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Driskill E, Zhang Z, Chi J, Cui Q. Increased Rate of Complications Following Total Knee Arthroplasty in Patients Who Have Polymyositis. J Arthroplasty 2024; 39:1731-1735. [PMID: 38211729 DOI: 10.1016/j.arth.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/14/2023] [Accepted: 01/02/2024] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Polymyositis (PM) is a systemic connective tissue disorder that can lead to early onset degenerative joint disease and a need for total knee arthroplasty (TKA). Outcomes of TKA in patients who have PM are not well documented in the literature. The purpose of this study was to evaluate PM as a risk factor for complications after TKA. METHODS Using a national private payer insurance database from 2010 to 2022, PM patients undergoing primary TKA were compared to 10:1 matched controls based on age, sex, and comorbidities. Multivariable logistic regression analyses were done for medical complications up to 90 days and surgical complications up to 2 years. 90-day emergency department visits and inpatient readmissions were also documented. A total of 25,039 patients undergoing primary TKA were queried, of which 2,290 had PM. RESULTS Compared to the matched controls, patients who had PM demonstrated higher rates of medical and surgical complications, including pulmonary embolism (1.0% versus 0.5%, P = .001), cerebrovascular accident (1.3% versus 0.7%, P = .002), wound complications (3.4% versus 2.1%, P < .001), and periprosthetic joint infection at 1 year (1.7% versus 1.3%, P = .042) and 2 years (2.6% versus 1.9%, P = .006). Patients who had PM displayed elevated 90-day emergency department (14.9% versus 13.3%, P = .032) and hospital readmission rate (7.1% versus 4.8%, P < .001). CONCLUSIONS Patients who have PM are at higher risks of postoperative medical and surgical complications, including pulmonary embolism, cerebrovascular accident, wound complication, and periprosthetic joint infection. Given these results, it is helpful for orthopedic surgeons and patients to consider these risks when considering TKA for patients who have PM.
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Affiliation(s)
- Elizabeth Driskill
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Zhichang Zhang
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, Virginia; Department of Orthopaedic Surgery, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan, China
| | - Jialun Chi
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Quanjun Cui
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
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2
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Bar O, Ebenau L, Weiner K, Mintz M, Boles RG. Whole exome/genome sequencing in cyclic vomiting syndrome reveals multiple candidate genes, suggesting a model of elevated intracellular cations and mitochondrial dysfunction. Front Neurol 2023; 14:1151835. [PMID: 37234784 PMCID: PMC10208274 DOI: 10.3389/fneur.2023.1151835] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/03/2023] [Indexed: 05/28/2023] Open
Abstract
Objective To utilize whole exome or genome sequencing and the scientific literature for identifying candidate genes for cyclic vomiting syndrome (CVS), an idiopathic migraine variant with paroxysmal nausea and vomiting. Methods A retrospective chart review of 80 unrelated participants, ascertained by a quaternary care CVS specialist, was conducted. Genes associated with paroxysmal symptoms were identified querying the literature for genes associated with dominant cases of intermittent vomiting or both discomfort and disability; among which the raw genetic sequence was reviewed. "Qualifying" variants were defined as coding, rare, and conserved. Additionally, "Key Qualifying" variants were Pathogenic/Likely Pathogenic, or "Clinical" based upon the presence of a corresponding diagnosis. Candidate association to CVS was based on a point system. Results Thirty-five paroxysmal genes were identified per the literature review. Among these, 12 genes were scored as "Highly likely" (SCN4A, CACNA1A, CACNA1S, RYR2, TRAP1, MEFV) or "Likely" (SCN9A, TNFRSF1A, POLG, SCN10A, POGZ, TRPA1) CVS related. Nine additional genes (OTC, ATP1A3, ATP1A2, GFAP, SLC2A1, TUBB3, PPM1D, CHAMP1, HMBS) had sufficient evidence in the literature but not from our study participants. Candidate status for mitochondrial DNA was confirmed by the literature and our study data. Among the above-listed 22 CVS candidate genes, a Key Qualifying variant was identified in 31/80 (34%), and any Qualifying variant was present in 61/80 (76%) of participants. These findings were highly statistically significant (p < 0.0001, p = 0.004, respectively) compared to an alternative hypothesis/control group regarding brain neurotransmitter receptor genes. Additional, post-analyses, less-intensive review of all genes (exome) outside our paroxysmal genes identified 13 additional genes as "Possibly" CVS related. Conclusion All 22 CVS candidate genes are associated with either cation transport or energy metabolism (14 directly, 8 indirectly). Our findings suggest a cellular model in which aberrant ion gradients lead to mitochondrial dysfunction, or vice versa, in a pathogenic vicious cycle of cellular hyperexcitability. Among the non-paroxysmal genes identified, 5 are known causes of peripheral neuropathy. Our model is consistent with multiple current hypotheses of CVS.
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Affiliation(s)
- Omri Bar
- NeurAbilities Healthcare, Voorhees, NJ, United States
| | - Laurie Ebenau
- NeurAbilities Healthcare, Voorhees, NJ, United States
| | - Kellee Weiner
- NeurAbilities Healthcare, Voorhees, NJ, United States
| | - Mark Mintz
- NeurAbilities Healthcare, Voorhees, NJ, United States
| | - Richard G. Boles
- NeurAbilities Healthcare, Voorhees, NJ, United States
- NeuroNeeds, Old Lyme, CT, United States
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3
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Xiong A, Hu Z, Zhou S, Qiang Y, Song Z, Chen H, Xiang Q, Zhang Y, Cao Y, Cui H, Luo J, Wang Y, Yang Y, Cui B, Li M, Shuai S. Cardiovascular events in adult polymyositis and dermatomyositis: a meta-analysis of observational studies. Rheumatology (Oxford) 2021; 61:2728-2739. [PMID: 34791063 DOI: 10.1093/rheumatology/keab851] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/11/2021] [Accepted: 11/06/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES We aimed to review whether polymyositis (PM) and dermatomyositis (DM) patients have an increased cardiovascular (CV) risk, including ischaemic heart disease (IHD), cerebrovascular accidents (CVA), and venous thromboembolism (VTE). METHODS We searched PubMed, Embase, and the Cochrane database for relevant studies from inception to February 2021. RESULTS Twenty-two studies comprising 25,433 patients were included. With PM/DM versus general populations, the risk was significantly increased for CV events (relative risk (RR)=2.37, 95%CI:1.86-3.02). The RR of CV events for males with PM/DM was higher than for females (RR = 1.43; 95%CI:1.17-1.74). PM/DM patients followed for one to five years had a significantly higher CV risk than those followed for five to ten years (RR = 3.51, 95%CI:1.95-6.32). The risk was increased for North Americans (RR = 4.28, 95%CI:2.57-7.11), Europeans (RR = 2.29, 95%CI:1.58-3.31), and Asians (RR = 2.03, 95%CI:1.41-2.90). Our meta-analysis found that the elevated CV event risk was related to PM (RR = 2.35, 95%CI:1.51-3.66) and DM (RR = 2.55, 95%CI:1.66-3.93). Subgroup analyses showed that the risk was significantly increased for IHD (RR = 1.76, 95%CI:1.40-2.21), CVA morbidity (RR = 1.31, 95%CI:1.03-1.67), and ischaemic stroke (IS) (RR = 1.47, 95%CI:1.26-1.73), with no statistically significant increased risk of haemorrhagic stroke mortality (RR = 1.43, 95%CI:0.92-2.21). The CV event risk was increased for VTE (RR = 4.60, 95%CI:3.17-6.66), deep venous thrombosis (DVT) (RR = 5.53, 95%CI:3.25-9.39), and pulmonary embolism (PE) (RR = 5.26, 95%CI:2.62-10.55). CONCLUSION This meta-analysis found that PM/DM patients had a ∼2.37 times increased CV risk, particularly males diagnosed in the previous five years. PM/DM may be an independent risk factor for developing IHD, IS, DVT, and PE.
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Affiliation(s)
- Anji Xiong
- Department of Rheumatology and Immunology, Nanchong Central Hospital, Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China.,Inflammation and Immunology Key Laboratory of Nanchong City, Sichuan, China
| | - Ziyi Hu
- Department of Rheumatology and Immunology, Nanchong Central Hospital, Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China
| | - Shifeng Zhou
- Department of Rheumatology and Immunology, Nanchong Central Hospital, Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China
| | - Yiying Qiang
- Department of Rheumatology and Immunology, Nanchong Central Hospital, Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China
| | - Zhuoyao Song
- Department of Rheumatology and Immunology, Nanchong Central Hospital, Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China
| | - Huini Chen
- Department of Rheumatology and Immunology, Nanchong Central Hospital, Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China
| | - Qilang Xiang
- Department of Rheumatology and Immunology, Nanchong Central Hospital, Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China
| | - Yan Zhang
- Department of Rheumatology and Immunology, Nanchong Central Hospital, Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China
| | - Yuzi Cao
- Department of Rheumatology and Immunology, Nanchong Central Hospital, Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China
| | - Hongxu Cui
- Department of Rheumatology and Immunology, Nanchong Central Hospital, Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China
| | - Jie Luo
- Department of Rheumatology and Immunology, Nanchong Central Hospital, Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China
| | - Ye Wang
- Department of Rheumatology and Immunology, Nanchong Central Hospital, Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China
| | - Yuan Yang
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Beibei Cui
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Menglan Li
- Department of Rheumatology and Immunology, Nanchong Central Hospital, Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China.,Inflammation and Immunology Key Laboratory of Nanchong City, Sichuan, China
| | - Shiquan Shuai
- Department of Rheumatology and Immunology, Nanchong Central Hospital, Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, China.,Inflammation and Immunology Key Laboratory of Nanchong City, Sichuan, China
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Abstract
Maternally mitochondrial dysfunction includes a heterogeneous group of genetic disorders which leads to the impairment of the final common pathway of energy metabolism. Coronary heart disease and coronary venous disease are two important clinical manifestations of mitochondrial dysfunction due to abnormality in the setting of underlying pathways. Mitochondrial dysfunction can lead to cardiomyopathy, which is involved in the onset of acute cardiac and pulmonary failure. Mitochondrial diseases present other cardiac manifestations such as left ventricular noncompaction and cardiac conduction disease. Different clinical findings from mitochondrial dysfunction originate from different mtDNA mutations, and this variety of clinical symptoms poses a diagnostic challenge for cardiologists. Heart transplantation may be a good treatment, but it is not always possible, and other complications of the disease, such as mitochondrial encephalopathy, lactic acidosis, and stroke-like syndrome, should be considered. To diagnose and treat most mitochondrial disorders, careful cardiac, neurological, and molecular studies are needed. In this study, we looked at molecular genetics of MIDs and cardiac manifestations in patients with mitochondrial dysfunction.
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5
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Similar risk of cardiovascular events in idiopathic inflammatory myopathy and rheumatoid arthritis in the first 5 years after diagnosis. Clin Rheumatol 2020; 40:231-238. [PMID: 32572804 PMCID: PMC7782367 DOI: 10.1007/s10067-020-05237-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/06/2020] [Accepted: 06/10/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To estimate the incidence of cardiovascular (CV) events in idiopathic inflammatory myopathy (IIM) compared to patients with rheumatoid arthritis (RA) and the general population. To explore the contribution of traditional CV risk factors to any difference observed. METHODS A retrospective matched population-based cohort study was conducted using UK Clinical Practice Research Datalink (CPRD) from 1987 to 2013. The incidence of CV events was calculated for each cohort over time and compared using Cox proportional hazards models. Multivariable analyses were used to adjust for traditional CV risk factors. RESULTS A total of 603 patients with IIM 4047 RA and 4061 healthy controls were included. The rate of CV events in IIM was significantly greater than healthy controls [hazard ratio (HR) 1.47 (95% confidence interval (CI) 1.18-1.83)] and remained significant after adjustment for CV risk factors [HR 1.38 (95% CI 1.11-1.72)]. Risk was similar between IIM and RA [HR 1.01 (95% CI 0.78-1.31)]. The rate of myocardial infarction [HR 1.61 (95% CI 1.27-2.04)] but not stroke [HR 0.92 (95% CI 0.59-1.44)] was significantly greater in IIM compared to healthy controls. After the first 5 years, the rate of CV events for RA remained significantly greater compared to the control group, but appeared to return to that of the healthy controls in the IIM group. CONCLUSION IIM is associated with an increased risk of CV events in the first 5 years after diagnosis similar to that of RA. Beyond 5 years, the risk appears to return to that of the general population in IIM but not RA. Key Points • The excess risk of cardiovascular events in IIM is similar to that found in RA. • The excess risk of cardiovascular events is greatest in the first 5 years after diagnosis.
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Finsterer J, Zarrouk-Mahjoub S. Is vascular compromise during stroke-like episodes primary or secondary? Acta Neurol Belg 2020; 120:439-440. [PMID: 30056482 DOI: 10.1007/s13760-018-0997-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 06/07/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Josef Finsterer
- Neurological Department, Krankenanstalt Rudolfstiftung, 1030, Vienna, Austria.
| | - Sinda Zarrouk-Mahjoub
- University of Tunis El Manar and Genomics Platform, Pasteur Institute of Tunis, Tunis, Tunisia
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7
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8
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Finsterer J. Consider Stroke-Like Episodes as a Differential in Children with Acute Hemiparesis. J Neurosci Rural Pract 2019; 10:379-380. [PMID: 31001042 PMCID: PMC6454968 DOI: 10.4103/jnrp.jnrp_357_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Josef Finsterer
- KAR, Messerli Institute, Veterinary University of Vienna, Austria
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9
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Ramakrishna MP, Pavithran PV, Bhavani N, Kumar H, Nair V, Menon AS, Menon UV, Abraham N. Mitochondrial Diabetes: More Than Just Hyperglycemia. Clin Diabetes 2019; 37:298-301. [PMID: 31371866 PMCID: PMC6640889 DOI: 10.2337/cd18-0090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Manjunath P Ramakrishna
- Department of Endocrinology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Praveen V Pavithran
- Department of Endocrinology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Nisha Bhavani
- Department of Endocrinology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Harish Kumar
- Department of Endocrinology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Vasantha Nair
- Department of Endocrinology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Arun S Menon
- Department of Endocrinology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Usha V Menon
- Department of Endocrinology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Nithya Abraham
- Department of Endocrinology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
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10
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Finsterer J. Mitochondrial metabolic stroke: Phenotype and genetics of stroke-like episodes. J Neurol Sci 2019; 400:135-141. [PMID: 30946993 DOI: 10.1016/j.jns.2019.03.021] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 02/07/2023]
Abstract
Stroke-like episodes (SLEs) are the hallmark of mitochondrial encephalopathy with lactic acidosis and stroke-like episode (MELAS) syndrome but rarely occur also in other specific or nonspecific mitochondrial disorders. Pathophysiologically, SLLs are most likely due to a regional disruption of the blood-brain barrier triggered by the underlying metabolic defect, epileptic activity, drugs, or other factors. SLEs manifest clinically with a plethora of cerebral manifestations, which not only include features typically seen in ischemic stroke, but also headache, epilepsy, ataxia, visual impairment, vomiting, and psychiatric abnormalities. The morphological correlate of a SLE is the stroke-like lesion (SLL), best visualised on multimodal MRI. In the acute stages, a SLL presents as vasogenic edema but may be mixed up with cytotoxic components. Additionally, SLLs are characterized by hyperperfusion on perfusion studies. In the chronic stage, SLLs present with a colorful picture before they completely disappear, or end up as white matter lesion, cyst, laminar cortical necrosis, focal atrophy, or as toenail sign. Treatment of SLLs is symptomatic and relies on recommendations by experts. Beneficial effects have been reported with nitric-oxide precursors, antiepileptic drugs, antioxidants, the ketogenic diet, and steroids. Lot of research is still needed to uncover the enigma SLE/SLL.
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Affiliation(s)
- Josef Finsterer
- Krankenanstalt Rudolfstiftung, Messerli Institute, Vienna, Austria.
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11
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Finsterer J, Zarrouk-Mahjoub S. Diagnosing MELAS requires clinical and genetic information. J Clin Neurosci 2019; 61:325-326. [DOI: 10.1016/j.jocn.2018.10.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 10/28/2018] [Indexed: 11/15/2022]
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12
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Finsterer J, Zarrouk-Mahjoub S. Survival and outcome in MELAS not only depends on onset and disease duration. J Neurol Sci 2019; 397:9-10. [DOI: 10.1016/j.jns.2018.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022]
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13
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Ryzhkova AI, Sazonova MA, Sinyov VV, Galitsyna EV, Chicheva MM, Melnichenko AA, Grechko AV, Postnov AY, Orekhov AN, Shkurat TP. Mitochondrial diseases caused by mtDNA mutations: a mini-review. Ther Clin Risk Manag 2018; 14:1933-1942. [PMID: 30349272 PMCID: PMC6186303 DOI: 10.2147/tcrm.s154863] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
There are several types of mitochondrial cytopathies, which cause a set of disorders, arise as a result of mitochondria’s failure. Mitochondria’s functional disruption leads to development of physical, growing and cognitive disabilities and includes multiple organ pathologies, essentially disturbing the nervous and muscular systems. The origins of mitochondrial cytopathies are mutations in genes of nuclear DNA encoding mitochondrial proteins or in mitochondrial DNA. Nowadays, numerous mtDNA mutations significant to the appearance and progress of pathologies in humans are detected. In this mini-review, we accent on the mitochondrial cytopathies related to mutations of mtDNA. As well known, there are definite set of symptoms of mitochondrial cytopathies distinguishing or similar for different syndromes. The present article contains data about mutations linked with cytopathies that facilitate diagnosis of different syndromes by using genetic analysis methods. In addition, for every individual, more effective therapeutic approach could be developed after wide-range mutant background analysis of mitochondrial genome.
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Affiliation(s)
- Anastasia I Ryzhkova
- Laboratory of Medical Genetics, National Medical Research Center of Cardiology, Moscow, Russian Federation, .,Department of Virology, K.I. Skryabin Moscow State Academy of Veterinary Medicine and Biotechnology-MVA, Moscow, Russian Federation,
| | - Margarita A Sazonova
- Laboratory of Medical Genetics, National Medical Research Center of Cardiology, Moscow, Russian Federation, .,Laboratory of Angiopathology, Institute of General Pathology and Pathophysiology, Moscow, Russian Federation
| | - Vasily V Sinyov
- Laboratory of Medical Genetics, National Medical Research Center of Cardiology, Moscow, Russian Federation,
| | - Elena V Galitsyna
- Department of Genetics, Southern Federal University, Rostov-on-Don, Russian Federation
| | - Mariya M Chicheva
- Department of Genetics, Southern Federal University, Rostov-on-Don, Russian Federation
| | | | - Andrey V Grechko
- Federal Research and Clinical Center of Reanimatology and Rehabilitology, Moscow, Russian Federation
| | - Anton Yu Postnov
- Laboratory of Medical Genetics, National Medical Research Center of Cardiology, Moscow, Russian Federation,
| | - Alexander N Orekhov
- Laboratory of Angiopathology, Institute of General Pathology and Pathophysiology, Moscow, Russian Federation.,Institute for Atherosclerosis Research, Skolkovo Innovative Centre, Moscow Region, Russian Federation
| | - Tatiana P Shkurat
- Department of Genetics, Southern Federal University, Rostov-on-Don, Russian Federation
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Spicher C, Schneider R, Mönnings P, Schneider-Gold C, Kallenberg D, Cevik B, Lukas C, Gold R, Krogias C. Mechanical thrombectomy in a young stroke patient with Duchenne muscular dystrophy. Ther Adv Neurol Disord 2018; 11:1756286418759188. [PMID: 29552091 PMCID: PMC5846908 DOI: 10.1177/1756286418759188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 01/12/2018] [Indexed: 01/14/2023] Open
Abstract
Background: Duchenne muscular dystrophy (DMD) is an X-linked recessive skeletal muscle myopathy which is caused by mutations in the dystrophin gene. Lack of dystrophin also results to cardiomyopathy, which raises significantly the stroke risk in DMD-patients. However, data about therapeutic opportunities in the acute setting are scarce in literature. So far, only two cases receiving IV thrombolysis are described, one of them with fatal outcome. Method: Case report of a case of successful mechanical thrombectomy (MTE) in an acute ischemic stroke (AIS) patient with DMD and associated dilatative cardiomyopathy. Results: A 20-year old DMD-patient was transferred at 08:56 h to our department due to wake up stroke with severe right-sided hemiparesis and aphasia (NIHSS=20). Last-seen-normal was at 03:00 h. Cerebral CT-scan revealed only slight early ischemic changes (ASPECT-Score=8). CT-angiography detected occlusion of left middle cerebral artery (LMCA). MTE started rapidly at 9:23 h and using direct thrombus aspiration (Penumbra System®) complete recanalization was achieved 20 min later (TICI-grade 3). Considering the specific risks of general anesthesia in DMD, the procedure was performed with propofol, remifentanil and rocuronium. The patient recovered quickly from the acute symptoms, due to preexisting hypotonic tetraparesis his NIHSS-score at discharge was 12 points. Conclusions: To the best of our knowledge, this is the first report on MTE in a patient with DMD related cardioembolic stroke. In contrast to the few reports with IV thrombolysis, MTE seems to represent an optimal treatment option. Specific characteristics of DMD-patients like anesthetic regimen should be taken into account.
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Affiliation(s)
- Charlotte Spicher
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Germany
| | - Ruth Schneider
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Germany
| | - Peter Mönnings
- Department of Radiology, St. Josef-Hospital, Ruhr University Bochum, Germany
| | | | - Dennis Kallenberg
- Department of Anesthesiology, St. Josef-Hospital, Ruhr University Bochum, Germany
| | - Bilal Cevik
- Department of Anesthesiology, St. Josef-Hospital, Ruhr University Bochum, Germany
| | - Carsten Lukas
- Department of Radiology, St. Josef-Hospital, Ruhr University Bochum, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Germany
| | - Christos Krogias
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Gudrunstr. 56, 44791 Bochum, Germany
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15
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Finsterer J, Zarrouk-Mahjoub S. A beneficial effect of l-arginine for stroke-like episodes is currently unsupported. Mol Genet Metab Rep 2018; 15:67-68. [PMID: 30023293 PMCID: PMC6047059 DOI: 10.1016/j.ymgmr.2018.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 02/20/2018] [Indexed: 12/04/2022] Open
Affiliation(s)
| | - Sinda Zarrouk-Mahjoub
- University of Tunis El Manar and Genomics Platform, Pasteur Institute of Tunis, Tunisia
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16
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Finsterer J, Zarrouk-Mahjoub S. Affection of immune cells by a C10orf2 mutation manifesting as mitochondrial myopathy and transient sensory transverse syndrome. Acta Neurol Belg 2017; 117:969-970. [PMID: 28735506 DOI: 10.1007/s13760-017-0821-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 07/19/2017] [Indexed: 10/19/2022]
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17
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Abstract
ABSTRACTThis review aims at summarizing and discussing previous and recent findings concerning the cerebral manifestations of mitochondrial disorders (MIDs). MIDs frequently present as mitochondrial multiorgan disorder syndrome (MIMODS) either already at onset or later in the course. After the muscle, the brain is the organ second most frequently affected in MIMODS. Cerebral manifestations of MIDs are variable and may present with or without a lesion on imaging or functional studies, but there can be imaging/functional lesions without clinical manifestations. The most well-known cerebral manifestations of MIDs include stroke-like episodes, epilepsy, headache, ataxia, movement disorders, hypopituitarism, muscle weakness, psychiatric abnormalities, nystagmus, white and gray matter lesions, atrophy, basal ganglia calcification, and hypometabolism on 2-deoxy-2-[fluorine-18]fluoro-D-glucose positron-emission tomography. For most MIDs, only symptomatic therapy is currently available. Symptomatic treatment should be supplemented by vitamins, cofactors, and antioxidants. In conclusion, cerebral manifestations of MIDs need to be recognized and appropriately managed because they strongly determine the outcome of MID patients.
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Finsterer J, Zarrouk-Mahjoub S. Low blood heteroplasmy-rate may cause late-onset MELAS. Mol Genet Metab Rep 2017; 10:100. [PMID: 28224084 PMCID: PMC5295506 DOI: 10.1016/j.ymgmr.2017.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 01/27/2017] [Indexed: 11/11/2022] Open
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Finsterer J, Wakil SM. Stroke-like episodes, peri-episodic seizures, and MELAS mutations. Eur J Paediatr Neurol 2016; 20:824-829. [PMID: 27562097 DOI: 10.1016/j.ejpn.2016.08.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 07/26/2016] [Accepted: 08/01/2016] [Indexed: 12/22/2022]
Abstract
PURPOSE Stroke-like episodes (SLEs) are a hallmark of various mitochondrial disorders, in particular MELAS syndrome. SLEs manifest with vasogenic oedema (DWI and ADC hyperintensity) or partial cytotoxic oedema (DWI hyperintensity, ADC hypointensity) in the acute and subacute stage, and with gyriform T1-hyperintensity (cortical necrosis) in the chronic stage. PRINCIPAL RESULTS SLEs must be clearly distinguished from ischaemic stroke, since management of these two entities is different. SLEs may go along with or without seizures or epileptiform discharges on EEG. However, in MELAS syndrome seizures may also occur in the absence of SLEs. Focal and generalised seizures have been reported but it is currently unknown if the one or the other prevail. SLEs with and without seizures may respond to NO-precursors l-arginine, succinate, or citrulline. As a supportive measure a ketogenic diet should be initiated. Seizures prior to or during a SLE or paroxysmal EEG-activity during a SLE should be initially treated with antiepileptic drugs (AEDs) with low mitochondrion-toxicity. Only in case these AEDs are ineffective, AEDs with higher mitochondrion-toxicity should be added. MAJOR CONCLUSIONS All patients with SLEs need to have an EEG recorded irrespective if they have manifesting seizures or not. There are no mtDNA or nDNA mutations which predispose for SLEs with seizures.
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Affiliation(s)
| | - Salma Majid Wakil
- Department of Genetics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Kelland E, Rupar C, Prasad AN, Tay K, Downie A, Prasad C. Response to: Letter to the Editor Regarding: The Expanding Phenotype of MELAS Caused by the m.3291 T > C tRNA Mutation E Kelland, C. A. Rupar, Asuri N. Prasad, K. Y. Tay, A. Downie and C. Prasad (1) by Josef Finsterer, MD, PhD [1], Sinda Zarrouk-Mahjoub, PhD [2] [1] Krankenanstalt Rudolfstiftung, Vienna [2] Genomics Platform, Pasteur Institute of Tunis, Tunisia. Mol Genet Metab Rep 2016; 8:41-2. [PMID: 27493879 PMCID: PMC4963257 DOI: 10.1016/j.ymgmr.2016.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 07/07/2016] [Indexed: 11/18/2022] Open
Affiliation(s)
- E. Kelland
- Department of Pediatrics, Children's Hospital London Health Sciences Centre, London, Ontario, Canada
| | - C.A. Rupar
- Department of Pediatrics, Children's Hospital London Health Sciences Centre, London, Ontario, Canada
- Department of Biochemistry, Children's Hospital London Health Sciences Centre, London, Ontario, Canada
- Department of Pathology and Laboratory Medicine, Children's Hospital London Health Sciences Centre, London, Ontario, Canada
- Children's Health Research Institute, Children's Hospital London Health Sciences Centre, London, Ontario, Canada
- Western University, Children's Hospital London Health Sciences Centre, London, Ontario, Canada
| | - Asuri N. Prasad
- Department of Pediatrics, Children's Hospital London Health Sciences Centre, London, Ontario, Canada
- Department of Neurology, Children's Hospital London Health Sciences Centre, London, Ontario, Canada
- Children's Health Research Institute, Children's Hospital London Health Sciences Centre, London, Ontario, Canada
- Western University, Children's Hospital London Health Sciences Centre, London, Ontario, Canada
| | - K.Y. Tay
- Medical Imaging, Children's Hospital London Health Sciences Centre, London, Ontario, Canada
- Western University, Children's Hospital London Health Sciences Centre, London, Ontario, Canada
| | - A. Downie
- Western University, Children's Hospital London Health Sciences Centre, London, Ontario, Canada
- Paediatric Psychology, Children's Hospital London Health Sciences Centre, London, Ontario, Canada
| | - C. Prasad
- Department of Pediatrics, Children's Hospital London Health Sciences Centre, London, Ontario, Canada
- Children's Health Research Institute, Children's Hospital London Health Sciences Centre, London, Ontario, Canada
- Western University, Children's Hospital London Health Sciences Centre, London, Ontario, Canada
- Corresponding author at: Department of Pediatrics, Children's Hospital London Health Sciences Centre, London, Ontario, Canada.Department of PediatricsChildren's Hospital London Health Sciences CentreLondonOntarioCanada
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Finsterer J, Zarrouk-Mahjoub S. Assessment of the phenotype genotype variability and correlation in m.3243A > G mutation carriers requires prospective studies. Mol Genet Metab Rep 2016; 8:33. [PMID: 27453820 PMCID: PMC4941563 DOI: 10.1016/j.ymgmr.2016.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 07/05/2016] [Indexed: 11/24/2022] Open
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Winterholler M, Holländer C, Kerling F, Weber I, Dittrich S, Türk M, Schröder R. Stroke in Duchenne Muscular Dystrophy: A Retrospective Longitudinal Study in 54 Patients. Stroke 2016; 47:2123-6. [PMID: 27354222 DOI: 10.1161/strokeaha.116.013678] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 05/19/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND PURPOSE Duchenne muscular dystrophy (DMD) is the most frequent skeletal muscle myopathy. Nearly all patients develop cardiomyopathy in their second decade of life. The purpose of this study was to evaluate the frequency, cause, and outcome of stroke in a German cohort of patients with DMD. METHODS Retrospective analysis of medical records of 54 DMD patients, who lived in a regional facility for handicapped people (Wichernhaus Altdorf, Germany) between 1963 and 2013. RESULTS Fifty-four DMD patients were followed up for 7.4 years on average. Mean age at admission and discharge from the long-term care facility or death were 11.4 and 18.8 years, respectively. Covering a total observation period of 400 patient-years, we identified 4 DMD patients with juvenile arterial ischemic strokes. Off-label systemic thrombolysis in 2 patients resulted in a nearly complete regression of stroke-related symptoms, but 1 patient died of septic pneumonia and cardiac failure 24 days after thrombolysis therapy. In the other 2 patients, who had their ischemic strokes in 1994 and 1998, severe infarction-related symptoms persisted, and 1 patient died 13 days later. DMD-associated cardiomyopathy without evidence of atrial fibrillation was the only risk factor for ischemic stroke in all patients. CONCLUSIONS This study indicates an increased risk for ischemic strokes in DMD patients. Regular cardiological assessment of all DMD patients is mandatory to evaluate the individual risk profile for cardioembolic events and to adapt therapeutic strategies.
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Affiliation(s)
- Martin Winterholler
- From the Department of Neurology, Hospital Rummelsberg, Schwarzenbruck, Germany (M.W., F.K., I.W.); Rummelsberger Diakonie, Wichernhaus Altdorf, Altdorf, Germany (C.H.); and Department of Pediatric Cardiology (S.D.), Department of Neurology (M.T.), and Institute of Neuropathology (R.S.), Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.
| | - Christian Holländer
- From the Department of Neurology, Hospital Rummelsberg, Schwarzenbruck, Germany (M.W., F.K., I.W.); Rummelsberger Diakonie, Wichernhaus Altdorf, Altdorf, Germany (C.H.); and Department of Pediatric Cardiology (S.D.), Department of Neurology (M.T.), and Institute of Neuropathology (R.S.), Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Frank Kerling
- From the Department of Neurology, Hospital Rummelsberg, Schwarzenbruck, Germany (M.W., F.K., I.W.); Rummelsberger Diakonie, Wichernhaus Altdorf, Altdorf, Germany (C.H.); and Department of Pediatric Cardiology (S.D.), Department of Neurology (M.T.), and Institute of Neuropathology (R.S.), Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Irina Weber
- From the Department of Neurology, Hospital Rummelsberg, Schwarzenbruck, Germany (M.W., F.K., I.W.); Rummelsberger Diakonie, Wichernhaus Altdorf, Altdorf, Germany (C.H.); and Department of Pediatric Cardiology (S.D.), Department of Neurology (M.T.), and Institute of Neuropathology (R.S.), Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Sven Dittrich
- From the Department of Neurology, Hospital Rummelsberg, Schwarzenbruck, Germany (M.W., F.K., I.W.); Rummelsberger Diakonie, Wichernhaus Altdorf, Altdorf, Germany (C.H.); and Department of Pediatric Cardiology (S.D.), Department of Neurology (M.T.), and Institute of Neuropathology (R.S.), Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias Türk
- From the Department of Neurology, Hospital Rummelsberg, Schwarzenbruck, Germany (M.W., F.K., I.W.); Rummelsberger Diakonie, Wichernhaus Altdorf, Altdorf, Germany (C.H.); and Department of Pediatric Cardiology (S.D.), Department of Neurology (M.T.), and Institute of Neuropathology (R.S.), Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Rolf Schröder
- From the Department of Neurology, Hospital Rummelsberg, Schwarzenbruck, Germany (M.W., F.K., I.W.); Rummelsberger Diakonie, Wichernhaus Altdorf, Altdorf, Germany (C.H.); and Department of Pediatric Cardiology (S.D.), Department of Neurology (M.T.), and Institute of Neuropathology (R.S.), Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
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Response to: Letter to the Editor regarding: The expanding phenotype of MELAS caused by the m.3291T>C tRNA mutation E. Kelland, C.A. Rupar, Asuri N. Prasad, A. Downie and C. Prasad (1) by Josef Finsterer, MD, PhD [1], Sinda Zarrouk-Mahjoub, PhD [2]. Mol Genet Metab Rep 2016; 7:96-7. [PMID: 27331010 PMCID: PMC4901176 DOI: 10.1016/j.ymgmr.2016.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 05/09/2016] [Indexed: 11/23/2022] Open
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Finsterer J, Zarrouk-Mahjoub S. Mitochondrial vasculopathy. World J Cardiol 2016; 8:333-339. [PMID: 27231520 PMCID: PMC4877362 DOI: 10.4330/wjc.v8.i5.333] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Revised: 01/16/2016] [Accepted: 03/14/2016] [Indexed: 02/06/2023] Open
Abstract
Mitochondrial disorders (MIDs) are usually multisystem disorders (mitochondrial multiorgan disorder syndrome) either on from onset or starting at a point during the disease course. Most frequently affected tissues are those with a high oxygen demand such as the central nervous system, the muscle, endocrine glands, or the myocardium. Recently, it has been shown that rarely also the arteries may be affected (mitochondrial arteriopathy). This review focuses on the type, diagnosis, and treatment of mitochondrial vasculopathy in MID patients. A literature search using appropriate search terms was carried out. Mitochondrial vasculopathy manifests as either microangiopathy or macroangiopathy. Clinical manifestations of mitochondrial microangiopathy include leukoencephalopathy, migraine-like headache, stroke-like episodes, or peripheral retinopathy. Mitochondrial macroangiopathy manifests as atherosclerosis, ectasia of arteries, aneurysm formation, dissection, or spontaneous rupture of arteries. The diagnosis relies on the documentation and confirmation of the mitochondrial metabolic defect or the genetic cause after exclusion of non-MID causes. Treatment is not at variance compared to treatment of vasculopathy due to non-MID causes. Mitochondrial vasculopathy exists and manifests as micro- or macroangiopathy. Diagnosing mitochondrial vasculopathy is crucial since appropriate treatment may prevent from severe complications.
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Arrhythmias in MELAS syndrome. Mol Genet Metab Rep 2016; 7:54. [PMID: 27134827 PMCID: PMC4834673 DOI: 10.1016/j.ymgmr.2016.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 03/28/2016] [Indexed: 11/21/2022] Open
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Finsterer J, Zarrouk-Mahjoub S. MELAS syndrome due to the m.3291T > C mutation. Mol Genet Metab Rep 2016; 7:50. [PMID: 27134825 PMCID: PMC4834681 DOI: 10.1016/j.ymgmr.2016.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 03/30/2016] [Indexed: 11/19/2022] Open
Affiliation(s)
- Josef Finsterer
- Krankenanstalt Rudolfstiftung, Vienna, Austria
- Corresponding author at: Postfach 20, 1180 Vienna, Austria.Postfach 20Vienna1180Austria
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Lorenzoni PJ, Werneck LC, Kay CSK, Silvado CES, Scola RH. When should MELAS (Mitochondrial myopathy, Encephalopathy, Lactic Acidosis, and Stroke-like episodes) be the diagnosis? ARQUIVOS DE NEURO-PSIQUIATRIA 2016; 73:959-67. [PMID: 26517220 DOI: 10.1590/0004-282x20150154] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 06/23/2015] [Indexed: 12/13/2022]
Abstract
Mitochondrial myopathy, Encephalopathy, Lactic Acidosis, and Stroke-like episodes (MELAS) is a rare mitochondrial disorder. Diagnostic criteria for MELAS include typical manifestations of the disease: stroke-like episodes, encephalopathy, evidence of mitochondrial dysfunction (laboratorial or histological) and known mitochondrial DNA gene mutations. Clinical features of MELAS are not necessarily uniform in the early stages of the disease, and correlations between clinical manifestations and physiopathology have not been fully elucidated. It is estimated that point mutations in the tRNALeu(UUR) gene of the DNAmt, mainly A3243G, are responsible for more of 80% of MELAS cases. Morphological changes seen upon muscle biopsy in MELAS include a substantive proportion of ragged red fibers (RRF) and the presence of vessels with a strong reaction for succinate dehydrogenase. In this review, we discuss mainly diagnostic criterion, clinical and laboratory manifestations, brain images, histology and molecular findings as well as some differential diagnoses and current treatments.
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Affiliation(s)
- Paulo José Lorenzoni
- Departamento de Clínica Médica, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Lineu Cesar Werneck
- Departamento de Clínica Médica, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Cláudia Suemi Kamoi Kay
- Departamento de Clínica Médica, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | | | - Rosana Herminia Scola
- Departamento de Clínica Médica, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
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MR screening of candidates for thrombolysis: How to identify stroke mimics? J Neuroradiol 2014; 41:283-95. [PMID: 25451670 DOI: 10.1016/j.neurad.2014.05.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 05/24/2014] [Accepted: 05/26/2014] [Indexed: 11/21/2022]
Abstract
Stroke mimics account for up to a third of suspected strokes. The main causes are epileptic deficit, migraine aura, hypoglycemia, and functional disorders. Accurate recognition of stroke mimics is important for adequate identification of candidates for thrombolysis. This decreases the number of unnecessary treatments and invasive vascular investigations. Correctly identifying the cause of symptoms also avoids delaying proper care. Therefore, this pictorial review focuses on what the radiologist should know about the most common MRI patterns of stroke mimics in the first hours after onset of symptoms. The issues linked to the accurate diagnosis of stroke mimics in the management of candidates for thrombolysis will be discussed.
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Heterogeneous phenotypic manifestations of maternally inherited deafness associated with the mitochondrial A3243G mutation. Case report. Neurol Neurochir Pol 2014; 48:150-3. [DOI: 10.1016/j.pjnns.2013.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 12/23/2013] [Indexed: 11/21/2022]
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Skeletal muscle microvasculature in the diagnosis of neuromuscular disease. J Neuropathol Exp Neurol 2013; 72:906-18. [PMID: 24042201 DOI: 10.1097/nen.0b013e3182a7f0b8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Blood vessels are often overlooked in analyses of skeletal muscle biopsies. However, there are many vascular features in skeletal muscle biopsies that, when interpreted in the context of other histologic patterns and clinical history, provide useful information that allows muscle pathologists to narrow their differential diagnoses and provide more accurate guidance to treating physicians. Here, we provide a review of normal skeletal muscle vasculature with details of the ultrastructure of vessel walls. We discuss the vascular effects of factors common to many patients undergoing muscle biopsy, for example, diabetes mellitus, hypertension, and aging. We then discuss vascular findings relevant to diagnostic muscle biopsy evaluation, with current theories of pathogenesis and detailed descriptions of the important features.
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Liang C, Ahmad K, Sue CM. The broadening spectrum of mitochondrial disease: shifts in the diagnostic paradigm. Biochim Biophys Acta Gen Subj 2013; 1840:1360-7. [PMID: 24239706 DOI: 10.1016/j.bbagen.2013.10.040] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 10/21/2013] [Accepted: 10/26/2013] [Indexed: 01/08/2023]
Abstract
BACKGROUND The diagnosis of mitochondrial disease requires a complex synthesis of clinical, biochemical, histological, and genetic investigations. An expanding number of mitochondrial diseases are being recognized, despite their phenotypic diversity, largely due to improvements in methods to detect mutations in affected individuals and the discovery of genes contributing to mitochondrial function. Improved understanding of the investigational pitfalls and the development of new laboratory methodologies that lead to a molecular diagnosis have necessitated the field to rapidly adopt changes to its diagnostic approach. SCOPE OF REVIEW We review the clinical, investigational and genetic challenges that have resulted in shifts to the way we define and diagnose mitochondrial disease. Incorporation of changes, including the use of fibroblast growth factor 21 (FGF-21) and next generation sequencing techniques, may allow affected patients access to earlier molecular diagnosis and management. MAJOR CONCLUSIONS There have been important shifts in the diagnostic paradigm for mitochondrial disease. Diagnosis of mitochondrial disease is no longer reliant on muscle biopsy alone, but should include clinical assessment accompanied by the use of serological biomarkers and genetic analysis. Because affected patients will be defined on a molecular basis, oligosymptomatic mutation carriers should be included in the spectrum of mitochondrial disease. Use of new techniques such as the measurement of serum FGF-21 levels and next-generation-sequencing protocols should simplify the diagnosis of mitochondrial disease. GENERAL SIGNIFICANCE Improvements in the diagnostic pathway for mitochondrial disease will result in earlier, cheaper and more accurate methods to identify patients with mitochondrial disease. This article is part of a Special Issue entitled Frontiers of Mitochondrial Research.
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Affiliation(s)
- Christina Liang
- Department of Neurology, Royal North Shore Hospital, St. Leonards, New South Wales 2065, Australia
| | - Kate Ahmad
- Department of Neurology, Royal North Shore Hospital, St. Leonards, New South Wales 2065, Australia
| | - Carolyn M Sue
- Department of Neurology, Royal North Shore Hospital, St. Leonards, New South Wales 2065, Australia; Department of Neurogenetics, Kolling Institute of Medical Research, Royal North Shore Hospital and the University of Sydney, St. Leonards, New South Wales 2065, Australia.
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Finsterer J, Stöllberger C. Unclassified cardiomyopathies in neuromuscular disorders. Wien Med Wochenschr 2013; 163:505-13. [DOI: 10.1007/s10354-013-0243-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 09/27/2013] [Indexed: 02/01/2023]
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Finsterer J, Stöllberger C, Kovacs GG, Sehnal E. Left ventricular hypertrabeculation/noncompaction coincidentally found in sporadic inclusion body myositis. Int J Cardiol 2013; 168:610-2. [DOI: 10.1016/j.ijcard.2013.01.221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 12/29/2012] [Accepted: 01/18/2013] [Indexed: 11/28/2022]
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