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Xu L, Zhong M, Yang Y, Wang M, An N, Xu X, Zhu Y, Li Z, Chen H, Zhao R, Zheng X. Adult-onset vanishing white matter in a patient with EIF2B3 variants misdiagnosed as multiple sclerosis. Neurol Sci 2021; 43:2659-2667. [PMID: 34755279 DOI: 10.1007/s10072-021-05710-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/29/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Vanishing white matter (VWM) is an autosomal recessive disorder characterized by childhood ataxia with central hypomyelination. Adult-onset VWM should be considered as a differential diagnosis for suspected cases of multiple sclerosis (MS). METHODS Targeted region sequencing (TRS) and Sanger sequencing validation were performed to identify and validate the likely pathogenic mutations in a family with VWM. RESULTS The main clinical manifestations of the proband included decreased vision and sleepiness accompanied by atrophy of the corpus callosum, affected inner rim of the corpus callosum, decreased apparent diffusion coefficient value or persistent hyperintensity-diffusion-weighted imaging, atrophied optic nerve, and no recordable visual evoked potentials. Due to the slow development and atypical VWM image features, MS was initially suspected. After prednisone was administered, the patient's condition did not improve significantly, and other diseases were considered. The TRS and Sanger sequencing identified compound heterozygous mutations of EIF2B3 in the proband; c.965C > G /p.Ala322Gly in exon 8 and c.130G > A/p.Glu44Lys in exon 2 were missense mutations inherited from the mother and father, respectively. The proband's oldest brother had the same compound heterozygous mutations but showed no symptoms. CONCLUSION This is the first report of adult-onset VWM in a Chinese family. Initially, MS was suspected, and genetic testing confirmed the diagnosis of VWM. This study may further broaden the clinical spectrum of EIF2B3, thus providing a foundation for further research on the pathogenesis and genetic therapy for VWM.
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Affiliation(s)
- Lulu Xu
- Department of Geriatric Medicine, the Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266000, Shandong, China
| | - Meixiang Zhong
- Department of Geriatric Medicine, the Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266000, Shandong, China
| | - Yuyuan Yang
- Department of Geriatric Medicine, the Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266000, Shandong, China
| | - Meng Wang
- Department of Geriatric Medicine, the Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266000, Shandong, China
| | - Nina An
- Department of Geriatric Medicine, the Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266000, Shandong, China
| | - Xin Xu
- Department of Neurology, the Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266000, Shandong, China
| | - Yufeng Zhu
- Department of Graduate School, Qinghai University, Xining, 810016, Qinghai, China
| | - Zengwen Li
- Department of Radiology, Gaomi Municipal Hospital, Gaomi, 261500, Shandong, China
| | - Huili Chen
- Department of Ophthalmology, Yijishan Hospital of Wannan Medical College, Wuhu, 241000, China
| | - Renliang Zhao
- Department of Neurology, the Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266000, Shandong, China.
| | - Xueping Zheng
- Department of Geriatric Medicine, the Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266000, Shandong, China.
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Hsu CL, Iwanowski P, Hsu CH, Kozubski W. Genetic diseases mimicking multiple sclerosis. Postgrad Med 2021; 133:728-749. [PMID: 34152933 DOI: 10.1080/00325481.2021.1945898] [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: 10/21/2022]
Abstract
Multiple sclerosis (MS) is an inflammatory neurodegenerative disorder manifesting as gradual or progressive loss of neurological functions. Most patients present with relapsing-remitting disease courses. Extensive research over recent decades has expounded our insights into the presentations and diagnostic features of MS. Groups of genetic diseases, CADASIL and leukodystrophies, for example, have been frequently misdiagnosed with MS due to some overlapping clinical and radiological features. The delayed identification of these diseases in late adulthood can lead to severe neurological complications. Herein we discuss genetic diseases that have the potential to mimic multiple sclerosis, with highlights on clinical identification and practicing pearls that may aid physicians in recognizing MS-mimics with genetic background in clinical settings.
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Affiliation(s)
- Chueh Lin Hsu
- Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
| | - Piotr Iwanowski
- Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
| | - Chueh Hsuan Hsu
- Department of Neurology, China Medical University, Taichung, Taiwan
| | - Wojciech Kozubski
- Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
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Accogli A, Brais B, Tampieri D, La Piana R. Long-Standing Psychiatric Features as the Only Clinical Presentation of Vanishing White Matter Disease. J Neuropsychiatry Clin Neurosci 2020; 31:276-279. [PMID: 31046592 DOI: 10.1176/appi.neuropsych.18110279] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Andrea Accogli
- The Departments of Neurology and Neurosurgery and Pediatrics, McGill University, Montreal (Accogli); DINOGMI-Università di Genova, Italy (Accogli); IRCCS Ospedale Policlinico San Martino, Genova, Italy (Accogli); the Laboratory of Neurogenetics of Motion, Montreal Neurological Institute, McGill University, Montreal (Brais, La Piana); the Department of Human Genetics, McGill University, Montreal (Brais); the Department of Diagnostic Radiology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada (Tampieri); and the Department of Neuroradiology, Montreal Neurological Hospital and Institute, McGill University, Montreal (La Piana)
| | - Bernard Brais
- The Departments of Neurology and Neurosurgery and Pediatrics, McGill University, Montreal (Accogli); DINOGMI-Università di Genova, Italy (Accogli); IRCCS Ospedale Policlinico San Martino, Genova, Italy (Accogli); the Laboratory of Neurogenetics of Motion, Montreal Neurological Institute, McGill University, Montreal (Brais, La Piana); the Department of Human Genetics, McGill University, Montreal (Brais); the Department of Diagnostic Radiology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada (Tampieri); and the Department of Neuroradiology, Montreal Neurological Hospital and Institute, McGill University, Montreal (La Piana)
| | - Donatella Tampieri
- The Departments of Neurology and Neurosurgery and Pediatrics, McGill University, Montreal (Accogli); DINOGMI-Università di Genova, Italy (Accogli); IRCCS Ospedale Policlinico San Martino, Genova, Italy (Accogli); the Laboratory of Neurogenetics of Motion, Montreal Neurological Institute, McGill University, Montreal (Brais, La Piana); the Department of Human Genetics, McGill University, Montreal (Brais); the Department of Diagnostic Radiology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada (Tampieri); and the Department of Neuroradiology, Montreal Neurological Hospital and Institute, McGill University, Montreal (La Piana)
| | - Roberta La Piana
- The Departments of Neurology and Neurosurgery and Pediatrics, McGill University, Montreal (Accogli); DINOGMI-Università di Genova, Italy (Accogli); IRCCS Ospedale Policlinico San Martino, Genova, Italy (Accogli); the Laboratory of Neurogenetics of Motion, Montreal Neurological Institute, McGill University, Montreal (Brais, La Piana); the Department of Human Genetics, McGill University, Montreal (Brais); the Department of Diagnostic Radiology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada (Tampieri); and the Department of Neuroradiology, Montreal Neurological Hospital and Institute, McGill University, Montreal (La Piana)
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Huber T, Herwerth M, Alberts E, Kirschke JS, Zimmer C, Ilg R. Automated segmentation reveals silent radiographic progression in adult-onset vanishing white-matter disease. Neuroradiol J 2016; 30:5-9. [PMID: 27864579 DOI: 10.1177/1971400916678222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Adult-onset vanishing white-matter disease (VWM) is a rare autosomal recessive disease with neurological symptoms such as ataxia and paraparesis, showing extensive white-matter hyperintensities (WMH) on magnetic resonance (MR) imaging. Besides symptom-specific scores like the International Cooperative Ataxia Rating Scale (ICARS), there is no established tool to monitor disease progression. Because of extensive WMH, visual comparison of MR images is challenging. Here, we report the results of an automated method of segmentation to detect alterations in T2-weighted fluid-attenuated-inversion-recovery (FLAIR) sequences in a one-year follow-up study of a clinically stable patient with genetically diagnosed VWM. Signal alterations in MR imaging were quantified with a recently published WMH segmentation method by means of extreme value distribution (EVD). Our analysis revealed progressive FLAIR alterations of 5.84% in the course of one year, whereas no significant WMH change could be detected in a stable multiple sclerosis (MS) control group. This result demonstrates that automated EVD-based segmentation allows a precise and rapid quantification of extensive FLAIR alterations like in VWM and might be a powerful tool for the clinical and scientific monitoring of degenerative white-matter diseases and potential therapeutic interventions.
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Affiliation(s)
- Thomas Huber
- 1 Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Marina Herwerth
- 2 Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Esther Alberts
- 1 Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Jan S Kirschke
- 1 Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Claus Zimmer
- 1 Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Ruediger Ilg
- 2 Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Germany.,3 Department of Neurology, Asklepios Stadtklinik Bad Toelz, Germany
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Ayrignac X, Menjot de Champfleur N, Menjot de Champfleur S, Carra-Dallière C, Deverdun J, Corlobe A, Labauge P. Brain magnetic resonance imaging helps to differentiate atypical multiple sclerosis with cavitary lesions and vanishing white matter disease. Eur J Neurol 2016; 23:995-1000. [DOI: 10.1111/ene.12931] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 11/04/2015] [Indexed: 02/01/2023]
Affiliation(s)
- X. Ayrignac
- Department of Neurology; Montpellier University Hospital; Gui de Chauliac Hospital; Montpellier France
- Neuroscience Institute of Montpellier (INM); Inserm UMR1051; Saint-Eloi Hospital; Montpellier France
| | - N. Menjot de Champfleur
- Department of Neuroradiology; Montpellier University Hospital; Gui de Chauliac Hospital; Montpellier France
- I2FH; Institut d'Imagerie Fonctionnelle Humaine; Montpellier University Hospital; Montpellier France
| | - S. Menjot de Champfleur
- Department of Neuroradiology; Montpellier University Hospital; Gui de Chauliac Hospital; Montpellier France
- I2FH; Institut d'Imagerie Fonctionnelle Humaine; Montpellier University Hospital; Montpellier France
| | - C. Carra-Dallière
- Department of Neurology; Montpellier University Hospital; Gui de Chauliac Hospital; Montpellier France
| | - J. Deverdun
- Department of Neuroradiology; Montpellier University Hospital; Gui de Chauliac Hospital; Montpellier France
- I2FH; Institut d'Imagerie Fonctionnelle Humaine; Montpellier University Hospital; Montpellier France
| | - A. Corlobe
- Department of Neurology; Nimes University Hospital; Gui de Chauliac Hospital; Montpellier France
| | - P. Labauge
- Department of Neurology; Montpellier University Hospital; Gui de Chauliac Hospital; Montpellier France
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