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Tierradentro-García LO, Zandifar A, Stern J, Nel JH, Ub Kim JD, Andronikou S. Magnetic Resonance Imaging-Based Distribution and Reversibility of Lesions in Pediatric Vigabatrin-Related Brain Toxicity. Pediatr Neurol 2023; 148:86-93. [PMID: 37690269 DOI: 10.1016/j.pediatrneurol.2023.08.012] [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: 10/26/2022] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND We aimed to systematically characterize the magnetic resonance imaging (MRI) findings in vigabatrin-related neurotoxicity in children and determine the reversibility of lesions based on follow-up images. METHODS We evaluated children with a history of refractory seizures who had a brain MRI while on vigabatrin therapy. We included available brain MRI studies before vigabatrin therapy initiation, during vigabatrin treatment, and after vigabatrin was discontinued. A pediatric neuroradiologist systematically assessed images on T2/fluid-attenuated inversion recovery (FLAIR) and diffusion-weighted imaging /apparent diffusion coefficient sequences to identify hyperintense lesions and/or restricted diffusion. The frequency of abnormal signal at each location was determined, as well as the reversibility of these after vigabatrin discontinuation. RESULTS MRIs of 43 patients were reviewed: 13 before vigabatrin initiation, 18 during treatment, and 12 after vigabatrin discontinuation. In the MRIs acquired during vigabatrin treatment, most lesions on T2/FLAIR occurred in the globus pallidi, thalami, and midbrain. Correspondingly, the most common locations for restricted diffusion were the globus pallidi, thalami, and subthalamic nuclei. On MRI after vigabatrin discontinuation, complete resolution of lesions on T2/FLAIR in all patients was seen in the midbrain, dentate nuclei, subthalamic nuclei, and hypothalami. Complete resolution of restricted diffusion was observed in the globus pallidi, midbrain, dentate nuclei, hippocampi, anterior commissure, and hypothalami. CONCLUSION Globus pallidi and thalami are the most commonly affected structures in vigabatrin-related toxicity, and most vigabatrin-related neuroimaging findings are reversible.
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Affiliation(s)
- Luis Octavio Tierradentro-García
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Alireza Zandifar
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Joseph Stern
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jean Henri Nel
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Jorge Du Ub Kim
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Savvas Andronikou
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Dablan A, Limon YK, Oktay C, Karaali K. Central tegmental tract hyperintensity: follow-up outcomes from a single-center study. Neuroradiology 2023:10.1007/s00234-023-03149-2. [PMID: 37067564 DOI: 10.1007/s00234-023-03149-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/07/2023] [Indexed: 04/18/2023]
Abstract
PURPOSE To evaluate the follow-up outcomes of symmetrical central tegmental tract hyperintensity (CTTH) and discuss possible etiological factors involved. METHODS Brain MRI scans of 7028 pediatric patients aged 0 to 18 years obtained between July 2015 and May 2020, were reviewed retrospectively for the presence of CTTH. Clinical data of the patients were retrieved from the hospital information system. Patients with follow-up MRI scans were evaluated separately. RESULTS A total of 5113 patients meeting the study inclusion criteria were identified in whom the prevalence of CTTH was 4.02% (n = 206). Of the patients with CTTH, 40.3% (n = 83) were girls, and the median age was 19 months (range, 1-108). The most common MRI indication was seizures (40.3%, n = 83), and among those with a definitive diagnosis, epilepsy was the most prevalent etiology (7.8%, n = 16). 40.7% (n = 84) of the patients with CTTH had follow-up MRI scans. CTTH disappeared on follow-up in 28.6% (n = 24) of the patients. The median age at CTTH disappearance was 51.5 months, and the mean (± SD) time to CTTH disappearance was 31.50 (± 19.02) months. CONCLUSION CTTH is a radiological finding commonly seen in early childhood but its clinical relevance has not been fully elucidated. While CTTH may be a transient phenomenon representing the maturation process, it may also be associated with a number of clinical conditions. Using a large patient series and follow-up MRI scans, our study shed light on the possible etiological factors of CTTH and its evolution over time.
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Affiliation(s)
- Ali Dablan
- Department of Radiology, Basaksehir Cam and Sakura City Hospital, TR-34488, İstanbul, Turkey.
| | - Yusuf Kerem Limon
- Department of Radiology, Ercis Country Hospital, TR-65400, Van, Turkey
| | - Cemil Oktay
- Department of Radiology, Adıyaman University Education and Research Hospital, TR-02200, Adıyaman, Turkey
| | - Kamil Karaali
- Department of Radiology, Akdeniz University School of Medicine, TR-07070, Antalya, Turkey
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Sakpichaisakul K, Boonkrongsak R, Lertbutsayanukul P, Iemwimangsa N, Klumsathian S, Panthan B, Trachoo O. Epileptic spasms related to neuronal differentiation factor 2 (NEUROD2) mutation respond to combined vigabatrin and high dose prednisolone therapy. BMC Neurol 2022; 22:461. [PMID: 36494631 PMCID: PMC9733267 DOI: 10.1186/s12883-022-02992-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 11/25/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Epileptic spasms are a devastating form of early infantile epileptic encephalopathy (EIEE) with various etiologies. Early diagnosis and a shorter lead time to treatment are crucial to stop the seizures and optimize the neurodevelopmental outcome. Genetic testing has become an integral part of epilepsy care that directly guides management and family planning and discovers new targeted treatments. Neuronal differentiation Factor 2 (NEUROD2) variants have recently been a cause of neurodevelopmental disorders (NDDs) and EIEEs with distinctive features. However, there is limited information about the clinical and electroencephalographic response of epileptic spasm treatment in NEUROD2-related NDD syndrome. CASE PRESENTATION We report a female patient of Southeast Asian ethnicity with global developmental delay and epileptic spasms commencing in the first few months of life. A novel de novo heterozygous pathogenic NEUROD2 variant, p. E130Q, was subsequently identified by whole-exome sequencing. Electroencephalogram before treatment showed multifocal independent spikes predominantly in both posterior head regions and demonstrated marked improvement following combined vigabatrin and high-dose prednisolone treatment. However, multiple courses of relapse occurred after weaning off the antiseizure medication. CONCLUSIONS We propose that epileptic spasms related to de novo NEUROD2 pathogenic variant respond well to combined vigabatrin and high-dose prednisolone therapy. These findings may imply the benefit of using combination therapy to treat epileptic spasms in NEUROD2-related NDD syndrome.
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Affiliation(s)
- Kullasate Sakpichaisakul
- grid.415584.90000 0004 0576 1386Department of Pediatrics, Queen Sirikit National Institute of Child Health, College of Medicine, Rangsit University, Bangkok, 10400 Thailand
| | - Rachata Boonkrongsak
- grid.415584.90000 0004 0576 1386Department of Pediatrics, Queen Sirikit National Institute of Child Health, College of Medicine, Rangsit University, Bangkok, 10400 Thailand
| | | | - Nareenart Iemwimangsa
- grid.10223.320000 0004 1937 0490Centre for Medical Genomics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400 Thailand
| | - Sommon Klumsathian
- grid.10223.320000 0004 1937 0490Centre for Medical Genomics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400 Thailand
| | | | - Objoon Trachoo
- grid.10223.320000 0004 1937 0490Centre for Medical Genomics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400 Thailand ,grid.10223.320000 0004 1937 0490Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Ratchathewi, Bangkok, 10400 Thailand
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Suppiej A, Ceccato C, Lonardi V, Reffo ME. Infantile nystagmus without overt eye abnormality: Early features and neuro-ophthalmological diagnosis. Dev Med Child Neurol 2022; 64:1532-1538. [PMID: 35644009 PMCID: PMC9796881 DOI: 10.1111/dmcn.15284] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 04/22/2022] [Accepted: 04/22/2022] [Indexed: 01/31/2023]
Abstract
AIM To analyse the neuro-ophthalmological data of children referred for further work-up of infantile nystagmus where ophthalmological evaluation had not achieved a diagnosis. METHOD We retrospectively reviewed medical records of patients presenting with infantile nystagmus at our institution between 2007 and 2019. Inclusion criteria were onset before 6 months of age, availability of complete ophthalmic examination, visual electrophysiological tests, and neurological examination. Children with a previous definite ophthalmological diagnosis at onset and those with uncertain nystagmus onset age were not recruited. RESULTS Out of 142 infants (mean age at nystagmus onset 3.6 mo, SD 1.7, range 0-6 mo; 56 females, 86 males), 23% had neurological nystagmus, 7% mixed neurological and sensory nystagmus, 48% sensory defect, and 22% idiopathic infantile nystagmus. The neurological diagnoses were inborn errors of metabolism, white matter genetic disorders, and brain malformations. The prevalent diagnosis in the sensory defect subgroup was retinal dystrophy. INTERPRETATION Infantile nystagmus without diagnostic ocular findings may be due to neurological, retinal, and optic nerve disorders or be a benign idiopathic condition. In infants with and without neurological abnormalities, the search for a sensory defect should include visual electrophysiology performed early in the diagnostic pathway. WHAT THIS PAPER ADDS Infantile nystagmus without diagnostic ophthalmological signs has an underlying neurological cause in 30% of cases. Neurological diagnoses include congenital brain malformations, and metabolic and genetic disorders. Sensory defects are part of systemic neurological disorders in 23% of infants. Electrophysiology is useful when ophthalmological examination is uninformative.
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Affiliation(s)
- Agnese Suppiej
- Department of Medical Sciences, Paediatric SectionUniversity of FerraraFerraraItaly,Robert Hollman FoundationPadovaItaly
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Cherian A, Priya L, Divya KP. “Cock-walk” gait and “horseshoe moustache” sign on MRI in inherited hypermanganesemia. Neurol Sci 2022; 43:1441-1445. [DOI: 10.1007/s10072-021-05793-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 11/26/2021] [Indexed: 10/19/2022]
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Van Bergen NJ, Hock DH, Spencer L, Massey S, Stait T, Stark Z, Lunke S, Roesley A, Peters H, Lee JY, Le Fevre A, Heath O, Mignone C, Yang JYM, Ryan MM, D’Arcy C, Nash M, Smith S, Caruana NJ, Thorburn DR, Stroud DA, White SM, Christodoulou J, Brown NJ. Biallelic Variants in PYROXD2 Cause a Severe Infantile Metabolic Disorder Affecting Mitochondrial Function. Int J Mol Sci 2022; 23:ijms23020986. [PMID: 35055180 PMCID: PMC8777681 DOI: 10.3390/ijms23020986] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 12/04/2022] Open
Abstract
Pyridine Nucleotide-Disulfide Oxidoreductase Domain 2 (PYROXD2; previously called YueF) is a mitochondrial inner membrane/matrix-residing protein and is reported to regulate mitochondrial function. The clinical importance of PYROXD2 has been unclear, and little is known of the protein’s precise biological function. In the present paper, we report biallelic variants in PYROXD2 identified by genome sequencing in a patient with suspected mitochondrial disease. The child presented with acute neurological deterioration, unresponsive episodes, and extreme metabolic acidosis, and received rapid genomic testing. He died shortly after. Magnetic resonance imaging (MRI) brain imaging showed changes resembling Leigh syndrome, one of the more common childhood mitochondrial neurological diseases. Functional studies in patient fibroblasts showed a heightened sensitivity to mitochondrial metabolic stress and increased mitochondrial superoxide levels. Quantitative proteomic analysis demonstrated decreased levels of subunits of the mitochondrial respiratory chain complex I, and both the small and large subunits of the mitochondrial ribosome, suggesting a mitoribosomal defect. Our findings support the critical role of PYROXD2 in human cells, and suggest that the biallelic PYROXD2 variants are associated with mitochondrial dysfunction, and can plausibly explain the child’s clinical presentation.
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Affiliation(s)
- Nicole J. Van Bergen
- Brain and Mitochondrial Research Group, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (L.S.); (S.M.); (T.S.); (D.R.T.); (D.A.S.)
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3010, Australia; (Z.S.); (S.L.); (J.Y.L.); (J.Y.-M.Y.); (S.M.W.)
- Correspondence: (N.J.V.B.); (J.C.); (N.J.B.)
| | - Daniella H. Hock
- Department of Biochemistry and Pharmacology and Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Parkville, VIC 3010, Australia; (D.H.H.); (N.J.C.)
| | - Lucy Spencer
- Brain and Mitochondrial Research Group, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (L.S.); (S.M.); (T.S.); (D.R.T.); (D.A.S.)
| | - Sean Massey
- Brain and Mitochondrial Research Group, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (L.S.); (S.M.); (T.S.); (D.R.T.); (D.A.S.)
| | - Tegan Stait
- Brain and Mitochondrial Research Group, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (L.S.); (S.M.); (T.S.); (D.R.T.); (D.A.S.)
| | - Zornitza Stark
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3010, Australia; (Z.S.); (S.L.); (J.Y.L.); (J.Y.-M.Y.); (S.M.W.)
- Victorian Clinical Genetics Services, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia; (A.R.); (A.L.F.)
- Australian Genomics Health Alliance, Parkville, VIC 3052, Australia
| | - Sebastian Lunke
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3010, Australia; (Z.S.); (S.L.); (J.Y.L.); (J.Y.-M.Y.); (S.M.W.)
- Department of Pathology, University of Melbourne, Parkville, VIC 3010, Australia
| | - Ain Roesley
- Victorian Clinical Genetics Services, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia; (A.R.); (A.L.F.)
| | - Heidi Peters
- Department of Metabolic Medicine, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (H.P.); (O.H.)
| | - Joy Yaplito Lee
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3010, Australia; (Z.S.); (S.L.); (J.Y.L.); (J.Y.-M.Y.); (S.M.W.)
- Department of Metabolic Medicine, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (H.P.); (O.H.)
| | - Anna Le Fevre
- Victorian Clinical Genetics Services, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia; (A.R.); (A.L.F.)
| | - Oliver Heath
- Department of Metabolic Medicine, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (H.P.); (O.H.)
| | - Cristina Mignone
- Medical Imaging Department, Royal Children’s Hospital, Parkville, VIC 3052, Australia;
| | - Joseph Yuan-Mou Yang
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3010, Australia; (Z.S.); (S.L.); (J.Y.L.); (J.Y.-M.Y.); (S.M.W.)
- Department of Neurosurgery, Neuroscience Advanced Clinical Imaging Service (NACIS), The Royal Children’s Hospital, Parkville, VIC 3052, Australia
- Developmental Imaging, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
- Neuroscience Research, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
| | - Monique M. Ryan
- Neurology Department, Royal Children’s Hospital, Parkville, VIC 3052, Australia;
| | - Colleen D’Arcy
- Anatomical Pathology Department, Royal Children’s Hospital, Parkville, VIC 3052, Australia;
| | - Margot Nash
- General Medicine, Royal Children’s Hospital, Parkville, VIC 3052, Australia;
| | - Sile Smith
- Paediatric Intensive Care Unit, Royal Children’s Hospital, Parkville, VIC 3052, Australia;
| | - Nikeisha J. Caruana
- Department of Biochemistry and Pharmacology and Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Parkville, VIC 3010, Australia; (D.H.H.); (N.J.C.)
- Institute for Health and Sport (iHeS), Victoria University, Footscray, VIC 3011, Australia
| | - David R. Thorburn
- Brain and Mitochondrial Research Group, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (L.S.); (S.M.); (T.S.); (D.R.T.); (D.A.S.)
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3010, Australia; (Z.S.); (S.L.); (J.Y.L.); (J.Y.-M.Y.); (S.M.W.)
- Victorian Clinical Genetics Services, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia; (A.R.); (A.L.F.)
| | - David A. Stroud
- Brain and Mitochondrial Research Group, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (L.S.); (S.M.); (T.S.); (D.R.T.); (D.A.S.)
- Department of Biochemistry and Pharmacology and Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Parkville, VIC 3010, Australia; (D.H.H.); (N.J.C.)
| | - Susan M. White
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3010, Australia; (Z.S.); (S.L.); (J.Y.L.); (J.Y.-M.Y.); (S.M.W.)
- Victorian Clinical Genetics Services, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia; (A.R.); (A.L.F.)
| | - John Christodoulou
- Brain and Mitochondrial Research Group, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (L.S.); (S.M.); (T.S.); (D.R.T.); (D.A.S.)
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3010, Australia; (Z.S.); (S.L.); (J.Y.L.); (J.Y.-M.Y.); (S.M.W.)
- Victorian Clinical Genetics Services, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia; (A.R.); (A.L.F.)
- Discipline of Child and Adolescent Health, University of Sydney, Camperdown, NSW 2006, Australia
- Correspondence: (N.J.V.B.); (J.C.); (N.J.B.)
| | - Natasha J. Brown
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3010, Australia; (Z.S.); (S.L.); (J.Y.L.); (J.Y.-M.Y.); (S.M.W.)
- Victorian Clinical Genetics Services, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia; (A.R.); (A.L.F.)
- Correspondence: (N.J.V.B.); (J.C.); (N.J.B.)
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Kuseyri Hübschmann O, Mohr A, Friedman J, Manti F, Horvath G, Cortès-Saladelafont E, Mercimek-Andrews S, Yildiz Y, Pons R, Kulhánek J, Oppebøen M, Koht JA, Podzamczer-Valls I, Domingo-Jimenez R, Ibáñez S, Alcoverro-Fortuny O, Gómez-Alemany T, de Castro P, Alfonsi C, Zafeiriou DI, López-Laso E, Guder P, Santer R, Honzík T, Hoffmann GF, Garbade SF, Sivri HS, Leuzzi V, Jeltsch K, García-Cazorla A, Opladen T, Harting I. Brain MR patterns in inherited disorders of monoamine neurotransmitters: An analysis of 70 patients. J Inherit Metab Dis 2021; 44:1070-1082. [PMID: 33443316 DOI: 10.1002/jimd.12360] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 12/29/2022]
Abstract
Inherited monoamine neurotransmitter disorders (iMNDs) are rare disorders with clinical manifestations ranging from mild infantile hypotonia, movement disorders to early infantile severe encephalopathy. Neuroimaging has been reported as non-specific. We systematically analyzed brain MRIs in order to characterize and better understand neuroimaging changes and to re-evaluate the diagnostic role of brain MRI in iMNDs. 81 MRIs of 70 patients (0.1-52.9 years, 39 patients with tetrahydrobiopterin deficiencies, 31 with primary disorders of monoamine metabolism) were retrospectively analyzed and clinical records reviewed. 33/70 patients had MRI changes, most commonly atrophy (n = 24). Eight patients, six with dihydropteridine reductase deficiency (DHPR), had a common pattern of bilateral parieto-occipital and to a lesser extent frontal and/or cerebellar changes in arterial watershed zones. Two patients imaged after acute severe encephalopathy had signs of profound hypoxic-ischemic injury and a combination of deep gray matter and watershed injury (aromatic l-amino acid decarboxylase (AADCD), tyrosine hydroxylase deficiency (THD)). Four patients had myelination delay (AADCD; THD); two had changes characteristic of post-infantile onset neuronal disease (AADCD, monoamine oxidase A deficiency), and nine T2-hyperintensity of central tegmental tracts. iMNDs are associated with MRI patterns consistent with chronic effects of a neuronal disorder and signs of repetitive injury to cerebral and cerebellar watershed areas, in particular in DHPRD. These will be helpful in the (neuroradiological) differential diagnosis of children with unknown disorders and monitoring of iMNDs. We hypothesize that deficiency of catecholamines and/or tetrahydrobiopterin increase the incidence of and the CNS susceptibility to vascular dysfunction.
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Affiliation(s)
- Oya Kuseyri Hübschmann
- Department of Child Neurology and Metabolic Disorders, University Children's Hospital, Heidelberg, Germany
| | - Alexander Mohr
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Jennifer Friedman
- UCSD Departments of Neuroscience and Pediatrics; Rady Children's Hospital Division of Neurology, Rady Children's Institute for Genomic Medicine, San Diego, California, USA
| | - Filippo Manti
- Unit of Child Neurology and Psychiatry, Department of Human Neuroscience, Sapienza, University of Rome, Rome, Italy
| | - Gabriella Horvath
- University of British Columbia, Department of Pediatrics, Division of Biochemical Genetics, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Elisenda Cortès-Saladelafont
- Inborn Errors of Metabolism Unit, Department of Neurology, Institut de Recerca Sant Joan de Déu and CIBERER-ISCIII, Barcelona, Spain
- Unit of Pediatric Neurology and Metabolic Disorders, Department of Pediatrics, Hospital Germans Trias i Pujol and Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Saadet Mercimek-Andrews
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Yilmaz Yildiz
- Faculty of Medicine, Department of Pediatrics, Section of Metabolism, Hacettepe University, Ankara, Turkey
| | - Roser Pons
- First Department of Pediatrics of the University of Athens, Aghia Sofia Hospital, Athens, Greece
| | - Jan Kulhánek
- Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Mari Oppebøen
- Children's Department, Division of Child Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | | | - Inés Podzamczer-Valls
- Department of Neurology, Neurometabolic Unit, and Synaptic Metabolism Laboratory, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Rosario Domingo-Jimenez
- Department of Pediatric Neurology, Hospital Virgen de la Arrixaca, Murcia, Madrid, Spain
- IMIB-Arrixaca, Murcia, CIBERER-ISCIII, Madrid, Spain
| | - Salvador Ibáñez
- Department of Pediatric Neurology, Hospital Virgen de la Arrixaca, Murcia, Madrid, Spain
| | - Oscar Alcoverro-Fortuny
- Service of Psychiatry, Hospital Benito Menni - Hospital General de Granollers, Barcelona, Spain
| | - Teresa Gómez-Alemany
- Service of Psychiatry, Hospital Benito Menni - Hospital General de Granollers, Barcelona, Spain
| | - Pedro de Castro
- Department of Pediatric Neurology, Hospital Gregorio Marañón, Madrid, Spain
| | - Chiara Alfonsi
- Inborn Errors of Metabolism Unit, Department of Neurology, Institut de Recerca Sant Joan de Déu and CIBERER-ISCIII, Barcelona, Spain
- Department of Human Neuroscience, Sapienza, University of Rome, Rome, Italy
| | - Dimitrios I Zafeiriou
- Child Neurology and Developmental Pediatrics, 1st Department of Pediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eduardo López-Laso
- Pediatric Neurology Unit, Department of Pediatrics, University Hospital Reina Sofía, IMIBIC and CIBERER, Córdoba, Spain
| | | | | | - Tomáš Honzík
- Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Georg F Hoffmann
- Department of Child Neurology and Metabolic Disorders, University Children's Hospital, Heidelberg, Germany
| | - Sven F Garbade
- Department of Child Neurology and Metabolic Disorders, University Children's Hospital, Heidelberg, Germany
| | - H Serap Sivri
- Faculty of Medicine, Department of Pediatrics, Section of Metabolism, Hacettepe University, Ankara, Turkey
| | - Vincenzo Leuzzi
- Unit of Child Neurology and Psychiatry, Department of Human Neuroscience, Sapienza, University of Rome, Rome, Italy
| | - Kathrin Jeltsch
- Department of Child Neurology and Metabolic Disorders, University Children's Hospital, Heidelberg, Germany
| | - Angeles García-Cazorla
- Inborn Errors of Metabolism Unit, Department of Neurology, Institut de Recerca Sant Joan de Déu and CIBERER-ISCIII, Barcelona, Spain
| | - Thomas Opladen
- Department of Child Neurology and Metabolic Disorders, University Children's Hospital, Heidelberg, Germany
| | - Inga Harting
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
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Harini C, Yuskaitis CJ, Libenson MH, Yang E, DeLeo M, Zhang B, Mysak K, Marti C, Peters JM, Bergin AM, Pearl PL, Prabhu SP. Hippocampal Involvement With Vigabatrin-Related MRI Signal Abnormalities in Patients With Infantile Spasms: A Novel Finding. J Child Neurol 2021; 36:575-582. [PMID: 33432856 DOI: 10.1177/0883073820985395] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND In a subset of infants exhibiting typical vigabatrin-related magnetic resonance imaging (MRI) changes, the authors observed additional hippocampal signal abnormalities. The authors investigated occurrence and significance of additional signal abnormalities. METHODS A retrospective review of infantile spasms patients with typical vigabatrin-related MRI abnormalities was performed. Atypical features included signal changes unilaterally or at previously unreported sites. Comparisons were made between patients with and without atypical features. RESULTS In all, 26/55 (47%) exhibited typical vigabatrin-related MRI changes, with additional signal abnormalities in the hippocampi in 6 of 26. On follow-up, evolution of hippocampal signal changes paralleled changes at typical locations in 4 patients. Two patients, clinically well, without follow-up MRI. Patients with and without additional hippocampal signal changes did not differ with respect to clinical factors, including seizure status. One patient had unilateral thalamic/cerebral peduncle signal abnormality along with typical vigabatrin changes. CONCLUSIONS Hippocampal changes seen in subset of patients with typical vigabatrin-related changes may be attributable to vigabatrin exposure in the appropriate circumstance.
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Affiliation(s)
- Chellamani Harini
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, 1862Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christopher J Yuskaitis
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, 1862Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark H Libenson
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, 1862Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Edward Yang
- Neuroradiology Division, Department of Radiology, 1862Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michelle DeLeo
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, 1862Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Bo Zhang
- Department of Neurology and ICCTR Biostatistics and Research Design Center, 1862Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Kate Mysak
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, 1862Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Candice Marti
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, 1862Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jurriaan M Peters
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, 1862Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ann Marie Bergin
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, 1862Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Phillip L Pearl
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, 1862Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sanjay P Prabhu
- Neuroradiology Division, Department of Radiology, 1862Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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9
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Genetic and Clinical Predictors of Ataxia in Pediatric Primary Mitochondrial Disorders. THE CEREBELLUM 2021; 21:116-131. [PMID: 34052969 DOI: 10.1007/s12311-021-01276-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/02/2021] [Indexed: 10/21/2022]
Abstract
Evaluation of ataxia in children is challenging in clinical practice. This is particularly true for highly heterogeneous conditions such as primary mitochondrial disorders (PMD). This study aims to explore cerebellar and brain abnormalities identified on MRI as potential predictors of ataxia in patients with PMD and, likewise, to determine the effect of the patient's genetic profile on these predictors as well as determination of the temporal relationship of clinical ataxia with MRI findings. We evaluated clinical, radiological, and genetic characteristics of 111 PMD patients younger than 21 years of age at The Children's Hospital of Philadelphia. Data was extracted from charts. Blinded radiological evaluations were carried out by experienced neuroradiologists. Multivariate logistic regression and generalized equation estimates were used for analysis. Ataxia was identified in 41% of patients. Cerebellar atrophy or putaminal involvement with mitochondrial DNA (mtDNA) mutations (OR 1.18, 95% CI 1.1-1.3, p < 0.001) and nuclear DNA mutation with no atrophy of the cerebellum (OR 1.14, 95% CI 1.0-1.3, p = 0.007) predicted an increased likelihood of having ataxia per year of age. Central tegmental tract predicted the presence of ataxia independent of age and pathogenic variant origin (OR 9.8, 95% CI 2-74, p = 0.009). Ataxia tended to precede the imaging finding of cerebellar atrophy. Cerebellar atrophy and putaminal involvement on MRI of pediatric-onset PMD may predict the presence of ataxia with age in patients with mtDNA mutations. This study provides predicted probabilities of having ataxia per year of age that may help in family counseling and future research of the population.
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10
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Sarma A, Heck JM, Bhatia A, Krishnasarma RS, Pruthi S. Magnetic resonance imaging of the brainstem in children, part 2: acquired pathology of the pediatric brainstem. Pediatr Radiol 2021; 51:189-204. [PMID: 33464360 DOI: 10.1007/s00247-020-04954-0] [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: 04/24/2020] [Revised: 09/10/2020] [Accepted: 12/20/2020] [Indexed: 10/22/2022]
Abstract
Part 1 of this series of two articles describes conventional and advanced MRI techniques that are useful for evaluating brainstem pathologies. In addition, it provides a review of the embryology, normal progression of myelination, and clinically and radiologically salient imaging anatomy of the normal brainstem. Finally, it discusses congenital diseases of the brainstem with a focus on distinctive imaging features that allow for differentiating pathologies. Part 2 of this series of two articles includes discussion of neoplasms; infections; and vascular, demyelinating, toxic, metabolic and miscellaneous disease processes affecting the brainstem. The ultimate goal of this pair of articles is to empower the radiologist to add clinical value in the care of pediatric patients with brainstem pathologies.
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Affiliation(s)
- Asha Sarma
- Department of Radiology and Radiological Sciences, Monroe Carell Jr. Children's Hospital, Vanderbilt University Medical Center, 2200 Children's Way, Nashville, TN, 37232, USA
| | - Josh M Heck
- Department of Radiology and Radiological Sciences, Monroe Carell Jr. Children's Hospital, Vanderbilt University Medical Center, 2200 Children's Way, Nashville, TN, 37232, USA
| | - Aashim Bhatia
- Department of Radiology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Rekha S Krishnasarma
- Department of Radiology and Radiological Sciences, Monroe Carell Jr. Children's Hospital, Vanderbilt University Medical Center, 2200 Children's Way, Nashville, TN, 37232, USA
| | - Sumit Pruthi
- Department of Radiology and Radiological Sciences, Monroe Carell Jr. Children's Hospital, Vanderbilt University Medical Center, 2200 Children's Way, Nashville, TN, 37232, USA.
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11
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Misser SK, Barkovich AJ, Lotz JW, Archary M. A pictorial review of the pathophysiology and classification of the magnetic resonance imaging patterns of perinatal term hypoxic ischemic brain injury - What the radiologist needs to know…. SA J Radiol 2020; 24:1915. [PMID: 33240541 PMCID: PMC7670012 DOI: 10.4102/sajr.v24i1.1915] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 07/16/2020] [Indexed: 11/01/2022] Open
Abstract
This article provides a correlation of the pathophysiology and magnetic resonance imaging (MRI) patterns identified on imaging of children with hypoxic ischemic brain injury (HIBI). The purpose of this pictorial review is to empower the reading radiologist with a simplified classification of the patterns of cerebral injury matched to images of patients demonstrating each subtype. A background narrative literature review was undertaken of the regional, continental and international databases looking at specific patterns of cerebral injury related to perinatal HIBI. In addition, a database of MRI studies accumulated over a decade (including a total of 314 studies) was analysed and subclassified into the various patterns of cerebral injury. Selected cases were annotated to highlight the areas involved and for ease of identification of the affected substrate in daily practice. KEYWORDS Hypoxic ischemic encephalopathy; Magnetic resonance imaging; Acute profound; Partial prolonged; Hypoxic ischemic brain injury; Ulegyria; Multicystic; Encephalopathy.
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Affiliation(s)
- Shalendra K Misser
- Department of Radiology, Faculty of Health Sciences Medicine, College of Health Sciences, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.,Department of Radiology, Faculty of Radiology, Lake, Smit and Partners Inc, Durban, South Africa
| | - Anthony J Barkovich
- Department of Radiology, Faculty of Medicine, Neurology and Neurosurgery, Division of Neuroradiology, University of California, San Francisco, United States of America
| | - Jan W Lotz
- Department of Radiology, Faculty of Medicine, University of Stellenbosch, Stellenbosch, South Africa
| | - Moherndran Archary
- Department of Paediatrics, Faculty of Health Sciences Medicine, College of Health Sciences, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
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12
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D'Gama AM, England E, Madden JA, Shi J, Chao KR, Wojcik MH, Torres AR, Tan WH, Berry GT, Prabhu SP, Agrawal PB. Exome sequencing identifies novel missense and deletion variants in RTN4IP1 associated with optic atrophy, global developmental delay, epilepsy, ataxia, and choreoathetosis. Am J Med Genet A 2020; 185:203-207. [PMID: 33037779 DOI: 10.1002/ajmg.a.61910] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 09/11/2020] [Accepted: 09/20/2020] [Indexed: 11/05/2022]
Abstract
Inherited optic neuropathies (IONs) are neurodegenerative disorders characterized by optic atrophy with or without extraocular manifestations. Optic atrophy-10 (OPA10) is an autosomal recessive ION recently reported to be caused by mutations in RTN4IP1, which encodes reticulon 4 interacting protein 1 (RTN4IP1), a mitochondrial ubiquinol oxydo-reductase. Here we report novel compound heterozygous mutations in RTN4IP1 in a male proband with developmental delay, epilepsy, optic atrophy, ataxia, and choreoathetosis. Workup was notable for transiently elevated lactate and lactate-to-pyruvate ratio, brain magnetic resonance imaging with optic atrophy and T2 signal abnormalities, and a nondiagnostic initial genetic workup, including chromosomal microarray and mitochondrial panel testing. Exome sequencing identified a paternally inherited missense variant (c.263T>G, p.Val88Gly) predicted to be deleterious and a maternally inherited deletion encompassing RTN4IP1. To our knowledge, this is the first report of a non-single nucleotide pathogenic variant associated with OPA10. This case highlights the expanding phenotypic spectrum of OPA10, the association between "syndromic" cases and severe RTN4IP1 mutations, and the importance of nonbiased genetic testing, such as ES, to analyze multiple genes and variants types, in patients suspected of having genetic disease.
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Affiliation(s)
- Alissa M D'Gama
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, Massachusetts, USA.,The Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Eleina England
- The Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Jill A Madden
- The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jiahai Shi
- Department of Biomedical Sciences, City University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Katherine R Chao
- The Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Monica H Wojcik
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, Massachusetts, USA.,The Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Alcy R Torres
- Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Wen-Hann Tan
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gerard T Berry
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Sanjay P Prabhu
- Neuroradiology Division, Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Pankaj B Agrawal
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, Massachusetts, USA.,The Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
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13
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Işık U, Dinçer A. Central tegmentum tract hyperintensities in pediatric neurological patients: Incidence or coincidence. Brain Dev 2017; 39:411-417. [PMID: 28010956 DOI: 10.1016/j.braindev.2016.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 11/28/2016] [Accepted: 11/28/2016] [Indexed: 11/27/2022]
Abstract
AIM The central tegmental tract hyperintensities (CTTH) have been found in many different pediatric neurological conditions. There is only scarce data about the value of this radiological phenomenon. In this study we aimed to show the neurological conditions associated with this radiological finding. MATERIALS AND METHODS We performed a retrospective analysis of all pediatric brain MRI's between 2013 and 2015. After finding those patients with CTTH, we evaluated them in the pediatric neurology clinic. RESULTS There were 41 out of 1464 brain MRI's with CTTH with 2.8% prevalence. Thirty four patients (23 male, age range 3months-98months) were available for evaluation. CTTH were present in mainly younger age group. There were many different neurological conditions associated with CTTH. These included brain tumors, epilepsy, developmental delay, metabolic disorders and genetic syndromes. CONCLUSION CTTH is found in many different pediatric neurological conditions. Further neuropathological and prospective MRI and clinical studies are needed to better understand this interesting radiological finding.
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Affiliation(s)
- Uğur Işık
- Acıbadem University, Department of Pediatrics, Division of Pediatric Neurology, Kozyatağı Acıbadem Hastanesi, İnönü Cad. Okur Sok. No: 20, Kozyatağı, Istanbul, Turkey.
| | - Alp Dinçer
- Acıbadem University, Department of Radiology, Kozyatağı Acıbadem Hastanesi, İnönü Cad. Okur Sok. No: 20, Kozyatağı, Istanbul, Turkey.
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14
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Derinkuyu BE, Ozmen E, Akmaz-Unlu H, Altinbas NK, Gurkas E, Boyunaga O. A magnetic resonance imaging finding in children with cerebral palsy: Symmetrical central tegmental tract hyperintensity. Brain Dev 2017; 39:211-217. [PMID: 27843044 DOI: 10.1016/j.braindev.2016.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 08/25/2016] [Accepted: 10/13/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Central tegmental tract is an extrapyramidal tract between red nucleus and inferior olivary nucleus which is located in the tegmentum pontis bilaterally and symmetrically. The etiology of the presence of central tegmental tract hyperintensity on MRI is unclear. PURPOSE In this study our aim is to evaluate the frequency of central tegmental tract lesions in patients with cerebral palsy and control group, as well as to determine whether there is an association between central tegmental tract lesions and cerebral palsy types. MATERIALS AND METHODS Clinical and MRI data of 200 patients with cerebral palsy in study group (87 female, 113 male; mean age, 5.81years; range, 0-16years) and 258 patients in control group (114 female, 144 male; mean age, 6.28years; range, 0-16years) were independently evaluated by two reader for presence of central tegmental tract hyperintensity and other associated abnormalities. RESULTS Central tegmental tract hyperintensities on T2WI were detected in 19% of the study group (38/200) and 3.5% of the control group (9/258) (p<0.0001). Among the total of 38 central tegmental tract lesions in study group, the frequency of central tegmental tract hyperintensity was 16% (24/150) in spastic cerebral palsy and 35% (14/40) in dyskinetic cerebral palsy (p=0.0131). CONCLUSION The prevalence of central tegmental tract hyperintensity is higher in patients with cerebral palsy particularly in dyskinetic type. We suggest that there is an increased association of the tegmental lesions with dyskinetic CP. Patients with cerebral palsy and ischemic changes were more likely to have central tegmental tract lesions. According to our results we advocate that an ischemic process may have a role in the etiopathogenesis.
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Affiliation(s)
- Betul Emine Derinkuyu
- Gazi University School of Medicine, Department of Radiology, Division of Pediatric Radiology, Besevler, Ankara, Turkey.
| | - Evrim Ozmen
- Istanbul University Cerrahpasa Medical School, Department of Radiology, Istanbul, Turkey
| | - Havva Akmaz-Unlu
- Ankara Pediatric and Pediatric Hematology Oncology Training and Research Hospital, Department of Radiology, Ankara, Turkey
| | - Namik Kemal Altinbas
- Ankara Pediatric and Pediatric Hematology Oncology Training and Research Hospital, Department of Radiology, Ankara, Turkey
| | - Esra Gurkas
- Ankara Pediatric and Pediatric Hematology Oncology Training and Research Hospital, Department of Pediatric Neurology, Ankara, Turkey
| | - Oznur Boyunaga
- Gazi University School of Medicine, Department of Radiology, Division of Pediatric Radiology, Besevler, Ankara, Turkey
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15
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Staufner C, Blom HJ, Dionisi-Vici C, Freisinger P, Makhseed N, Ballhausen D, Kölker S, Hoffmann GF, Harting I. MRI and (1)H-MRS in adenosine kinase deficiency. Neuroradiology 2016; 58:697-703. [PMID: 26993811 DOI: 10.1007/s00234-016-1676-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 03/09/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Adenosine kinase deficiency (ADK deficiency) is a recently described disorder of methionine and adenosine metabolism resulting in a neurological phenotype with developmental delay, muscular hypotonia, and epilepsy as well as variable systemic manifestations. The underlying neuropathology is poorly understood. We have investigated MRI and (1)H-MRS changes in ADK deficiency in order to better understand the in vivo neuropathologic changes of ADK deficiency. METHODS Systematic evaluation of 21 MRIs from eight patients (age range 9 days-14.6 years, mean 3.9 years, median 2.7 years) including diffusion-weighted imaging in six and (1)H-MRS in five patients. RESULTS Brain maturation was delayed in the neonatal period and in infancy (6/6), but ultimately complete. White matter changes occurring in five of eight patients were discrete, periventricular, and unspecific (4/5), or diffuse with sparing of optic radiation, corona radiata, and pyramidal tracts (1/5). Choline was low in white matter spectra (3/3), while there was no indication of low creatine in white matter or basal ganglia (5/5), and diffusion was variably decreased or increased. Central tegmental tract hyperintensity was a common finding (6/8), as was supratentorial atrophy (6/8). CONCLUSIONS MRI changes in ADK deficiency consist of delayed but ultimately completed brain maturation with later onset of mostly unspecific white matter changes and potentially transient central tegmental tract hyperintensity. Immaturity on neonatal MRI is consistent with prenatal onset of disease and reduced choline with lower membrane turnover resulting in delayed myelination and deficient myelin maintenance.
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Affiliation(s)
- C Staufner
- Department of General Pediatrics, Division of Neuropediatrics and Pediatric Metabolic Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - H J Blom
- Center for Pediatrics and Adolescent Medicine, University Hospital Freiburg, Freiburg, Germany
| | - C Dionisi-Vici
- Division of Metabolism, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - P Freisinger
- Children's Hospital Reutlingen, Reutlingen, Germany
| | - N Makhseed
- Department of Pediatrics, Jahra Hospital, Jahra, Kuwait
| | - D Ballhausen
- Center for Molecular Diseases, CHUV Lausanne, Lausanne, Switzerland
| | - S Kölker
- Department of General Pediatrics, Division of Neuropediatrics and Pediatric Metabolic Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - G F Hoffmann
- Department of General Pediatrics, Division of Neuropediatrics and Pediatric Metabolic Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - I Harting
- Department of Neuroradiology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
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16
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Quattrocchi CC, Fariello G, Longo D. Brainstem tegmental lesions in neonates with hypoxic-ischemic encephalopathy: Magnetic resonance diagnosis and clinical outcome. World J Radiol 2016; 8:117-123. [PMID: 26981220 PMCID: PMC4770173 DOI: 10.4329/wjr.v8.i2.117] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 10/11/2015] [Accepted: 12/11/2015] [Indexed: 02/06/2023] Open
Abstract
Lesions of the brainstem have been reported in the clinical scenarios of hypoxic-ischemic encephalopathy (HIE), although the prevalence of these lesions is probably underestimated. Neuropathologic studies have demonstrated brainstem involvement in severely asphyxiated infants as an indicator of poor outcome. Among survivors to HIE, the most frequent clinical complaints that may be predicted by brainstem lesions include feeding problems, speech, language and communication problems and visual impairments. Clinical series, including vascular and metabolic etiologies, have found selective involvement of the brainstem with the demonstration of symmetric bilateral columnar lesions of the tegmentum. The role of brainstem lesions in HIE is currently a matter of debate, especially when tegmental lesions are present in the absence of supra-tentorial lesions. Differential diagnosis of tegmental lesions in neonates and infants include congenital metabolic syndromes and drug-related processes. Brainstem injury with the presence of supratentorial lesions is a predictor of poor outcome and high rates of mortality and morbidity. Further investigation will be conducted to identify specific sites of the brainstem that are vulnerable to hypoxic-ischemic and toxic-metabolic insults.
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17
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Singh P, Kaur A, Kaur R, Aggarwal S, Singh R. Symmetrical central tegmental tract hyperintensities on magnetic resonance imaging. J Pediatr Neurosci 2015; 10:235-6. [PMID: 26557163 PMCID: PMC4611891 DOI: 10.4103/1817-1745.165666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Paramdeep Singh
- Department of Radiology, Paediatrics and Medicine, Guru Gobind Singh Medical College and Hospital, Baba Farid University of Health Sciences, Faridkot, Punjab, India
| | - Amarpreet Kaur
- Department of Radiology, Paediatrics and Medicine, Guru Gobind Singh Medical College and Hospital, Baba Farid University of Health Sciences, Faridkot, Punjab, India
| | - Rupinderjeet Kaur
- Department of Radiology, Paediatrics and Medicine, Guru Gobind Singh Medical College and Hospital, Baba Farid University of Health Sciences, Faridkot, Punjab, India
| | - Simmi Aggarwal
- Department of Radiology, Paediatrics and Medicine, Guru Gobind Singh Medical College and Hospital, Baba Farid University of Health Sciences, Faridkot, Punjab, India
| | - Ramandeep Singh
- Department of Radiology, Paediatrics and Medicine, Guru Gobind Singh Medical College and Hospital, Baba Farid University of Health Sciences, Faridkot, Punjab, India
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18
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Harkins KD, Valentine WM, Gochberg DF, Does MD. In-vivo multi-exponential T2, magnetization transfer and quantitative histology in a rat model of intramyelinic edema. NEUROIMAGE-CLINICAL 2013; 2:810-7. [PMID: 24179832 PMCID: PMC3777678 DOI: 10.1016/j.nicl.2013.06.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 06/10/2013] [Accepted: 06/12/2013] [Indexed: 11/26/2022]
Abstract
Two MRI methods, multi-exponential analysis of transverse relaxation (MET2) and quantitative magnetization transfer (qMT), were used along with quantitative evaluation of histology in a study of intra-myelinic edema in rat spinal white matter. The results showed a strong linear correlation between a distinct long-T2 signal from MET2 analysis and the edema water volume fraction as measured by histology, although this analysis overestimated the edema water content by ≈ 100% relative to quantitative histological measurements. This overestimation was reasoned to result from the effects of inter-compartmental water exchange on observed transverse relaxation. Commonly studied MRI markers for myelin, the myelin water fraction (from MET2 analysis) and the macromolecular pool size ratio (from qMT analysis) produced results that could not be explained purely by changes in myelin content. The results demonstrate the potential for MET2 analysis as well as the limits of putative myelin markers for characterizing white matter abnormalities involving intra-myelinic edema. We studied a rat model of intra-myelinic edema induced by hexachlorophene ingestion. We used multi-exponential T2 (MET2) and quantitative magnetization transfer MRI. Histology was quantitatively evaluated to measure edema volume and myelin content. MET2 provides a measure that correlates but overestimates with edema volume fraction. MET2 measure of edema is affected by microscopic water dynamics.
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19
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Whitehead MT, Choudhri AF, Salim S. Magnetic resonance imaging findings in Axenfeld-Rieger syndrome. Clin Ophthalmol 2013; 7:911-6. [PMID: 23723681 PMCID: PMC3665571 DOI: 10.2147/opth.s42933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Axenfeld–Rieger syndrome (ARS) is a genetic disorder representing a disease spectrum resulting from neural crest cell maldevelopment. Glaucoma is a common complication from the incomplete formation of the iridocorneal angle structures. Neural crest cells also form structures of the forebrain and pituitary gland, dental papillae, aortic arch walls, genitalia, and long bones; therefore, patients with ARS manifest a wide range of systemic findings. To our knowledge, detailed magnetic resonance imaging findings have not been previously reported. We report a case of a 19-month-old Indian male diagnosed with ARS with emphasis on magnetic resonance imaging findings of the globes, brain, teeth, and skull base.
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Affiliation(s)
- Matthew T Whitehead
- Department of Radiology, University of Tennessee Health Science Center, Memphis, TN, USA ; Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA
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