| | - TianMeng Xu
- CHU Sainte-Justine, Université de Montréal, Montréal, QC, H3T 1C5, Canada
| | | | - William M McKillop
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Michael W Lawlor
- Department of Pathology and Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | | | - Olena Isaeva
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Matthew D Budde
- Clement J. Zablocki Veteran's Affairs Medical Center, Milwaukee, WI, 53295, USA
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Maria Fuller
- Genetics and Molecular Pathology, SA Pathology at Women's and Children's Hospital, and Adelaide Medical School, University of Adelaide, Adelaide, SA, 5006, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA, 5005, Australia
| | - Jeffrey A Medin
- Department of Medical Biophysics, University of Toronto, Toronto, M5G 1L7, ON, Canada.
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, 53226, USA.
- Department of Biochemistry, Medical College of Wisconsin, Milwaukee, WI, 53226, USA.
| |
Collapse
|
14
|
Perrier S, Guerrero K, Tran LT, Michell-Robinson MA, Legault G, Brais B, Sylvain M, Dorman J, Demos M, Köhler W, Pastinen T, Thiffault I, Bernard G. Solving inherited white matter disorder etiologies in the neurology clinic: Challenges and lessons learned using next-generation sequencing. Front Neurol 2023; 14:1148377. [PMID: 37077564 PMCID: PMC10108901 DOI: 10.3389/fneur.2023.1148377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 02/23/2023] [Indexed: 04/05/2023] Open
Abstract
IntroductionRare neurodevelopmental disorders, including inherited white matter disorders or leukodystrophies, often present a diagnostic challenge on a genetic level given the large number of causal genes associated with a range of disease subtypes. This study aims to demonstrate the challenges and lessons learned in the genetic investigations of leukodystrophies through presentation of a series of cases solved using exome or genome sequencing.MethodsEach of the six patients had a leukodystrophy associated with hypomyelination or delayed myelination on MRI, and inconclusive clinical diagnostic genetic testing results. We performed next generation sequencing (case-based exome or genome sequencing) to further investigate the genetic cause of disease.ResultsFollowing different lines of investigation, molecular diagnoses were obtained for each case, with patients harboring pathogenic variants in a range of genes including TMEM106B, GJA1, AGA, POLR3A, and TUBB4A. We describe the lessons learned in reaching the genetic diagnosis, including the importance of (a) utilizing proper multi-gene panels in clinical testing, (b) assessing the reliability of biochemical assays in supporting diagnoses, and (c) understanding the limitations of exome sequencing methods in regard to CNV detection and region coverage in GC-rich areas.DiscussionThis study illustrates the importance of applying a collaborative diagnostic approach by combining detailed phenotyping data and metabolic results from the clinical environment with advanced next generation sequencing analysis techniques from the research environment to increase the diagnostic yield in patients with genetically unresolved leukodystrophies.
Collapse
Affiliation(s)
- Stefanie Perrier
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
- Child Health and Human Development Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Kether Guerrero
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
- Child Health and Human Development Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Luan T. Tran
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
- Child Health and Human Development Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Mackenzie A. Michell-Robinson
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
- Child Health and Human Development Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Geneviève Legault
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
- Child Health and Human Development Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Department of Pediatrics, McGill University, Montreal, QC, Canada
| | - Bernard Brais
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
- Department of Human Genetics, McGill University, Montreal, QC, Canada
| | - Michel Sylvain
- Division of Pediatric Neurology, Centre Mère-Enfant Soleil du CHU de Québec - Université Laval, Québec City, QC, Canada
| | - James Dorman
- John H. Stroger Jr. Hospital of Cook County, Chicago, IL, United States
- Department of Neurological Sciences, Rush Medical College, Chicago, IL, United States
| | - Michelle Demos
- Division of Neurology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada
| | - Wolfgang Köhler
- Leukodystrophy Center, University of Leipzig Medical Center, Leipzig, Germany
| | - Tomi Pastinen
- Genomic Medicine Center, Children's Mercy Hospital, Kansas City, MO, United States
- University of Missouri Kansas City School of Medicine, Kansas City, MO, United States
| | - Isabelle Thiffault
- Genomic Medicine Center, Children's Mercy Hospital, Kansas City, MO, United States
- University of Missouri Kansas City School of Medicine, Kansas City, MO, United States
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO, United States
- Isabelle Thiffault
| | - Geneviève Bernard
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
- Child Health and Human Development Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Department of Pediatrics, McGill University, Montreal, QC, Canada
- Department of Human Genetics, McGill University, Montreal, QC, Canada
- Department of Specialized Medicine, Division of Medical Genetics, McGill University Health Center, Montreal, QC, Canada
- *Correspondence: Geneviève Bernard
| |
Collapse
|
15
|
Rossi S, Concolino P, Di Natale D, Pasquetti D, Di Lella GM, Chiurazzi P, Silvestri G. Clinical Reasoning: A Young Man With Subacute Onset of Spastic Paraparesis. Neurology 2023; 100:199-205. [PMID: 36302663 DOI: 10.1212/wnl.0000000000201516] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 09/20/2022] [Indexed: 01/25/2023] Open
Abstract
Leukodystrophies are a group of rare neurodegenerative disorders, usually presenting in infancy with a variable combination of cognitive, motor, and coordination impairment. Adult-onset cases are even more rare, often representing a diagnostic challenge even for experienced neurologists. Here, we present a case of a 44-year-old man with subacute and rapidly progressive spastic paraplegia, whose brain MRI revealed white matter abnormalities compatible with a diagnosis of leukodystrophy. We discuss how to apply a simplified diagnostic algorithm to distinguish acquired leukoencephalopathies from leukodystrophies and how to delve into the maze of genetic testing for white matter diseases. In our patient, we reached the diagnosis of a treatable disorder, whose early recognition is essential to prevent severe neurologic deterioration.
Collapse
Affiliation(s)
- Salvatore Rossi
- From the Dipartimento di Scienze dell'Invecchiamento (S.R., D.D.N., G.S.), Neurologiche, Ortopediche e della Testa-Collo, UOC Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento di Neuroscienze Università Cattolica del Sacro Cuore (S.R., D.D.N., G.S.), Facoltà di Medicina e Chirurgia, Rome, Italy; UOC Chimica (Paola Concolino), Biochimica e Biologia Molecolare Clinica - Area Diagnostica di Laboratorio, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Istituto di Medicina Genomica (D.P., Pietro Chiurazzi), Università Cattolica del Sacro Cuore, Rome, Italy; Department of Diagnostic Imaging (G.M.D.L.), Oncological Radiotherapy, and Hematology, UOC Neuroradiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Università Cattolica del Sacro Cuore, 00168 Rome, Italy; and UOC Genetica Medica (Pietro Chiurazzi), Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Paola Concolino
- From the Dipartimento di Scienze dell'Invecchiamento (S.R., D.D.N., G.S.), Neurologiche, Ortopediche e della Testa-Collo, UOC Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento di Neuroscienze Università Cattolica del Sacro Cuore (S.R., D.D.N., G.S.), Facoltà di Medicina e Chirurgia, Rome, Italy; UOC Chimica (Paola Concolino), Biochimica e Biologia Molecolare Clinica - Area Diagnostica di Laboratorio, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Istituto di Medicina Genomica (D.P., Pietro Chiurazzi), Università Cattolica del Sacro Cuore, Rome, Italy; Department of Diagnostic Imaging (G.M.D.L.), Oncological Radiotherapy, and Hematology, UOC Neuroradiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Università Cattolica del Sacro Cuore, 00168 Rome, Italy; and UOC Genetica Medica (Pietro Chiurazzi), Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Daniele Di Natale
- From the Dipartimento di Scienze dell'Invecchiamento (S.R., D.D.N., G.S.), Neurologiche, Ortopediche e della Testa-Collo, UOC Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento di Neuroscienze Università Cattolica del Sacro Cuore (S.R., D.D.N., G.S.), Facoltà di Medicina e Chirurgia, Rome, Italy; UOC Chimica (Paola Concolino), Biochimica e Biologia Molecolare Clinica - Area Diagnostica di Laboratorio, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Istituto di Medicina Genomica (D.P., Pietro Chiurazzi), Università Cattolica del Sacro Cuore, Rome, Italy; Department of Diagnostic Imaging (G.M.D.L.), Oncological Radiotherapy, and Hematology, UOC Neuroradiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Università Cattolica del Sacro Cuore, 00168 Rome, Italy; and UOC Genetica Medica (Pietro Chiurazzi), Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Domizia Pasquetti
- From the Dipartimento di Scienze dell'Invecchiamento (S.R., D.D.N., G.S.), Neurologiche, Ortopediche e della Testa-Collo, UOC Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento di Neuroscienze Università Cattolica del Sacro Cuore (S.R., D.D.N., G.S.), Facoltà di Medicina e Chirurgia, Rome, Italy; UOC Chimica (Paola Concolino), Biochimica e Biologia Molecolare Clinica - Area Diagnostica di Laboratorio, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Istituto di Medicina Genomica (D.P., Pietro Chiurazzi), Università Cattolica del Sacro Cuore, Rome, Italy; Department of Diagnostic Imaging (G.M.D.L.), Oncological Radiotherapy, and Hematology, UOC Neuroradiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Università Cattolica del Sacro Cuore, 00168 Rome, Italy; and UOC Genetica Medica (Pietro Chiurazzi), Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Giuseppe Maria Di Lella
- From the Dipartimento di Scienze dell'Invecchiamento (S.R., D.D.N., G.S.), Neurologiche, Ortopediche e della Testa-Collo, UOC Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento di Neuroscienze Università Cattolica del Sacro Cuore (S.R., D.D.N., G.S.), Facoltà di Medicina e Chirurgia, Rome, Italy; UOC Chimica (Paola Concolino), Biochimica e Biologia Molecolare Clinica - Area Diagnostica di Laboratorio, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Istituto di Medicina Genomica (D.P., Pietro Chiurazzi), Università Cattolica del Sacro Cuore, Rome, Italy; Department of Diagnostic Imaging (G.M.D.L.), Oncological Radiotherapy, and Hematology, UOC Neuroradiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Università Cattolica del Sacro Cuore, 00168 Rome, Italy; and UOC Genetica Medica (Pietro Chiurazzi), Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Pietro Chiurazzi
- From the Dipartimento di Scienze dell'Invecchiamento (S.R., D.D.N., G.S.), Neurologiche, Ortopediche e della Testa-Collo, UOC Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento di Neuroscienze Università Cattolica del Sacro Cuore (S.R., D.D.N., G.S.), Facoltà di Medicina e Chirurgia, Rome, Italy; UOC Chimica (Paola Concolino), Biochimica e Biologia Molecolare Clinica - Area Diagnostica di Laboratorio, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Istituto di Medicina Genomica (D.P., Pietro Chiurazzi), Università Cattolica del Sacro Cuore, Rome, Italy; Department of Diagnostic Imaging (G.M.D.L.), Oncological Radiotherapy, and Hematology, UOC Neuroradiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Università Cattolica del Sacro Cuore, 00168 Rome, Italy; and UOC Genetica Medica (Pietro Chiurazzi), Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Gabriella Silvestri
- From the Dipartimento di Scienze dell'Invecchiamento (S.R., D.D.N., G.S.), Neurologiche, Ortopediche e della Testa-Collo, UOC Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento di Neuroscienze Università Cattolica del Sacro Cuore (S.R., D.D.N., G.S.), Facoltà di Medicina e Chirurgia, Rome, Italy; UOC Chimica (Paola Concolino), Biochimica e Biologia Molecolare Clinica - Area Diagnostica di Laboratorio, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Istituto di Medicina Genomica (D.P., Pietro Chiurazzi), Università Cattolica del Sacro Cuore, Rome, Italy; Department of Diagnostic Imaging (G.M.D.L.), Oncological Radiotherapy, and Hematology, UOC Neuroradiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Università Cattolica del Sacro Cuore, 00168 Rome, Italy; and UOC Genetica Medica (Pietro Chiurazzi), Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.
| |
Collapse
|
16
|
Schoenmakers DH, Beerepoot S, Krägeloh‐Mann I, Elgün S, Bender B, van der Knaap MS, Wolf NI, Groeschel S. Recognizing early MRI signs (or their absence) is crucial in diagnosing metachromatic leukodystrophy. Ann Clin Transl Neurol 2022; 9:1999-2009. [PMID: 36334091 PMCID: PMC9735365 DOI: 10.1002/acn3.51692] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/21/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Metachromatic leukodystrophy (MLD) has characteristic white matter (WM) changes on brain MRI, which often trigger biochemical and genetic confirmation of the diagnosis. In early or pre-symptomatic disease stages, these typical MRI changes might be absent, hampering early diagnosis. This study aims to describe the characteristics of MRI WM abnormalities at diagnosis, related to clinical presentation. METHODS We retrospectively reviewed brain MRIs of MLD patients followed in 2 centers at the time of diagnosis regarding MLD MRI score and presence of tigroid pattern. In addition, MLD subtype, symptom status, CNS/PNS phenotype, motor/cognitive/mixed phenotype, and the presence of CNS symptoms were evaluated. RESULTS We included 104 brain MRIs from patients with late-infantile (n = 43), early-juvenile (n = 24), late-juvenile (n = 20) and adult (n = 17) onset. Involvement of the corpus callosum was a characteristic early MRI sign and was present in 71% of the symptomatic late-infantile patients, 94% of the symptomatic early-juvenile patients and 100% of the symptomatic late-juvenile and adult patients. Symptomatic early-juvenile, late-juvenile and adult patients generally had WM abnormalities on MRI suggestive of MLD. By contrast, 47% of the early-symptomatic late-infantile patients had no or only mild WM abnormalities on MRI, even in the presence of CNS symptoms including pyramidal signs. INTERPRETATION Patients with late-infantile MLD may have no or only mild, nonspecific abnormalities at brain MRI, partly suggestive of 'delayed myelination', even with clear clinical symptoms. This may lead to significant diagnostic delay. Knowledge of these early MRI signs (or their absence) is important for fast diagnosis.
Collapse
Affiliation(s)
- Daphne H. Schoenmakers
- Department of Child Neurology, Amsterdam Leukodystrophy CenterAmsterdam UMC location Vrije Universiteit Amsterdam, Emma's Children's HospitalBoelelaan 1117AmsterdamThe Netherlands,Amsterdam Neuroscience, Cellular & Molecular MechanismsAmsterdamThe Netherlands,Department of Endocrinology and MetabolismAmsterdam UMC location University of AmsterdamMeibergdreef 9AmsterdamThe Netherlands
| | - Shanice Beerepoot
- Department of Child Neurology, Amsterdam Leukodystrophy CenterAmsterdam UMC location Vrije Universiteit Amsterdam, Emma's Children's HospitalBoelelaan 1117AmsterdamThe Netherlands,Amsterdam Neuroscience, Cellular & Molecular MechanismsAmsterdamThe Netherlands,Center for Translational ImmunologyUniversity Medical Center UtrechtUtrechtThe Netherlands,Pediatric Transplant CenterPrincess Máxima Center for Pediatric OncologyUtrechtThe Netherlands
| | - Ingeborg Krägeloh‐Mann
- Department of Child Neurology and Developmental MedicineUniversity Children's Hospital TübingenHoppe‐Seyler‐Straße 172076TübingenGermany
| | - Saskia Elgün
- Department of Child Neurology and Developmental MedicineUniversity Children's Hospital TübingenHoppe‐Seyler‐Straße 172076TübingenGermany
| | - Benjamin Bender
- Diagnostic and Interventional Neuroradiology, Department of RadiologyUniversity Hospital TübingenHoppe‐Seyler‐Straße 372076TübingenGermany
| | - Marjo S. van der Knaap
- Department of Child Neurology, Amsterdam Leukodystrophy CenterAmsterdam UMC location Vrije Universiteit Amsterdam, Emma's Children's HospitalBoelelaan 1117AmsterdamThe Netherlands,Amsterdam Neuroscience, Cellular & Molecular MechanismsAmsterdamThe Netherlands,Department of Integrative Neurophysiology, Center for Neurogenomics and Cognitive ResearchVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Nicole I. Wolf
- Department of Child Neurology, Amsterdam Leukodystrophy CenterAmsterdam UMC location Vrije Universiteit Amsterdam, Emma's Children's HospitalBoelelaan 1117AmsterdamThe Netherlands,Amsterdam Neuroscience, Cellular & Molecular MechanismsAmsterdamThe Netherlands
| | - Samuel Groeschel
- Department of Child Neurology and Developmental MedicineUniversity Children's Hospital TübingenHoppe‐Seyler‐Straße 172076TübingenGermany
| |
Collapse
|
17
|
Volmrich AM, Cuénant LM, Forghani I, Hsieh SL, Shapiro LT. ABCD1 Gene Mutations: Mechanisms and Management of Adrenomyeloneuropathy. Appl Clin Genet 2022; 15:111-123. [PMID: 35983253 PMCID: PMC9381027 DOI: 10.2147/tacg.s359479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 08/06/2022] [Indexed: 01/05/2023] Open
Abstract
Pathogenic variants in the ABCD1 gene on the X chromosome may result in widely heterogenous phenotypes, including adrenomyeloneuropathy (AMN). Affected males typically present in their third or fourth decade of life with progressive lower limb weakness and spasticity, and may develop signs and symptoms of adrenal insufficiency and/or cerebral demyelination. Heterozygous females may be asymptomatic, but may develop a later-onset and more slowly progressive spastic paraparesis. In this review, we describe the clinical presentation of AMN, as well as its diagnosis and management. The role of rehabilitative therapies and options for management of spasticity are highlighted.
Collapse
Affiliation(s)
- Alyssa M Volmrich
- Department of Physical Medicine & Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Lauren M Cuénant
- Department of Physical Medicine & Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Irman Forghani
- Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sharon L Hsieh
- MD/MPH Program, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Lauren T Shapiro
- Department of Physical Medicine & Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, USA
- Correspondence: Lauren T Shapiro, Department of Physical Medicine & Rehabilitation; University of Miami Miller School of Medicine, P.O. Box 016960 (C-206), Miami, FL, 33101, USA, Tel +1 305 243-6605, Fax +1 305 243-4650, Email
| |
Collapse
|
18
|
Friedberg A, Ramos EM, Yang Z, Bonham LW, Yokoyama JS, Ljubenkov PA, Younes K, Geschwind DH, Miller BL. Case Report: Novel CSF1R Variant in a Patient With Behavioral Variant Frontotemporal Dementia Syndrome With Prodromal Repetitive Scratching Behavior. Front Neurol 2022; 13:909944. [PMID: 35812083 PMCID: PMC9256970 DOI: 10.3389/fneur.2022.909944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/02/2022] [Indexed: 11/16/2022] Open
Abstract
CSF1R-related leukoencephalopathy is an autosomal dominant neurodegenerative disease caused by mutations in the tyrosine kinase domain of the colony stimulating factor 1 receptor (CSF1R). Several studies have found that hematogenic stem cell transplantation is an effective disease modifying therapy however the literature regarding prodromal and early symptoms CSF1R-related leukoencephalopathy is limited. We describe a 63-year-old patient with 4 years of repetitive scratching and skin picking behavior followed by 10 years of progressive behavioral, cognitive, and motor decline in a pattern suggesting behavioral variant of frontotemporal dementia. Brain MRI demonstrated prominent frontal and parietal atrophy accompanied by underlying bilateral patchy white matter hyperintensities sparing the U fibers and cavum septum pellucidum. Whole-exome sequencing revealed a novel, predicted deleterious missense variant in a highly conserved amino acid in the tyrosine kinase domain of CSF1R (p.Gly872Arg). Given this evidence and the characteristic clinical and radiological findings this novel variant was classified as likely pathogenic according to the American College of Medical Genetics standard guidelines. Detailed description of the prodromal scratching and skin picking behavior and possible underlying mechanisms in this case furthers knowledge about early manifestations of CSF1R-related leukoencephalopathy with the hope that early detection and timely administration of disease modifying therapies becomes possible.
Collapse
Affiliation(s)
- Adit Friedberg
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States
- Trinity College Dublin, Dublin, Ireland
| | - Eliana Marisa Ramos
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Zhongan Yang
- Department of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Luke W. Bonham
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Jennifer S. Yokoyama
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States
- Trinity College Dublin, Dublin, Ireland
| | - Peter A. Ljubenkov
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Kyan Younes
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Daniel H. Geschwind
- Program in Neurogenetics, Department of Neurology, Center for Autism Research and Treatment, David Geffen School of Medicine, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Institute for Precision Health, University of California, Los Angeles, Los Angeles, CA, United States
| | - Bruce L. Miller
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States
- *Correspondence: Bruce L. Miller
| |
Collapse
|
19
|
Ferrer I. The Primary Microglial Leukodystrophies: A Review. Int J Mol Sci 2022; 23:ijms23116341. [PMID: 35683020 PMCID: PMC9181167 DOI: 10.3390/ijms23116341] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 06/03/2022] [Indexed: 11/17/2022] Open
Abstract
Primary microglial leukodystrophy or leukoencephalopathy are disorders in which a genetic defect linked to microglia causes cerebral white matter damage. Pigmented orthochromatic leukodystrophy, adult-onset orthochromatic leukodystrophy associated with pigmented macrophages, hereditary diffuse leukoencephalopathy with (axonal) spheroids, and adult-onset leukoencephalopathy with axonal spheroids and pigmented glia (ALSP) are different terms apparently used to designate the same disease. However, ALSP linked to dominantly inherited mutations in CSF1R (colony stimulating factor receptor 1) cause CSF-1R-related leukoencephalopathy (CRP). Yet, recessive ALSP with ovarian failure linked to AARS2 (alanyl-transfer (t)RNA synthase 2) mutations (LKENP) is a mitochondrial disease and not a primary microglial leukoencephalopathy. Polycystic membranous lipomembranous osteodysplasia with sclerosing leukoencephalopathy (PLOSL; Nasu–Hakola disease: NHD) is a systemic disease affecting bones, cerebral white matter, selected grey nuclei, and adipose tissue The disease is caused by mutations of one of the two genes TYROBP or TREM2, identified as PLOSL1 and PLOSL2, respectively. TYROBP associates with receptors expressed in NK cells, B and T lymphocytes, dendritic cells, monocytes, macrophages, and microglia. TREM2 encodes the protein TREM2 (triggering receptor expressed on myeloid cells 2), which forms a receptor signalling complex with TYROBP in macrophages and dendritic cells. Rather than pure microglial leukoencephalopathy, NHD can be considered a multisystemic “immunological” disease.
Collapse
Affiliation(s)
- Isidro Ferrer
- Network Centre of Biomedical Research of Neurodegenerative Diseases (CIBERNED), Department of Pathology and Experimental Therapeutics, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, 08907 Barcelona, L'Hospitalet de Llobregat, Spain
| |
Collapse
|
20
|
Ventura N. Inherited neurometabolic diseases and the importance of imaging-based classification systems. Radiol Bras 2022; 55:VII-VIII. [PMID: 35795600 PMCID: PMC9254713 DOI: 10.1590/0100-3984.2022.55.3e2-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Nina Ventura
- Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, RJ, Brazil; Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil; Hospital Samaritano, Grupo Fleury, Rio de Janeiro, RJ, Brazil
| |
Collapse
|
21
|
Ventura N. Doenças neurometabólicas hereditárias e a importância das classificações baseadas em achados de imagem. Radiol Bras 2022. [DOI: 10.1590/0100-3984.2022.55.3e2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Nina Ventura
- Instituto Estadual do Cérebro Paulo Niemeyer, Brazil; Universidade Federal do Rio de Janeiro, Brazil; Hospital Samaritano, Brazil
| |
Collapse
|
22
|
Murthy VD, McLarty E, Woolard KD, Parker RL, Kortz G, King JN, Poppenga RH, Knipe MF, Dickinson PJ. Case Report: MRI, Clinical, and Pathological Correlates of Bromethalin Toxicosis in Three Dogs. Front Vet Sci 2022; 9:879007. [PMID: 35558887 PMCID: PMC9087846 DOI: 10.3389/fvets.2022.879007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/16/2022] [Indexed: 11/13/2022] Open
Abstract
Bromethalin toxicosis is an increasingly common clinical presentation in dogs that may be fatal depending on the extent of intoxication. Antemortem diagnosis of bromethalin toxicosis was achieved in three dogs by demonstration of the active metabolite desmethylbromethalin in fat or serum. Magnetic resonance imaging (MRI) findings were consistent with a diffuse leukoencephalopathy with restricted diffusion and prominent involvement of the corticospinal motor tracts on T2-weighted and diffusion-weighted sequences. Imaging findings were confirmed in one non-surviving dog at necropsy. Resolution of MRI abnormalities was demonstrated in one surviving dog that was consistent with the associated resolution of clinical signs. Initial findings in these dogs support further investigation of specific MRI patterns in cases of leukoencephalopathy to aid differential diagnosis. While antemortem detection of bromethalin and its metabolites confirms exposure, quantitation may be informative as a prognostic biomarker.
Collapse
Affiliation(s)
- Vishal D. Murthy
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA, United States
- *Correspondence: Vishal D. Murthy
| | - Ehren McLarty
- Department of Surgical and Radiological Sciences, University of California, Davis, Davis, CA, United States
| | - Kevin D. Woolard
- Department of Pathology, Microbiology and Immunology, University of California, Davis, Davis, CA, United States
| | - Rell L. Parker
- Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Gregg Kortz
- Department of Neurology, VCA Sacramento Veterinary Referral Center, Sacramento, CA, United States
| | - Jamie N. King
- Department of Neurology, VCA Sacramento Veterinary Referral Center, Sacramento, CA, United States
| | - Robert H. Poppenga
- California Animal Health and Food Safety Laboratory System, University of California, Davis, Davis, CA, United States
| | - Marguerite F. Knipe
- Department of Surgical and Radiological Sciences, University of California, Davis, Davis, CA, United States
| | - Peter J. Dickinson
- Department of Surgical and Radiological Sciences, University of California, Davis, Davis, CA, United States
| |
Collapse
|
23
|
Forst DA, Restrepo JA, Gonzalez RG, Jones PS, Marshall MS. Case 7-2022: A 65-Year-Old Woman with Depression, Recurrent Falls, and Inability to Care for Herself. N Engl J Med 2022; 386:977-986. [PMID: 35263523 DOI: 10.1056/nejmcpc2115853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Deborah A Forst
- From the Departments of Neurology (D.A.F.), Psychiatry (J.A.R.), Radiology (R.G.G.), Neurosurgery (P.S.J.), and Pathology (M.S.M.), Massachusetts General Hospital, and the Departments of Neurology (D.A.F.), Psychiatry (J.A.R.), Radiology (R.G.G.), Neurosurgery (P.S.J.), and Pathology (M.S.M.), Harvard Medical School - both in Boston
| | - Judith A Restrepo
- From the Departments of Neurology (D.A.F.), Psychiatry (J.A.R.), Radiology (R.G.G.), Neurosurgery (P.S.J.), and Pathology (M.S.M.), Massachusetts General Hospital, and the Departments of Neurology (D.A.F.), Psychiatry (J.A.R.), Radiology (R.G.G.), Neurosurgery (P.S.J.), and Pathology (M.S.M.), Harvard Medical School - both in Boston
| | - R Gilberto Gonzalez
- From the Departments of Neurology (D.A.F.), Psychiatry (J.A.R.), Radiology (R.G.G.), Neurosurgery (P.S.J.), and Pathology (M.S.M.), Massachusetts General Hospital, and the Departments of Neurology (D.A.F.), Psychiatry (J.A.R.), Radiology (R.G.G.), Neurosurgery (P.S.J.), and Pathology (M.S.M.), Harvard Medical School - both in Boston
| | - Pamela S Jones
- From the Departments of Neurology (D.A.F.), Psychiatry (J.A.R.), Radiology (R.G.G.), Neurosurgery (P.S.J.), and Pathology (M.S.M.), Massachusetts General Hospital, and the Departments of Neurology (D.A.F.), Psychiatry (J.A.R.), Radiology (R.G.G.), Neurosurgery (P.S.J.), and Pathology (M.S.M.), Harvard Medical School - both in Boston
| | - Michael S Marshall
- From the Departments of Neurology (D.A.F.), Psychiatry (J.A.R.), Radiology (R.G.G.), Neurosurgery (P.S.J.), and Pathology (M.S.M.), Massachusetts General Hospital, and the Departments of Neurology (D.A.F.), Psychiatry (J.A.R.), Radiology (R.G.G.), Neurosurgery (P.S.J.), and Pathology (M.S.M.), Harvard Medical School - both in Boston
| |
Collapse
|
24
|
Mickeviciute GC, Valiuskyte M, Plattén M, Wszolek ZK, Andersen O, Danylaité Karrenbauer V, Ineichen BV, Granberg T. Neuroimaging phenotypes of CSF1R-related leukoencephalopathy: Systematic review, meta-analysis, and imaging recommendations. J Intern Med 2022; 291:269-282. [PMID: 34875121 DOI: 10.1111/joim.13420] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Colony-stimulating factor 1 receptor (CSF1R)-related leukoencephalopathy is a rare but fatal microgliopathy. The diagnosis is often delayed due to multifaceted symptoms that can mimic several other neurological disorders. Imaging provides diagnostic clues that help identify cases. The objective of this study was to integrate the literature on neuroimaging phenotypes of CSF1R-related leukoencephalopathy. A systematic review and meta-analysis were performed for neuroimaging findings of CSF1R-related leukoencephalopathy via PubMed, Web of Science, and Embase on 25 August 2021. The search included cases with confirmed CSF1R mutations reported under the previous terms hereditary diffuse leukoencephalopathy with spheroids, pigmentary orthochromatic leukodystrophy, and adult-onset leukoencephalopathy with axonal spheroids and pigmented glia. In 78 studies providing neuroimaging data, 195 cases were identified carrying CSF1R mutations in 14 exons and five introns. Women had a statistically significant earlier age of onset (p = 0.041, 40 vs 43 years). Mean delay between symptom onset and neuroimaging was 2.3 years. Main magnetic resonance imaging (MRI) findings were frontoparietal white matter lesions, callosal thinning, and foci of restricted diffusion. The hallmark computed tomography (CT) finding was white matter calcifications. Widespread cerebral hypometabolism and hypoperfusion were reported using positron emission tomography and single-photon emission computed tomography. In conclusion, CSF1R-related leukoencephalopathy is associated with progressive white matter lesions and brain atrophy that can resemble other neurodegenerative/-inflammatory disorders. However, long-lasting diffusion restriction and parenchymal calcifications are more specific findings that can aid the differential diagnosis. Native brain CT and brain MRI (with and without a contrast agent) are recommended with proposed protocols and pictorial examples are provided.
Collapse
Affiliation(s)
- Goda-Camille Mickeviciute
- Department of Physical Medicine and Rehabilitation, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Monika Valiuskyte
- Department of Skin and Venereal Diseases, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Michael Plattén
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.,School of Chemistry, Biotechnology, and Health, Royal Institute of Technology, Stockholm, Sweden
| | | | - Oluf Andersen
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Virginija Danylaité Karrenbauer
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Benjamin V Ineichen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Tobias Granberg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
25
|
Papapetropoulos S, Pontius A, Finger E, Karrenbauer V, Lynch DS, Brennan M, Zappia S, Koehler W, Schoels L, Hayer SN, Konno T, Ikeuchi T, Lund T, Orthmann-Murphy J, Eichler F, Wszolek ZK. Adult-Onset Leukoencephalopathy With Axonal Spheroids and Pigmented Glia: Review of Clinical Manifestations as Foundations for Therapeutic Development. Front Neurol 2022; 12:788168. [PMID: 35185751 PMCID: PMC8850408 DOI: 10.3389/fneur.2021.788168] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/14/2021] [Indexed: 12/11/2022] Open
Abstract
A comprehensive review of published literature was conducted to elucidate the genetics, neuropathology, imaging findings, prevalence, clinical course, diagnosis/clinical evaluation, potential biomarkers, and current and proposed treatments for adult-onset leukoencephalopathy with axonal spheroids and pigmented glia (ALSP), a rare, debilitating, and life-threatening neurodegenerative disorder for which disease-modifying therapies are not currently available. Details on potential efficacy endpoints for future interventional clinical trials in patients with ALSP and data related to the burden of the disease on patients and caregivers were also reviewed. The information in this position paper lays a foundation to establish an effective clinical rationale and address the clinical gaps for creation of a robust strategy to develop therapeutic agents for ALSP, as well as design future clinical trials, that have clinically meaningful and convergent endpoints.
Collapse
Affiliation(s)
- Spyros Papapetropoulos
- Vigil Neuroscience, Inc, Cambridge, MA, United States
- Massachusetts General Hospital, Boston, MA, United States
| | | | - Elizabeth Finger
- Clinical Neurological Sciences, Western University, London, ON, Canada
| | - Virginija Karrenbauer
- Neurology Medical Unit, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - David S. Lynch
- National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | | | | | | | - Ludger Schoels
- Department of Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research and Center of Neurology, University Hospital Tuebingen, Tuebingen, Germany
- German Research Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Stefanie N. Hayer
- Department of Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research and Center of Neurology, University Hospital Tuebingen, Tuebingen, Germany
- German Research Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Takuya Konno
- Brain Research Institute, Niigata University, Niigata, Japan
| | - Takeshi Ikeuchi
- Brain Research Institute, Niigata University, Niigata, Japan
| | - Troy Lund
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States
| | | | | | | |
Collapse
|
26
|
Goodison W, Baron F, Seary C, Murphy E, Lachmann R, Stevenson VL. Functional electrical stimulation to aid walking in patients with adrenomyeloneuropathy: A case study and observational series. JIMD Rep 2022; 63:11-18. [PMID: 35028266 PMCID: PMC8743338 DOI: 10.1002/jmd2.12254] [Citation(s) in RCA: 1] [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: 07/29/2021] [Revised: 09/22/2021] [Accepted: 10/06/2021] [Indexed: 11/17/2022] Open
Abstract
Adrenomyeloneuropathy (AMN) is a rare inherited condition where affected individuals develop slowly progressive spastic paraparesis with a gradual decline in walking ability. There is no cure for AMN and treatment focuses on supportive measures and aids. One treatment option is functional electrical stimulation (FES), a treatment, approved by The National Institute for Health and Care Excellence (NICE), for managing foot drop in upper motor neuron disorders. Limited evidence exists for its use in AMN patients. We describe the effects of FES in an individual case and more broadly within a cohort of 21 patients successfully treated with FES. Patients with AMN referred for FES typically report frequent falls (71%) and foot drop (57%) as the most common barriers to walking. When using FES, walking speed at baseline (0.70 m/s [SD = 0.2]) was maintained at the 2-year review (0.68 m/s [SD = 0.2]) with a persistent orthotic effect (improvement in walking speed when device on vs. off) seen from wearing FES over the same 2-year period (11%-19%). Patient walking satisfaction (visual analogue scale: 0 - very dissatisfied; 10 - very satisfied) was also greater when comparing no-FES versus FES over the same period (Year 1: 2.5 vs. 7.7; Year 2: 2.1 vs. 6.1). FES is not effective in all patients. Twelve patients referred found no benefit from the device; although there was no clear evidence, this was related to the degree of AMN associated peripheral neuropathy. However, FES is a safe, cost-effective treatment option and should be considered, along with assessment in a multidisciplinary clinic, for all AMN patients with walking difficulties.
Collapse
Affiliation(s)
- William Goodison
- National Hospital for Neurology and NeurosurgeryUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Fred Baron
- National Hospital for Neurology and NeurosurgeryUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Coralie Seary
- National Hospital for Neurology and NeurosurgeryUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Elaine Murphy
- National Hospital for Neurology and NeurosurgeryUniversity College London Hospitals NHS Foundation TrustLondonUK
- Charles Dent Metabolic UnitNational Hospital for Neurology and NeurosurgeryLondonUK
| | - Robin Lachmann
- National Hospital for Neurology and NeurosurgeryUniversity College London Hospitals NHS Foundation TrustLondonUK
- Charles Dent Metabolic UnitNational Hospital for Neurology and NeurosurgeryLondonUK
| | - Valerie L. Stevenson
- National Hospital for Neurology and NeurosurgeryUniversity College London Hospitals NHS Foundation TrustLondonUK
| |
Collapse
|
27
|
Mukherjee S, Ray SK. Inborn Errors of Metabolism Screening in Neonates: Current Perspective with Diagnosis and Therapy. Curr Pediatr Rev 2022; 18:274-285. [PMID: 35379134 DOI: 10.2174/1573396318666220404194452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/24/2022] [Accepted: 02/14/2022] [Indexed: 11/22/2022]
Abstract
Inborn errors of metabolism (IEMs) are rare hereditary or acquired disorders resulting from an enzymatic deformity in biochemical and metabolic pathways influencing proteins, fats, carbohydrate metabolism, or hampered some organelle function. Even though individual IEMs are uncommon, together, they represent a diverse class of genetic diseases, with new issues and disease mechanisms being portrayed consistently. IEM includes the extraordinary multifaceted nature of the fundamental pathophysiology, biochemical diagnosis, molecular level investigation, and complex therapeutic choices. However, due to the molecular, biochemical, and clinical heterogeneity of IEM, screening alone will not detect and diagnose all illnesses included in newborn screening programs. Early diagnosis prevents the emergence of severe clinical symptoms in the majority of IEM cases, lowering morbidity and death. The appearance of IEM disease can vary from neonates to adult people, with the more serious conditions showing up in juvenile stages along with significant morbidity as well as mortality. Advances in understanding the physiological, biochemical, and molecular etiologies of numerous IEMs by means of modalities, for instance, the latest molecular-genetic technologies, genome engineering knowledge, entire exome sequencing, and metabolomics, have prompted remarkable advancement in detection and treatment in modern times. In this review, we analyze the biochemical basis of IEMs, clinical manifestations, the present status of screening, ongoing advances, and efficiency of diagnosis in treatment for IEMs, along with prospects for further exploration as well as innovation.
Collapse
Affiliation(s)
- Sukhes Mukherjee
- Department of Biochemistry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh-462020, India
| | - Suman Kumar Ray
- Independent Researcher, Bhopal, Madhya Pradesh-462020, India
| |
Collapse
|
28
|
Koens LH, de Vries JJ, Vansenne F, de Koning TJ, Tijssen MAJ. How to detect late-onset inborn errors of metabolism in patients with movement disorders - A modern diagnostic approach. Parkinsonism Relat Disord 2021; 85:124-132. [PMID: 33745796 DOI: 10.1016/j.parkreldis.2021.02.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 12/15/2020] [Accepted: 02/24/2021] [Indexed: 12/30/2022]
Abstract
We propose a modern approach to assist clinicians to recognize and diagnose inborn errors of metabolism (IEMs) in adolescents and adults that present with a movement disorder. IEMs presenting in adults are still largely unexplored. These disorders receive little attention in neurological training and daily practice, and are considered complicated by many neurologists. Adult-onset presentations of IEMs differ from childhood-onset phenotypes, which may lead to considerable diagnostic delay. The identification of adult-onset phenotypes at the earliest stage of the disease is important, since early treatment may prevent or lessen further brain damage. Our approach is based on a systematic review of all papers that concerned movement disorders due to an IEM in patients of 16 years or older. Detailed clinical phenotyping is the diagnostic cornerstone of the approach. An underlying IEM should be suspected in particular in patients with more than one movement disorder, or in patients with additional neurological, psychiatric, or systemic manifestations. As IEMs are all genetic disorders, we recommend next-generation sequencing (NGS) as the first diagnostic approach to confirm an IEM. Biochemical tests remain the first choice in acute-onset or treatable IEMs that require rapid diagnosis, or to confirm the metabolic diagnosis after NGS results. With the use of careful and systematic clinical phenotyping combined with novel diagnostic approaches such as NGS, the diagnostic yield of late-onset IEMs will increase, in particular in patients with mild or unusual phenotypes.
Collapse
Affiliation(s)
- Lisette H Koens
- Department of Neurology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands; Expertise Center Movement Disorders Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands
| | - Jeroen J de Vries
- Department of Neurology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands; Expertise Center Movement Disorders Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands
| | - Fleur Vansenne
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands; Department of Genetics, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands
| | - Tom J de Koning
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands; Department of Genetics, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands; Department of Clinical Sciences and Department of Pediatrics, Lund University, Box 188, SE-221 00, Lund, Sweden
| | - Marina A J Tijssen
- Department of Neurology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands; Expertise Center Movement Disorders Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands.
| |
Collapse
|
29
|
Liu M, Zhang J, Zhang M. Bilateral Temporal Pole Involvement in Adult-Onset X-Linked Adrenoleukodystrophy. JAMA Neurol 2021; 78:367-368. [PMID: 33346786 DOI: 10.1001/jamaneurol.2020.4651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Mao Liu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Zhang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Min Zhang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
30
|
Severe Adulthood Leukoencephalopathy: Highlighting Brain Adaptability to Insult. Can J Neurol Sci 2020; 48:585-586. [PMID: 33161917 DOI: 10.1017/cjn.2020.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
31
|
De Cocker LJL, Castillo M. Distinctive diffusion-weighted imaging features in late-onset genetic leukoencephalopathies. Neuroradiology 2020; 63:153-156. [PMID: 32879996 DOI: 10.1007/s00234-020-02543-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 08/27/2020] [Indexed: 10/23/2022]
Abstract
Genetic leukoencephalopathies are inherited disorders characterized by progressive white matter involvement. Although most are paediatric conditions, late-onset adult leukoencephalopathies are being increasingly recognized. Adult leukoencephalopathies may present as neurodegenerative diseases with cognitive decline and motor symptoms. Similar to their paediatric counterparts, different adult leukoencephalopathies often have distinctive MRI appearances. In particular, DWI has been recently shown to demonstrate specific patterns of persistent diffusion restriction in several adult-onset leukoencephalopathies. As such, DWI may provide important clues to the diagnosis of adult-onset leukoencephalopathy. The purpose of this review is to discuss characteristic DWI features in some late-onset leukoencephalopathies.
Collapse
Affiliation(s)
- Laurens J L De Cocker
- Department of Radiology, AZ Maria Middelares, Buitenring Sint-Denijs 30, 9000, Ghent, Belgium.
| | - Mauricio Castillo
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| |
Collapse
|
32
|
Tabarestani S, Varriano B, Rawal S, France Morel C, Carmela Tartaglia M, Andrade DM. Seizures and early onset dementia: D2HGA1 inborn error of metabolism in adults. Ann Clin Transl Neurol 2020; 7:2052-2056. [PMID: 32857435 PMCID: PMC7545601 DOI: 10.1002/acn3.51162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/16/2020] [Accepted: 07/30/2020] [Indexed: 11/24/2022] Open
Abstract
D‐2‐hydroxyglutaric aciduria type 1 (D2HGA1) is a rare inherited metabolic disorder usually manifesting in infancy/early childhood with seizures and significant central nervous system involvement. We report two siblings with D2HGA1 presenting with mild intellectual disability, and the onset of seizures in adulthood. One of them was misdiagnosed as tuberous sclerosis due to her presentation and the presence of subependymal nodules on brain imaging. Both further developed early onset dementia. This report expands the phenotype of D2HGA1 to include late‐onset seizures and early onset dementia in adults.
Collapse
Affiliation(s)
- Sepideh Tabarestani
- Epilepsy Genetics Program, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Brenda Varriano
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada
| | - Sapna Rawal
- Department of Medical Imaging, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Chantal France Morel
- Department of Medicine, Fred A. Litwin Centre in Genetic Medicine, University Health Network & Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Maria Carmela Tartaglia
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, Toronto Western Hospital, Krembil Neuroscience Centre, University of Toronto, Toronto, Ontario, Canada
| | - Danielle M Andrade
- Epilepsy Genetics Program, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, Toronto Western Hospital, Krembil Neuroscience Centre, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
33
|
Foxley S, Wildenberg G, Sampathkumar V, Karczmar GS, Brugarolas P, Kasthuri N. Sensitivity to myelin using model-free analysis of the water resonance line-shape in postmortem mouse brain. Magn Reson Med 2020; 85:667-677. [PMID: 32783262 DOI: 10.1002/mrm.28440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/17/2020] [Accepted: 06/30/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE Dysmyelinating diseases are characterized by abnormal myelin formation and function. Such microstructural abnormalities in myelin have been demonstrated to produce measurable effects on the MR signal. This work examines these effects on measurements of voxel-wise, high-resolution water spectra acquired using a 3D echo-planar spectroscopic imaging (EPSI) pulse sequence from both postmortem fixed control mouse brains and a dysmyelination mouse brain model. METHODS Perfusion fixed, resected control (n = 5) and shiverer (n = 4) mouse brains were imaged using 3D-EPSI with 100 µm isotropic resolution. The free induction decay (FID) was sampled every 2.74 ms over 192 echoes, for a total sampling duration of 526.08 ms. Voxel-wise FIDs were Fourier transformed to produce water spectra with 1.9 Hz resolution. Spectral asymmetry was computed and compared between the two tissue types. RESULTS The water resonance is more asymmetrically broadened in the white matter of control mouse brain compared with dysmyelinated white matter. In control brain, this is modulated by and consistent with previously reported orientationally dependent effects of white matter relative to B0 . Similar sensitivity to orientation is observed in dysmyelinated white matter as well; however, the magnitude of the resonance asymmetry is much lower across all directions. CONCLUSION Results demonstrate that components of the spectra are specifically differentially affected by myelin concentration. This suggests that water proton spectra may be sensitive to the presence of myelin, and as such, could serve as a MRI-based biomarker of dysmyelinating disease, free of mathematical models.
Collapse
Affiliation(s)
- Sean Foxley
- Department of Radiology, University of Chicago, Chicago, Illinois, USA
| | - Gregg Wildenberg
- Department of Neurobiology, University of Chicago, Chicago, Illinois, USA
| | | | | | - Pedro Brugarolas
- Department of Radiology, Harvard Medical School, Boston, Maryland, USA.,Gordon Center for Medical Imaging, Massachusetts General Hospital, Boston, Maryland, USA
| | - Narayanan Kasthuri
- Department of Neurobiology, University of Chicago, Chicago, Illinois, USA
| |
Collapse
|
34
|
Abbasov FA, Bril EV, Zimnyakova OS, Marchenkova MS, Bashkov AN, Bogolepova EA, Davtyan AA, Lepsveridze LT, Semenov MS, Yusupova MM. [Multifocal brain lesions]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:100-109. [PMID: 32621475 DOI: 10.17116/jnevro2020120051100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Despite the current laboratory and instrumental approaches to the diagnosis, a patient with multiple brain lesions remains a difficult one. The reason is that these lesions can be caused by a variety of disorders, including rare ones and atypical forms. Distinguishing neoplastic lesions from non-neoplastic CNS disorders is crucial due to different treatment options. The authors report the case of a patient with multiple brain lesions, present a literature review of diseases to be differentially diagnosed with multifocal brain lesions and suggest a simple algorithm for the differential diagnosis. Timely clinical evaluation and a multidisciplinary approach are required for making a definitive diagnosis that is extremely important to start the appropriate therapy.
Collapse
Affiliation(s)
- F A Abbasov
- Burnazyan Federal Medical and Biophysical Center, Moscow, Russia
| | - E V Bril
- Burnazyan Federal Medical and Biophysical Center, Moscow, Russia
| | - O S Zimnyakova
- Burnazyan Federal Medical and Biophysical Center, Moscow, Russia
| | - M S Marchenkova
- Burnazyan Federal Medical and Biophysical Center, Moscow, Russia
| | - A N Bashkov
- Burnazyan Federal Medical and Biophysical Center, Moscow, Russia
| | - E A Bogolepova
- Burnazyan Federal Medical and Biophysical Center, Moscow, Russia
| | - A A Davtyan
- Burnazyan Federal Medical and Biophysical Center, Moscow, Russia
| | - L T Lepsveridze
- Burnazyan Federal Medical and Biophysical Center, Moscow, Russia
| | - M S Semenov
- Burnazyan Federal Medical and Biophysical Center, Moscow, Russia
| | - M M Yusupova
- Burnazyan Federal Medical and Biophysical Center, Moscow, Russia
| |
Collapse
|
35
|
Rauschecker AM, Rudie JD, Xie L, Wang J, Duong MT, Botzolakis EJ, Kovalovich AM, Egan J, Cook TC, Bryan RN, Nasrallah IM, Mohan S, Gee JC. Artificial Intelligence System Approaching Neuroradiologist-level Differential Diagnosis Accuracy at Brain MRI. Radiology 2020; 295:626-637. [PMID: 32255417 DOI: 10.1148/radiol.2020190283] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Although artificial intelligence (AI) shows promise across many aspects of radiology, the use of AI to create differential diagnoses for rare and common diseases at brain MRI has not been demonstrated. Purpose To evaluate an AI system for generation of differential diagnoses at brain MRI compared with radiologists. Materials and Methods This retrospective study tested performance of an AI system for probabilistic diagnosis in patients with 19 common and rare diagnoses at brain MRI acquired between January 2008 and January 2018. The AI system combines data-driven and domain-expertise methodologies, including deep learning and Bayesian networks. First, lesions were detected by using deep learning. Then, 18 quantitative imaging features were extracted by using atlas-based coregistration and segmentation. Third, these image features were combined with five clinical features by using Bayesian inference to develop probability-ranked differential diagnoses. Quantitative feature extraction algorithms and conditional probabilities were fine-tuned on a training set of 86 patients (mean age, 49 years ± 16 [standard deviation]; 53 women). Accuracy was compared with radiology residents, general radiologists, neuroradiology fellows, and academic neuroradiologists by using accuracy of top one, top two, and top three differential diagnoses in 92 independent test set patients (mean age, 47 years ± 18; 52 women). Results For accuracy of top three differential diagnoses, the AI system (91% correct) performed similarly to academic neuroradiologists (86% correct; P = .20), and better than radiology residents (56%; P < .001), general radiologists (57%; P < .001), and neuroradiology fellows (77%; P = .003). The performance of the AI system was not affected by disease prevalence (93% accuracy for common vs 85% for rare diseases; P = .26). Radiologists were more accurate at diagnosing common versus rare diagnoses (78% vs 47% across all radiologists; P < .001). Conclusion An artificial intelligence system for brain MRI approached overall top one, top two, and top three differential diagnoses accuracy of neuroradiologists and exceeded that of less-specialized radiologists. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Zaharchuk in this issue.
Collapse
Affiliation(s)
- Andreas M Rauschecker
- From the Department of Radiology & Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave, Room S-261, Box 0628, San Francisco, CA 94143-0628 (A.M.R.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104 (A.M.R., J.D.R., L.X., J.W., M.T.D., A.M.K., J.E., T.C.C., I.M.N., S.M., J.C.G.); Mecklenburg Radiology Associates, Charlotte, NC (E.J.B.); and Department of Radiology, University of Texas at Austin, Austin, TX (R.N.B.)
| | - Jeffrey D Rudie
- From the Department of Radiology & Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave, Room S-261, Box 0628, San Francisco, CA 94143-0628 (A.M.R.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104 (A.M.R., J.D.R., L.X., J.W., M.T.D., A.M.K., J.E., T.C.C., I.M.N., S.M., J.C.G.); Mecklenburg Radiology Associates, Charlotte, NC (E.J.B.); and Department of Radiology, University of Texas at Austin, Austin, TX (R.N.B.)
| | - Long Xie
- From the Department of Radiology & Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave, Room S-261, Box 0628, San Francisco, CA 94143-0628 (A.M.R.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104 (A.M.R., J.D.R., L.X., J.W., M.T.D., A.M.K., J.E., T.C.C., I.M.N., S.M., J.C.G.); Mecklenburg Radiology Associates, Charlotte, NC (E.J.B.); and Department of Radiology, University of Texas at Austin, Austin, TX (R.N.B.)
| | - Jiancong Wang
- From the Department of Radiology & Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave, Room S-261, Box 0628, San Francisco, CA 94143-0628 (A.M.R.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104 (A.M.R., J.D.R., L.X., J.W., M.T.D., A.M.K., J.E., T.C.C., I.M.N., S.M., J.C.G.); Mecklenburg Radiology Associates, Charlotte, NC (E.J.B.); and Department of Radiology, University of Texas at Austin, Austin, TX (R.N.B.)
| | - Michael Tran Duong
- From the Department of Radiology & Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave, Room S-261, Box 0628, San Francisco, CA 94143-0628 (A.M.R.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104 (A.M.R., J.D.R., L.X., J.W., M.T.D., A.M.K., J.E., T.C.C., I.M.N., S.M., J.C.G.); Mecklenburg Radiology Associates, Charlotte, NC (E.J.B.); and Department of Radiology, University of Texas at Austin, Austin, TX (R.N.B.)
| | - Emmanuel J Botzolakis
- From the Department of Radiology & Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave, Room S-261, Box 0628, San Francisco, CA 94143-0628 (A.M.R.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104 (A.M.R., J.D.R., L.X., J.W., M.T.D., A.M.K., J.E., T.C.C., I.M.N., S.M., J.C.G.); Mecklenburg Radiology Associates, Charlotte, NC (E.J.B.); and Department of Radiology, University of Texas at Austin, Austin, TX (R.N.B.)
| | - Asha M Kovalovich
- From the Department of Radiology & Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave, Room S-261, Box 0628, San Francisco, CA 94143-0628 (A.M.R.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104 (A.M.R., J.D.R., L.X., J.W., M.T.D., A.M.K., J.E., T.C.C., I.M.N., S.M., J.C.G.); Mecklenburg Radiology Associates, Charlotte, NC (E.J.B.); and Department of Radiology, University of Texas at Austin, Austin, TX (R.N.B.)
| | - John Egan
- From the Department of Radiology & Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave, Room S-261, Box 0628, San Francisco, CA 94143-0628 (A.M.R.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104 (A.M.R., J.D.R., L.X., J.W., M.T.D., A.M.K., J.E., T.C.C., I.M.N., S.M., J.C.G.); Mecklenburg Radiology Associates, Charlotte, NC (E.J.B.); and Department of Radiology, University of Texas at Austin, Austin, TX (R.N.B.)
| | - Tessa C Cook
- From the Department of Radiology & Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave, Room S-261, Box 0628, San Francisco, CA 94143-0628 (A.M.R.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104 (A.M.R., J.D.R., L.X., J.W., M.T.D., A.M.K., J.E., T.C.C., I.M.N., S.M., J.C.G.); Mecklenburg Radiology Associates, Charlotte, NC (E.J.B.); and Department of Radiology, University of Texas at Austin, Austin, TX (R.N.B.)
| | - R Nick Bryan
- From the Department of Radiology & Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave, Room S-261, Box 0628, San Francisco, CA 94143-0628 (A.M.R.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104 (A.M.R., J.D.R., L.X., J.W., M.T.D., A.M.K., J.E., T.C.C., I.M.N., S.M., J.C.G.); Mecklenburg Radiology Associates, Charlotte, NC (E.J.B.); and Department of Radiology, University of Texas at Austin, Austin, TX (R.N.B.)
| | - Ilya M Nasrallah
- From the Department of Radiology & Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave, Room S-261, Box 0628, San Francisco, CA 94143-0628 (A.M.R.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104 (A.M.R., J.D.R., L.X., J.W., M.T.D., A.M.K., J.E., T.C.C., I.M.N., S.M., J.C.G.); Mecklenburg Radiology Associates, Charlotte, NC (E.J.B.); and Department of Radiology, University of Texas at Austin, Austin, TX (R.N.B.)
| | - Suyash Mohan
- From the Department of Radiology & Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave, Room S-261, Box 0628, San Francisco, CA 94143-0628 (A.M.R.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104 (A.M.R., J.D.R., L.X., J.W., M.T.D., A.M.K., J.E., T.C.C., I.M.N., S.M., J.C.G.); Mecklenburg Radiology Associates, Charlotte, NC (E.J.B.); and Department of Radiology, University of Texas at Austin, Austin, TX (R.N.B.)
| | - James C Gee
- From the Department of Radiology & Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave, Room S-261, Box 0628, San Francisco, CA 94143-0628 (A.M.R.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104 (A.M.R., J.D.R., L.X., J.W., M.T.D., A.M.K., J.E., T.C.C., I.M.N., S.M., J.C.G.); Mecklenburg Radiology Associates, Charlotte, NC (E.J.B.); and Department of Radiology, University of Texas at Austin, Austin, TX (R.N.B.)
| |
Collapse
|
36
|
Slama MCC, Torre M, Shatzman SM, Suh J, Krier JB, De Girolami U, Kimbrough DJ, Milligan TA. Clinical Reasoning: A 42-year-old woman with progressive cognitive difficulties and gait imbalance. Neurology 2020; 94:e1219-e1226. [PMID: 32107324 DOI: 10.1212/wnl.0000000000009099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Michaël C C Slama
- From the Department of Neurology (M.C.C.S., S.M.S., J.S., D.J.K., T.A.M.), Department of Pathology (M.T., U.D.G.), and Division of Genetics (J.B.K.), Department of Medicine, Brigham and Women's Hospital; and Department of Neurology (M.C.C.S., S.M.S., J.S.), Massachusetts General Hospital, Harvard Medical School, Boston.
| | - Matthew Torre
- From the Department of Neurology (M.C.C.S., S.M.S., J.S., D.J.K., T.A.M.), Department of Pathology (M.T., U.D.G.), and Division of Genetics (J.B.K.), Department of Medicine, Brigham and Women's Hospital; and Department of Neurology (M.C.C.S., S.M.S., J.S.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Stephanie M Shatzman
- From the Department of Neurology (M.C.C.S., S.M.S., J.S., D.J.K., T.A.M.), Department of Pathology (M.T., U.D.G.), and Division of Genetics (J.B.K.), Department of Medicine, Brigham and Women's Hospital; and Department of Neurology (M.C.C.S., S.M.S., J.S.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Joome Suh
- From the Department of Neurology (M.C.C.S., S.M.S., J.S., D.J.K., T.A.M.), Department of Pathology (M.T., U.D.G.), and Division of Genetics (J.B.K.), Department of Medicine, Brigham and Women's Hospital; and Department of Neurology (M.C.C.S., S.M.S., J.S.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Joel B Krier
- From the Department of Neurology (M.C.C.S., S.M.S., J.S., D.J.K., T.A.M.), Department of Pathology (M.T., U.D.G.), and Division of Genetics (J.B.K.), Department of Medicine, Brigham and Women's Hospital; and Department of Neurology (M.C.C.S., S.M.S., J.S.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Umberto De Girolami
- From the Department of Neurology (M.C.C.S., S.M.S., J.S., D.J.K., T.A.M.), Department of Pathology (M.T., U.D.G.), and Division of Genetics (J.B.K.), Department of Medicine, Brigham and Women's Hospital; and Department of Neurology (M.C.C.S., S.M.S., J.S.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Dorlan J Kimbrough
- From the Department of Neurology (M.C.C.S., S.M.S., J.S., D.J.K., T.A.M.), Department of Pathology (M.T., U.D.G.), and Division of Genetics (J.B.K.), Department of Medicine, Brigham and Women's Hospital; and Department of Neurology (M.C.C.S., S.M.S., J.S.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Tracey A Milligan
- From the Department of Neurology (M.C.C.S., S.M.S., J.S., D.J.K., T.A.M.), Department of Pathology (M.T., U.D.G.), and Division of Genetics (J.B.K.), Department of Medicine, Brigham and Women's Hospital; and Department of Neurology (M.C.C.S., S.M.S., J.S.), Massachusetts General Hospital, Harvard Medical School, Boston
| |
Collapse
|
37
|
De Cocker LJL. Persistent Diffusion-weighted Imaging Abnormalities in Adult Leukodystrophies. Radiographics 2019; 39:1231-1232. [PMID: 31283458 DOI: 10.1148/rg.2019190028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|