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Xu L, Zhong M, Yang Y, Wang M, An N, Xu X, Zhu Y, Li Z, Chen H, Zhao R, Zheng X. Adult-onset vanishing white matter in a patient with EIF2B3 variants misdiagnosed as multiple sclerosis. Neurol Sci 2021; 43:2659-2667. [PMID: 34755279 DOI: 10.1007/s10072-021-05710-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/29/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Vanishing white matter (VWM) is an autosomal recessive disorder characterized by childhood ataxia with central hypomyelination. Adult-onset VWM should be considered as a differential diagnosis for suspected cases of multiple sclerosis (MS). METHODS Targeted region sequencing (TRS) and Sanger sequencing validation were performed to identify and validate the likely pathogenic mutations in a family with VWM. RESULTS The main clinical manifestations of the proband included decreased vision and sleepiness accompanied by atrophy of the corpus callosum, affected inner rim of the corpus callosum, decreased apparent diffusion coefficient value or persistent hyperintensity-diffusion-weighted imaging, atrophied optic nerve, and no recordable visual evoked potentials. Due to the slow development and atypical VWM image features, MS was initially suspected. After prednisone was administered, the patient's condition did not improve significantly, and other diseases were considered. The TRS and Sanger sequencing identified compound heterozygous mutations of EIF2B3 in the proband; c.965C > G /p.Ala322Gly in exon 8 and c.130G > A/p.Glu44Lys in exon 2 were missense mutations inherited from the mother and father, respectively. The proband's oldest brother had the same compound heterozygous mutations but showed no symptoms. CONCLUSION This is the first report of adult-onset VWM in a Chinese family. Initially, MS was suspected, and genetic testing confirmed the diagnosis of VWM. This study may further broaden the clinical spectrum of EIF2B3, thus providing a foundation for further research on the pathogenesis and genetic therapy for VWM.
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Affiliation(s)
- Lulu Xu
- Department of Geriatric Medicine, the Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266000, Shandong, China
| | - Meixiang Zhong
- Department of Geriatric Medicine, the Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266000, Shandong, China
| | - Yuyuan Yang
- Department of Geriatric Medicine, the Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266000, Shandong, China
| | - Meng Wang
- Department of Geriatric Medicine, the Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266000, Shandong, China
| | - Nina An
- Department of Geriatric Medicine, the Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266000, Shandong, China
| | - Xin Xu
- Department of Neurology, the Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266000, Shandong, China
| | - Yufeng Zhu
- Department of Graduate School, Qinghai University, Xining, 810016, Qinghai, China
| | - Zengwen Li
- Department of Radiology, Gaomi Municipal Hospital, Gaomi, 261500, Shandong, China
| | - Huili Chen
- Department of Ophthalmology, Yijishan Hospital of Wannan Medical College, Wuhu, 241000, China
| | - Renliang Zhao
- Department of Neurology, the Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266000, Shandong, China.
| | - Xueping Zheng
- Department of Geriatric Medicine, the Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266000, Shandong, China.
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Wei C, Qin Q, Chen F, Zhou A, Wang F, Zuo X, Chen R, Lyu J, Jia J. Adult-onset vanishing white matter disease with the EIF2B2 gene mutation presenting as menometrorrhagia. BMC Neurol 2019; 19:203. [PMID: 31438897 PMCID: PMC6704498 DOI: 10.1186/s12883-019-1429-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 08/14/2019] [Indexed: 02/05/2023] Open
Abstract
Background Vanishing white matter disease (VWMD) is one of the most prevalent inherited leukoencephalopathies, which generally presents in childhood as a progressive disorder while less beginning in adulthood. The present report describes the clinical, neuroimaging, and genetic findings of a female patient with adult-onset VWMD. In addition, to provide a clearer delineation of the clinical and genetic characteristics of female adult-onset VWMD patients, 32 genetically confirmed female adult-onset EIF2B-mutated cases are summarized. Case presentation The patient described here suffered from long-term menometrorrhagia prior to manifesting progressive neurological impairments that included tremors, bilateral pyramidal tract injury, cerebellar ataxia, and dementia. To the best of our knowledge, this is the first female patient with adult-onset VWMD suffering from long-term menometrorrhagia attributed to the c.254 T > A and c.496A > G mutations in the EIF2B2 gene; the c.496A > G mutation has not been reported in previous studies. The patient also exhibited metabolic dysfunction. The present findings widen the spectrum of phenotypic heterogeneity observed in VWMD patients. Conclusions The present report summarizes 33 female patients with adult-onset VWMD to provide an overview of the clinical and genetic characteristics of this disorder and ovarioleukodystrophy. The mean age of clinical onset in female patients with adult-onset VWMD was 36.8 years and the neurological symptoms primarily included motor and cognitive dysfunction such as paraparesis, cerebellar ataxia, and executive deficits. In addition, ovarian failure occurred in all of these female patients and usually preceded the neurological symptoms. Furthermore, several patients also suffered from metabolic dysfunction. All 33 patients had mutations on EIF2B1–5, and of these, the c.338 G > A mutation in the EIF2B5 gene (p.Arg113His) was the most common. These findings suggest that clinicians should be aware of adult-onset forms of VWMD as well as its typical magnetic resonance imaging (MRI) and clinical characteristics although this pathology is usually recognized as a pediatric disorder. No curative treatment is presently available, and thus early recognition is important to prevent triggering events and to allow for genetic counseling. Electronic supplementary material The online version of this article (10.1186/s12883-019-1429-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cuibai Wei
- Innovation center for neurological disorders, Department of Neurology, Xuan Wu Hospital, Capital Medical University, 45 Changchun Street, Beijing, 100053, China.
| | - Qi Qin
- Innovation center for neurological disorders, Department of Neurology, Xuan Wu Hospital, Capital Medical University, 45 Changchun Street, Beijing, 100053, China
| | - Fei Chen
- Innovation center for neurological disorders, Department of Neurology, Xuan Wu Hospital, Capital Medical University, 45 Changchun Street, Beijing, 100053, China
| | - Aihong Zhou
- Innovation center for neurological disorders, Department of Neurology, Xuan Wu Hospital, Capital Medical University, 45 Changchun Street, Beijing, 100053, China
| | - Fen Wang
- Innovation center for neurological disorders, Department of Neurology, Xuan Wu Hospital, Capital Medical University, 45 Changchun Street, Beijing, 100053, China
| | - Xiumei Zuo
- Innovation center for neurological disorders, Department of Neurology, Xuan Wu Hospital, Capital Medical University, 45 Changchun Street, Beijing, 100053, China
| | - Rong Chen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Jihui Lyu
- Center for Cognitive Disorders, Beijing Geriatric Hospital, Beijing, China
| | - Jianping Jia
- Innovation center for neurological disorders, Department of Neurology, Xuan Wu Hospital, Capital Medical University, 45 Changchun Street, Beijing, 100053, China.,Center of Alzheimer's Disease, Beijing Institute for Brain Disorders; Beijing Key Laboratory of Geriatric Cognitive Disorders, Neurodegenerative Laboratory of Ministry of Education of the People's Republic of China, Beijing, China
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La Piana R, Vanderver A, van der Knaap M, Roux L, Tampieri D, Brais B, Bernard G. Adult-onset vanishing white matter disease due to a novel EIF2B3 mutation. ACTA ACUST UNITED AC 2012; 69:765-68. [PMID: 22312164 DOI: 10.1001/archneurol.2011.1942] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To report a novel mutation in the gene EIF2B3 responsible for a late-onset form of vanishing white matter disease. DESIGN Case report. SETTING University teaching hospital. PATIENT A 29-year-old pregnant woman with a history of premature ovarian failure and hemiplegic migraines presented with a 10-week history of progressive confusion and headaches. Magnetic resonance imaging of the brain revealed a diffuse leukoencephalopathy. RESULTS Sequencing of the exons and intron boundaries of EIF2B3 uncovered 2 missense mutations: c.260C>T(p.Ala87Val) and c.272G>A(p.Arg91His). To our knowledge,the latter missense mutation has never been previously reported. CONCLUSION This is the second report of adult-onset vanishing white matter disease due to mutations in EIF2B3 and the first report of the c.272G>A (p.Arg91His) missense mutation.
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Affiliation(s)
- Roberta La Piana
- Department of Neuroradiology, Montreal Neurological Institute, McGill University, Quebec, Canada
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