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Habibi SAH, Aghavali S, Azad Z, Amini E, Falah M, Gholibeigian Z, Yazdi N, Emamikhah M, Rohani M. Transcranial sonography in neurodegeneration with brain iron accumulation disorders. Clin Neurol Neurosurg 2024; 236:108074. [PMID: 38091703 DOI: 10.1016/j.clineuro.2023.108074] [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: 05/28/2023] [Revised: 11/21/2023] [Accepted: 11/26/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND Transcranial Sonography is a non-invasive technique that has been used as a diagnostic tool for a variety of neurodegenerative disorders. However, the utility and potential application of this technique in NBIA disorders is scarce and inconclusive. METHODS In this cross-sectional retrospective case-control study, the echogenicity of Substantia Nigra (SN), Lentiform Nucleus (LN), and Diameter of the Third Ventricle (DTV) were assessed by TCS in genetically confirmed NBIA patients referring to the movement disorder clinic. The normal echogenicity area of SN was defined based on the 90th percentile of an age-and-gender-matched control group. NBIA patients underwent neurologic examination at each visit, but their brain magnetic resonance imaging and demographics were extracted from electronic records. RESULTS Thirty-five NBIA patients of four subtypes with a mean disease duration of 10.54 years and 35 controls were enrolled. The normally defined SN echogenicity in controls was 0.23 cm2. DTV and SN echogenicity areas were significantly higher in patients compared to the controls (P = 0.002 and < 0.001, respectively). Around 85% and 63% of the patients showed LN and SN hyperechogenicity at least on one side, respectively. Disease duration was positively correlated with DTV (r = 0.422, p = 0.015). Cases with Pantothenate Kinase Associated Neurodegeneration (n = 23) also had significantly higher DTV and SN echogenicity area compared to the controls. CONCLUSION Despite most NBIA patients displayed increased DVT and higher SN and LN hyperechogenicity than healthy controls, the discriminatory role of TCS on different NBIA subtypes remains to be determined.
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Affiliation(s)
- Seyed Amir Hassan Habibi
- Department of Neurology, Rasoul Akram Hospital, School of Medicine, Iran University of Medical Sciences, Tehran 1445613131, Iran
| | - Sharmin Aghavali
- Department of Neurology, Rasoul Akram Hospital, School of Medicine, Iran University of Medical Sciences, Tehran 1445613131, Iran
| | - Zahra Azad
- Skull Base Research Center, The Five Senses Health Institute, Rasoul Akram Hospital, School of Medicine, Iran University of Medical Sciences, Tehran 1445613131, Iran.
| | - Elahe Amini
- Department of Neurology, Rasoul Akram Hospital, School of Medicine, Iran University of Medical Sciences, Tehran 1445613131, Iran; Skull Base Research Center, The Five Senses Health Institute, Rasoul Akram Hospital, School of Medicine, Iran University of Medical Sciences, Tehran 1445613131, Iran
| | - Masoumeh Falah
- ENT and Head and Neck Research Center and Department, Rasoul Akram Hospital, The Five Senses Health Institute, School of Medicine, Iran University of Medical Sciences, Tehran 1445613131, Iran
| | - Zeinab Gholibeigian
- Skull Base Research Center, The Five Senses Health Institute, Rasoul Akram Hospital, School of Medicine, Iran University of Medical Sciences, Tehran 1445613131, Iran
| | - Narges Yazdi
- Department of Neurology, Rasoul Akram Hospital, School of Medicine, Iran University of Medical Sciences, Tehran 1445613131, Iran
| | - Maziar Emamikhah
- Department of Neurology, Rasoul Akram Hospital, School of Medicine, Iran University of Medical Sciences, Tehran 1445613131, Iran
| | - Mohammad Rohani
- Department of Neurology, Rasoul Akram Hospital, School of Medicine, Iran University of Medical Sciences, Tehran 1445613131, Iran; Skull Base Research Center, The Five Senses Health Institute, Rasoul Akram Hospital, School of Medicine, Iran University of Medical Sciences, Tehran 1445613131, Iran
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Sheth S, Sud S, Buxi TBS, Bhargava S, Puri RD, Sandal S, Agrawal C. Aceruloplasminemia: MRI and Biochemical Profile Clue to Early Diagnosis in an Adolescent. JOURNAL OF PEDIATRIC NEUROLOGY 2021. [DOI: 10.1055/s-0041-1736603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractAceruloplasminemia (ACP) is a rare autosomal recessive genetic disorder with systemic and brain iron overload, secondary to ceruloplasmin gene mutation, usually presents in adults with neurological manifestations. An abnormal biochemical profile may be the only clue in an adolescent patient, that is, microcytic anemia, low transferrin saturation, hyperferritinemia, and should warrant a possible diagnosis of ACP, which can be established by low serum ceruloplasmin levels and appropriate genetic testing. We present a case of an adolescent patient in whom ACP was suspected when brain magnetic resonance imaging showed iron overload in basal ganglia, thalami, red nuclei, dentate nuclei, and choroid plexus and later on confirmed by biochemical profile. The final diagnosis was confirmed by the presences of a novel mutation on genetic analysis. To the best of our knowledge, our case is the second description of ACP with choroid plexus hemosiderosis.We proposed in this article that the combination of parenchymal and choroid plexus iron overload should prompt the suspicion of ACP.
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Affiliation(s)
- Swapnil Sheth
- Department of Radiology, Sir Ganga Ram Hospital, New Delhi, India
| | - Seema Sud
- Department of CT & MRI, Sir Ganga Ram Hospital, New Delhi, India
| | | | - Salil Bhargava
- Department of Radiology, Sir Ganga Ram Hospital, New Delhi, India
| | - Ratna Dua Puri
- Department of Genetics, Institute of Medical Genetics & Genomics, Sir Ganga Ram Hospital, New Delhi, India
| | - Sapna Sandal
- Department of Genetics, Institute of Medical Genetics & Genomics, Sir Ganga Ram Hospital, New Delhi, India
| | - C.S Agrawal
- Department of Neurology, Sir Ganga Ram Hospital, New Delhi, India
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Deputy SR, Tilton AH. Treatment of Disorders of Tone and Other Considerations in Pediatric Movement Disorders. Neurotherapeutics 2020; 17:1713-1723. [PMID: 33410106 PMCID: PMC7851300 DOI: 10.1007/s13311-020-00984-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2020] [Indexed: 12/26/2022] Open
Abstract
Pediatric movement disorders (PMDs) consist of a heterogeneous group of signs and symptoms caused by numerous neurological diseases. Different neurological disorders in children also share overlapping movement disorders making a diagnosis of the underlying cause of the movement disorder challenging. The similarity of the symptoms across multiple disease types suggests that there may be a final common motor pathway causing the overlapping movement disorders. There are numerous disorders in children associated with disturbances in tone and involuntary movements. This chapter will focus primarily on those disorders that involve abnormalities of tone and other important considerations of pediatric movement disorders. This chapter will address rating scales and goals for treatment and will include a review of symptomatic treatment and, where possible, the treatment of the underlying disease processes. The chapter will review representative disorders, including an inborn error of metabolism, an autoimmune disorder, and a group of neurodegenerative disorders. These examples demonstrate how the disorder's underlying pathophysiology results in a specific approach to the underlying disease and the associated conditions of tone and involuntary movements. Finally, the multiple treatment options for cerebral palsy and considerations of cerebral palsy mimics will be discussed.
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Affiliation(s)
- Stephen R Deputy
- Department of Neurology, Division of Child Neurology, Louisiana State University Health Sciences Center at New Orleans, Children's Hospital, 200 Henry Clay Ave., New Orleans, LA, 70118, USA
| | - Ann H Tilton
- Department of Neurology, Division of Child Neurology, Louisiana State University Health Sciences Center at New Orleans, Children's Hospital, 200 Henry Clay Ave., New Orleans, LA, 70118, USA.
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