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Godinho F, Guerreiro C, Parente Freixo J, Oliveira J, Lourenço Rosa J. Acute onset of adult Alexander disease and the concept of GFAP toxicity. J Neurol Sci 2023; 453:120800. [PMID: 37703708 DOI: 10.1016/j.jns.2023.120800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 09/15/2023]
Affiliation(s)
- Filipe Godinho
- Neurology Department, Centro Hospitalar Universitário de Lisboa Central, Hospital de São José, Rua José António Serrano, 1150-199, Lisbon, Portugal.
| | - Carolina Guerreiro
- Neurology Department, Centro Hospitalar Universitário de Lisboa Central, Hospital de São José, Rua José António Serrano, 1150-199, Lisbon, Portugal
| | - João Parente Freixo
- CGPP - Center for Predictive and Preventive Genetics, IBMC - Institute for Molecular and Cell Biology, Rua Júlio Amaral de Carvalho 45, 4200-135, Porto, Portugal; 3S - Instituto de Investigação e Inovação em Saúde, iRua Alfredo Allen 208, 4200-135, Porto, Portugal.
| | - Jorge Oliveira
- CGPP - Center for Predictive and Preventive Genetics, IBMC - Institute for Molecular and Cell Biology, Rua Júlio Amaral de Carvalho 45, 4200-135, Porto, Portugal; 3S - Instituto de Investigação e Inovação em Saúde, iRua Alfredo Allen 208, 4200-135, Porto, Portugal.
| | - José Lourenço Rosa
- Neurology Department, Centro Hospitalar Universitário de Lisboa Central, Hospital de São José, Rua José António Serrano, 1150-199, Lisbon, Portugal
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Kim MH, Lee JS, Hong JM, Sohn YB, Lee SJ. Aperiodic alternating nystagmus in adult-onset Alexander disease with a novel mutation. J Neurol 2023; 270:569-572. [PMID: 36153801 DOI: 10.1007/s00415-022-11390-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/19/2022] [Accepted: 09/19/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Min Hye Kim
- Department of Neurology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Jin Soo Lee
- Department of Neurology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Ji Man Hong
- Department of Neurology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Young Bae Sohn
- Department of Medical Genetics, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Seong-Joon Lee
- Department of Neurology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea.
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Heshmatzad K, Naderi N, Masoumi T, Pouraliakbar H, Kalayinia S. Identification of a novel de novo pathogenic variant in GFAP in an Iranian family with Alexander disease by whole-exome sequencing. Eur J Med Res 2022; 27:174. [PMID: 36088400 PMCID: PMC9464415 DOI: 10.1186/s40001-022-00799-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 08/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background Alexander disease (AxD) is a rare leukodystrophy with an autosomal dominant inheritance mode. Variants in GFAP lead to this disorder and it is classified into three distinguishable subgroups: infantile, juvenile, and adult-onset types. Objective The aim of this study is to report a novel variant causing AxD and collect all the associated variants with juvenile and adult-onset as well. Methods We report a 2-year-old female with infantile AxD. All relevant clinical and genetic data were evaluated. Search strategy for all AxD types was performed on PubMed. The extracted data include total recruited patients, number of patients carrying a GFAP variant, nucleotide and protein change, zygosity and all the clinical symptoms. Results A novel de novo variant c.217A > G: p. Met73Val was found in our case by whole-exome sequencing. In silico analysis categorized this variant as pathogenic. Totally 377 patients clinically diagnosed with juvenile or adult-onset forms were recruited in these articles, among them 212 patients were affected with juvenile or adult-onset form carrier of an alteration in GFAP. A total of 98 variants were collected. Among these variants c.262C > T 11/212 (5.18%), c.1246C > T 9/212 (4.24%), c.827G > T 8/212 (3.77%), c.232G > A 6/212 (2.83%) account for the majority of reported variants. Conclusion This study highlighted the role of genetic in AxD diagnosing. It also helps to provide more information in order to expand the genetic spectrum of Iranian patients with AxD. Our literature review is beneficial in defining a better genotype–phenotype correlation of AxD disorder.
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Kang YR, Lee SH, Lin NH, Lee SJ, Yang AW, Chandrasekaran G, Kang KW, Jin MS, Kim MK, Perng MD, Choi SY, Nam TS. A novel in-frame GFAP p.E138_L148del mutation in Type II Alexander disease with atypical phenotypes. Eur J Hum Genet 2022; 30:687-694. [PMID: 35246666 DOI: 10.1038/s41431-022-01073-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 01/29/2022] [Accepted: 02/14/2022] [Indexed: 12/14/2022] Open
Abstract
Alexander disease (AxD) is a neurodegenerative astrogliopathy caused by mutation in the glial fibrillary acidic protein (GFAP) gene. A 42-year-old Korean man presented with temporary gait disturbance and psychiatric regression after a minor head trauma in the absence of bulbar symptoms and signs. Magnetic resonance images of the brain and spinal cord showed significant atrophy of the medulla oblongata and the entire spinal cord as well as contrast-enhanced T2 hypointensity in the basal ganglia. DNA sequencing revealed a novel 33-bp in-frame deletion mutation (p.Glu138_Leu148del) within the 1B rod domain of GFAP, which was predicted to be deleterious by PROVEAN analysis. To test whether the deletion mutant is disease-causing, we performed in vitro GFAP assembly and sedimentation assays, and GFAP aggregation assays in human adrenal carcinoma SW13 (Vim-) cells and rat primary astrocytes. All the assays revealed that GFAP p.Glu138_Leu148del is aggregation prone. Based on these findings, we diagnosed the patient with Type II AxD. This is a report that demonstrates the pathogenicity of InDel mutation of GFAP through functional studies. This patient's atypical presentation as well as the discrepancy between clinical symptoms and radiologic findings may extend the scope of AxD.
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Affiliation(s)
- You-Ri Kang
- Department of Neurology, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, 61469, Republic of Korea
| | - So-Hyun Lee
- Department of Biomedical Sciences, Chonnam National University Medical School, Hwasun, 58128, Republic of Korea
| | - Ni-Hsuan Lin
- Institute of Molecular Medicine, College of Life Sciences, National Tsing Hua University, Hsinchu, 30013, Taiwan
| | - Seung-Jin Lee
- Department of Radiology, Chonnam National University Hospital, Gwangju, 61469, Republic of Korea
| | - Ai-Wen Yang
- Institute of Molecular Medicine, College of Life Sciences, National Tsing Hua University, Hsinchu, 30013, Taiwan
| | | | - Kyung Wook Kang
- Department of Neurology, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, 61469, Republic of Korea
| | - Mi Sun Jin
- School of Life Sciences, Gwangju Institute of Science and Technology, Gwangju, 61005, Republic of Korea
| | - Myeong-Kyu Kim
- Department of Neurology, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, 61469, Republic of Korea
| | - Ming-Der Perng
- Institute of Molecular Medicine, College of Life Sciences, National Tsing Hua University, Hsinchu, 30013, Taiwan.
| | - Seok-Yong Choi
- Department of Biomedical Sciences, Chonnam National University Medical School, Hwasun, 58128, Republic of Korea.
| | - Tai-Seung Nam
- Department of Neurology, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, 61469, Republic of Korea.
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Blood GFAP as an emerging biomarker in brain and spinal cord disorders. Nat Rev Neurol 2022; 18:158-172. [PMID: 35115728 DOI: 10.1038/s41582-021-00616-3] [Citation(s) in RCA: 191] [Impact Index Per Article: 95.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 12/14/2022]
Abstract
Blood-derived biomarkers for brain and spinal cord diseases are urgently needed. The introduction of highly sensitive immunoassays led to a rapid increase in the number of potential blood-derived biomarkers for diagnosis and monitoring of neurological disorders. In 2018, the FDA authorized a blood test for clinical use in the evaluation of mild traumatic brain injury (TBI). The test measures levels of the astrocytic intermediate filament glial fibrillary acidic protein (GFAP) and neuroaxonal marker ubiquitin carboxy-terminal hydrolase L1. In TBI, blood GFAP levels are correlated with clinical severity and extent of intracranial pathology. Evidence also indicates that blood GFAP levels hold the potential to reflect, and might enable prediction of, worsening of disability in individuals with progressive multiple sclerosis. A growing body of evidence suggests that blood GFAP levels can be used to detect even subtle injury to the CNS. Most importantly, the successful completion of the ongoing validation of point-of-care platforms for blood GFAP might ameliorate the decision algorithms for acute neurological diseases, such as TBI and stroke, with important economic implications. In this Review, we provide a systematic overview of the evidence regarding the utility of blood GFAP as a biomarker in neurological diseases. We propose a model for GFAP concentration dynamics in different conditions and discuss the limitations that hamper the widespread use of GFAP in the clinical setting. In our opinion, the clinical use of blood GFAP measurements has the potential to contribute to accelerated diagnosis and improved prognostication, and represents an important step forward in the era of precision medicine.
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Abstract
Alexander disease (ALXDRD) is a primary astrocyte disease caused by GFAP gene mutation. The clinical features of ALXDRD vary from infantile-onset cerebral white matter involvement to adult-onset brainstem involvement. Several studies revealed that the level of GFAP overexpression is correlated with disease severity, and basic research on therapies to reduce abnormal GFAP accumulation has recently been published. Therefore, the accumulation of clinical data to advance understanding of the natural history is essential for clinical trials expected in the future. This review focuses on the clinical characteristics of ALXDRD including the clinical symptoms, imaging findings and genetics to provide diagnostic information useful in daily clinical practice.
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Affiliation(s)
- Tomokatsu Yoshida
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
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Yoshida T. [Clinical characteristics and diagnostic criteria on Alexander disease]. Rinsho Shinkeigaku 2020; 60:581-588. [PMID: 32779598 DOI: 10.5692/clinicalneurol.cn-001442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Alexander disease (ALXDRD) is a primary astrocyte disease caused by glial fibrillary acidic protein (GFAP) gene mutation. ALXDRD had been clinically regarded as a cerebral white matter disease that affects only children for about 50 years since the initial report in 1949; however, in the early part of the 21st century, case reports of adult-onset ALXDRD with medulla and spinal cord lesions increased. Basic research on therapies to reduce abnormal GFAP accumulation, such as drug-repositioning and antisense oligonucleotide suppression, has recently been published. The accumulation of clinical data to advance understanding of natural history is essential for clinical trials expected in the future. In this review, I classified ALXDRD into two subtypes: early-onset and late-onset, and detail the clinical symptoms, imaging findings, and genetic characteristics as well as the epidemiology and historical changes in the clinical classification described in the literature. The diagnostic criteria based on Japanese ALXDRD patients that are useful in daily clinical practice are also mentioned.
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Affiliation(s)
- Tomokatsu Yoshida
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
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Benzoni C, Aquino D, Di Bella D, Sarto E, Moscatelli M, Pareyson D, Taroni F, Salsano E. Severe worsening of adult-onset Alexander disease after minor head trauma: Report of two patients and review of the literature. J Clin Neurosci 2020; 75:221-223. [PMID: 32223977 DOI: 10.1016/j.jocn.2020.03.033] [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: 01/10/2020] [Accepted: 03/20/2020] [Indexed: 11/26/2022]
Abstract
Alexander disease (ALXDRD) is a rare astrocytic leukodystrophy caused by GFAP mutations. The adult-onset (AO) variant is usually characterized by gradual onset of spastic ataxia and bulbar symptoms with slowly progressive course. We report two AO-ALXDRD cases with rapid worsening after minor head trauma. In one of them, the only post-traumatic neuroimaging change was revealed by diffusion tensor imaging study. Our observations support the link between head trauma and ALXDRD progression, and suggest that this progression may be ascribed to microstructural changes. Clinicians should inform ALXDRD patients to minimize the risk of head trauma.
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Affiliation(s)
- Chiara Benzoni
- Unit of Rare Neurodegenerative and Neurometabolic Diseases, Fondazione IRCCS Istituto Neurologico Carlo Besta, via Celoria 11, 20133 Milano, Italy
| | - Domenico Aquino
- Unit of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, via Celoria 11, 20133 Milano, Italy
| | - Daniela Di Bella
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, via Celoria 11, 20133 Milano, Italy
| | - Elisa Sarto
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, via Celoria 11, 20133 Milano, Italy
| | - Marco Moscatelli
- Unit of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, via Celoria 11, 20133 Milano, Italy
| | - Davide Pareyson
- Unit of Rare Neurodegenerative and Neurometabolic Diseases, Fondazione IRCCS Istituto Neurologico Carlo Besta, via Celoria 11, 20133 Milano, Italy
| | - Franco Taroni
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, via Celoria 11, 20133 Milano, Italy
| | - Ettore Salsano
- Unit of Rare Neurodegenerative and Neurometabolic Diseases, Fondazione IRCCS Istituto Neurologico Carlo Besta, via Celoria 11, 20133 Milano, Italy; Neuroscience PhD Program, University of Milano-Bicocca, Monza, Italy.
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Park J, Park ST, Kim J, Kwon KY. A case report of adult-onset Alexander disease clinically presenting as Parkinson's disease: is the comorbidity associated with genetic susceptibility? BMC Neurol 2020; 20:27. [PMID: 31952467 PMCID: PMC6967083 DOI: 10.1186/s12883-020-1616-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 01/14/2020] [Indexed: 12/02/2022] Open
Abstract
Background Alexander disease is a rare neurological disease characterized by progressive spastic quadriparesis and bulbar palsy. Moreover, certain patients with adult-onset Alexander disease were often misdiagnosed as other neurodegenerative disorders. Case presentation Herein, we report an adult a 58-year-old woman presented with typical parkinsonism with good levodopa-responsiveness. The patient’s dopamine transporter scanning showed significant striatal depletion, while her brain magnetic resonance imaging revealed bilateral tadpole shape of medulla oblongata and bilateral high signal intensity at both cerebellar dentate nuclei in T2-weighted images, suggesting the possibility of a genetic disorder beyond Parkinson’s disease. The patient’s genetic test resulted in known pathogenic glial fibrillary acidic protein variant, indicating Alexander disease. Conclusion This unique case highlights genetically diagnosed Alexander disease may present with clinical Parkinson’s disease.
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Affiliation(s)
- Jongkyu Park
- Department of Neurology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Sung-Tae Park
- Department of Radiology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Jieun Kim
- Department of Laboratory Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Kyum-Yil Kwon
- Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, 59 Daesagwan-ro, Yongsan-gu, Seoul, 04401, Republic of Korea.
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Crystal structure of the human glial fibrillary acidic protein 1B domain. Biochem Biophys Res Commun 2018; 503:2899-2905. [PMID: 30126635 DOI: 10.1016/j.bbrc.2018.08.066] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 08/07/2018] [Indexed: 01/09/2023]
Abstract
Glial fibrillary acidic protein (GFAP) is a homopolymeric type III intermediate filament (IF) that plays essential roles in cell migration, mitosis, development, and signaling in astrocytes and a specific type of glial cells. Its overexpression and genetic mutations lead to abnormal IF networks and accumulation of Rosenthal fibers, which results in the fatal neurodegenerative disorder Alexander disease. Herein, we present the first crystal structure of human GFAP spanning the central coiled-coil 1B domain at 2.5 Å resolution. The domain forms a tetramer comprising two equivalent parallel coiled-coil dimers that pack together in an antiparallel manner. Its assembly is stabilized by extensive networks of intermolecular hydrogen bonds, salt bridges, and hydrophobic interactions. Furthermore, mapping of the GFAP mutations associated with Alexander disease reveals that most involve residues buried in the core of the interface, and are likely to disrupt the intermolecular interactions and/or introduce steric clashes, thereby decreasing GFAP solubility and promoting aggregation. Based on our structural analysis and previous biochemical studies, we propose that GFAP assembles in the A11 mode in which coiled-coil 1B dimers lie in close axial proximity in an antiparallel fashion to provide a stable tetrameric platform for the organization of the GFAP filament.
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Neuroimaging of Pediatric Metabolic Disorders with Emphasis on Diffusion-Weighted Imaging and MR Spectroscopy: A Pictorial Essay. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0251-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Schulz A, Wagner F, Ungelenk M, Kurth I, Redecker C. Stroke-like onset of brain stem degeneration presents with unique MRI sign and heterozygous NMNAT2 variant: a case report. Transl Neurodegener 2016; 5:23. [PMID: 28035283 PMCID: PMC5187649 DOI: 10.1186/s40035-016-0069-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 12/02/2016] [Indexed: 02/01/2023] Open
Abstract
Background Acute-onset neurodegenerative diseases in older patients are rare clinical cases, especially when the degeneration only affects specific regions of the nervous system. Several neurological disorders have been described in which the degeneration of brain parenchyma originates from and/or primarily affects the brain stem. Clinical diagnosis in these patients, however, is often complicated due to a poor understanding of these diseases and their underlying mechanisms. Case presentation In this manuscript we report on a 73-year-old female who had experienced a sudden onset of complex neurological symptoms that progressively worsened over a period of 2 years. Original evaluation had suggested a MRI-negative stroke as underlying pathogenesis. The combination of patient’s medical history, clinical examination and exceptional pattern of brain stem degeneration presenting as “kissing swan sign” in MR imaging was strongly suggestive of acute onset of Alexander’s disease. This leukoencephalopathy is caused by GFAP (glial fibrilary acidic protein) gene mutations and may present with brain stem atrophy and stroke-like onset of symptoms in elderly individuals. However, a pathognomonic GFAP gene mutation could not be identified by Sanger sequencing. Conclusions After an extended differential diagnosis and exclusion of other diseases, a definite diagnosis of the patient’s condition presently remains elusive. However, whole-exome sequencing performed from patient’s blood revealed 12 potentially disease-causative heterozygous variants, amongst which several have been associated with neurological disorders in vitro and in vivo – in particular the axon degeneration-related NMNAT2 gene.
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Affiliation(s)
- Alexander Schulz
- Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Jena, 07747 Germany.,Present address: Department of Genetics and Program in Cellular Neuroscience, Neurodegeneration and Repair, Yale University School of Medicine, New Haven, CT 06510 USA
| | - Franziska Wagner
- Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Jena, 07747 Germany
| | - Martin Ungelenk
- Institute of Human Genetics, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, 07743 Germany
| | - Ingo Kurth
- Institute of Human Genetics, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, 07743 Germany.,Present address: Institute of Human Genetics, Uniklinik RWTH Aachen, Aachen, 52074 Germany
| | - Christoph Redecker
- Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Jena, 07747 Germany
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Type II (adult onset) Alexander disease in a paraplegic male with a rare D128N mutation in the GFAP gene. Clin Neuropathol 2015; 34:298-302. [PMID: 25997626 PMCID: PMC4766795 DOI: 10.5414/np300863] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2015] [Indexed: 11/18/2022] Open
Abstract
Abstract not available.
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Sugiyama A, Sawai S, Ito S, Mukai H, Beppu M, Yoshida T, Kuwabara S. Incidental diagnosis of an asymptomatic adult-onset Alexander disease by brain magnetic resonance imaging for preoperative evaluation. J Neurol Sci 2015; 354:131-2. [PMID: 25982497 DOI: 10.1016/j.jns.2015.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 04/24/2015] [Accepted: 05/01/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Atsuhiko Sugiyama
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan.
| | - Setsu Sawai
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shoichi Ito
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan; Office of Medical Education, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroki Mukai
- Department of Radiology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Minako Beppu
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomokatsu Yoshida
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Krishna SH, McKinney AM, Lucato LT. Congenital Genetic Inborn Errors of Metabolism Presenting as an Adult or Persisting Into Adulthood: Neuroimaging in the More Common or Recognizable Disorders. Semin Ultrasound CT MR 2014; 35:160-91. [DOI: 10.1053/j.sult.2013.10.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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