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Abstract
BACKGROUND Giant axonal neuropathy (GAN) is an autosomal recessive inherited progressive motor and sensory neuropathy with typical onset in early childhood. The disease is caused by GAN gene mutations on chromosome 16q24.1. To determine clinical and genetic results in Turkish patients with GAN. METHODS Eight children with GAN were retrospectively analyzed. Five (62.5%) were girls and 3 (37.5%) were boys with the mean age on admission 10.13±3.8 years (range: 5-15 years). RESULTS Parental consanguinity was found in all the families. The patients had the classical clinical phenotype characterized by a severe axonal neuropathy with kinky hair. Two patients had contractures of extremities, and not walking. One patient was walking with aid. The other patients were walking without aid. Mutation analysis was performed in two patients and IVS9 (+1G>T) (homozygous) mutation was detected. CONCLUSION The classical clinical findings allowed considering the GAN diagnosis, but, in atypical cases and milder phenotypes, the presence of giant axons in nerve biopsy was helpful to specify molecular analysis.
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Johnson-Kerner BL, Roth L, Greene JP, Wichterle H, Sproule DM. Giant axonal neuropathy: An updated perspective on its pathology and pathogenesis. Muscle Nerve 2014; 50:467-76. [DOI: 10.1002/mus.24321] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2014] [Indexed: 12/15/2022]
Affiliation(s)
- Bethany L. Johnson-Kerner
- Project A.L.S./Jenifer Estess Laboratory for Stem Cell Research; Center for Motor Neuron Biology and Disease, Columbia Stem Cell Initiative, Columbia University College of Physicians and Surgeons; New York New York USA
| | - Lisa Roth
- Project A.L.S./Jenifer Estess Laboratory for Stem Cell Research; Center for Motor Neuron Biology and Disease, Columbia Stem Cell Initiative, Columbia University College of Physicians and Surgeons; New York New York USA
| | - J. Palmer Greene
- Project A.L.S./Jenifer Estess Laboratory for Stem Cell Research; Center for Motor Neuron Biology and Disease, Columbia Stem Cell Initiative, Columbia University College of Physicians and Surgeons; New York New York USA
| | - Hynek Wichterle
- Project A.L.S./Jenifer Estess Laboratory for Stem Cell Research; Center for Motor Neuron Biology and Disease, Columbia Stem Cell Initiative, Columbia University College of Physicians and Surgeons; New York New York USA
| | - Douglas M. Sproule
- Division of Pediatric Neurosciences, Department of Neurology; SMA Clinical Research Center, Columbia University Medical Center; Harkness Pavilion, HP-519, 180 Fort Washington Avenue New York New York 10032-3791 USA
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Xu M, Da YW, Liu L, Wang F, Jia JP. Giant axonal neuropathy caused by a novel compound heterozygous mutation in the gigaxonin gene. J Child Neurol 2013; 28:1316-9. [PMID: 23248352 DOI: 10.1177/0883073812467688] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Giant axonal neuropathy is a rare autosomal recessive disorder, which typically involves both central and peripheral nervous system. Yet the phenotypic-genotypic correlation remains obscure. We report a novel compound heterozygous mutation with the c. 805C>T in exon 4(Arg545His missense mutation) and the c. 1634G>A in exon 11(Arg269Trp missense mutation) in an 11-year-old Chinese giant axonal neuropathy case. This patient had an atypical giant axonal neuropathy phenotype rather similar to Charcot-Marie-Tooth disease, without tightly curled hair and mental retardation. The patient had a slowly progressive sensory motor neuropathy since age 3 years, and she also had nystagmus, feet deformities, scoliosis, and cerebellar tonsillar protrusion. Electrophysiological studies indicated a predominantly axonal sensory-motor neuropathy. The diagnosis was confirmed by sural nerve biopsy and direct sequencing of all the 11 gigaxonin exons. The proband's parents are heterozygotes of the disease without symptoms. Our findings extend the number of gigaxonin mutations that cause giant axonal neuropathy.
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Affiliation(s)
- Min Xu
- 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
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Roth LA, Johnson-Kerner BL, Marra JD, LaMarca NH, Sproule DM. The absence of curly hair is associated with a milder phenotype in Giant Axonal Neuropathy. Neuromuscul Disord 2013; 24:48-55. [PMID: 23890932 DOI: 10.1016/j.nmd.2013.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 05/29/2013] [Accepted: 06/11/2013] [Indexed: 01/23/2023]
Abstract
Giant Axonal Neuropathy is a pediatric neurodegenerative disorder caused by autosomal recessive mutations in the GAN gene on chromosome 16q24.1. Mutations in the GAN gene lead to functional impairment of the cytoskeletal protein gigaxonin and a generalized disorder of intermediate filaments, including neurofilaments in axons. Tightly curled hair is a common but not universal feature of Giant Axonal Neuropathy. The pathogenesis of curly hair is unknown, although disruption of keratin architecture is thought to play a role. As part of a broader natural history study of Giant Axonal Neuropathy, we found that the absence of curly hair is correlated with superior motor function (p=0.013) when controlling for age, as measured by the Gross Motor Function Measure. Theoretically, higher levels of functional gigaxonin protein or compensatory mechanisms could produce fewer abnormalities of neurofilaments and keratin, accounting for this phenotype. We suggest that straight-haired patients with Giant Axonal Neuropathy are potentially underdiagnosed due to their divergence from the classic phenotype of the disease. Due to their non-specific features of an axonal neuropathy, these patients may be misdiagnosed with Charcot-Marie-Tooth Disease type 2. Genetic testing for Giant Axonal Neuropathy should be considered in relevant cases of Charcot-Marie-Tooth Disease type 2.
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Affiliation(s)
- Lisa A Roth
- College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, United States.
| | - Bethany L Johnson-Kerner
- College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, United States
| | - Jonathan D Marra
- Division of Pediatric Neurology, Department of Neurology, Columbia University Medical Center, New York, NY, United States
| | - Nicole H LaMarca
- Division of Pediatric Neurology, Department of Neurology, Columbia University Medical Center, New York, NY, United States
| | - Douglas M Sproule
- Division of Pediatric Neurology, Department of Neurology, Columbia University Medical Center, New York, NY, United States
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Erol I, Alehan F, Alkan O, Bruno C. Involvement of the globus pallidus in giant axonal neuropathy. Pediatr Neurol 2012; 47:382-4. [PMID: 23044025 DOI: 10.1016/j.pediatrneurol.2012.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 07/23/2012] [Indexed: 11/19/2022]
Abstract
Giant axonal neuropathy is a rare autosomal recessive disorder commonly characterized by chronic, progressive dysfunction in the peripheral nervous system. Lesions also can occur in the central nervous system, especially in the brainstem and cerebellum. We present cranial magnetic resonance imaging and magnetic resonance spectroscopy findings in a 5-year-old Turkish girl with giant axonal neuropathy. This study is the second to describe involvement of the globus pallidus on T(2)-weighted imaging in giant axonal neuropathy. Magnetic resonance spectroscopy of cerebellar white matter lesions and globus pallidus revealed metabolic changes, including increased choline/creatine ratios, increased lactate, and reduced N-acetyl aspartate/creatine ratios. Thus, magnetic resonance spectroscopy did not produce findings specific to giant axonal neuropathy, but indicated progressive neuronal loss, demyelination, and gliosis in the cerebellar white matter.
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Affiliation(s)
- Ilknur Erol
- Division of Pediatric Neurology, Department of Pediatrics, Adana Teaching and Medical Research Center, Faculty of Medicine, Baskent University, Adana, Turkey.
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Vasudev M, Bhat M, Bharath R, Prasad C, Arvinda H, Kulkarni G, Gayathri N. Giant Axonal Neuropathy: A Pictorial Essay and Review of Literature. Neuroradiol J 2010; 23:119-25. [DOI: 10.1177/197140091002300120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Accepted: 01/26/2010] [Indexed: 11/15/2022] Open
Abstract
Giant axonal neuropathy (GAN) is a neurodegenerative disorder classified within the hereditary motor and sensory neuropathies, affecting both the peripheral and central nervous systems. GAN typically presents in early childhood before the age of five years and progresses to death usually by early adulthood. Various imaging findings in giant axonal neuropathy have been described and documented in literature in the form multiple case reports. We here present a pictorial essay of all the major imaging GAN findings described in the literature. In addition, involvement of the dentate nucleus hitherto not described in the literature was noted in the present case.
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Affiliation(s)
- M.K. Vasudev
- Neuro Imaging and Interventional Radiology, National Institute of Mental Health and NeuroSciences; Bangalore, Karnataka, India
| | - M.D. Bhat
- Neuro Imaging and Interventional Radiology, National Institute of Mental Health and NeuroSciences; Bangalore, Karnataka, India
| | - R.D. Bharath
- Neuro Imaging and Interventional Radiology, National Institute of Mental Health and NeuroSciences; Bangalore, Karnataka, India
| | - C. Prasad
- Neuro Imaging and Interventional Radiology, National Institute of Mental Health and NeuroSciences; Bangalore, Karnataka, India
| | - H. Arvinda
- Neuro Imaging and Interventional Radiology, National Institute of Mental Health and NeuroSciences; Bangalore, Karnataka, India
| | - G. Kulkarni
- Neuro Imaging and Interventional Radiology, National Institute of Mental Health and NeuroSciences; Bangalore, Karnataka, India
| | - N. Gayathri
- Neuro Imaging and Interventional Radiology, National Institute of Mental Health and NeuroSciences; Bangalore, Karnataka, India
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Brenner C, Speck-Martins CE, Farage L, Barker PB. 3T MR with diffusion tensor imaging and single-voxel spectroscopy in giant axonal neuropathy. J Magn Reson Imaging 2008; 28:236-41. [PMID: 18581347 DOI: 10.1002/jmri.21425] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Magnetic resonance imaging (MRI), diffusion tensor imaging (DTI), and MR spectroscopy (MRS) data were obtained in a patient with giant axonal neuropathy (GAN) and compared to a control group. Fractional anisotropy (FA) and apparent coefficient diffusion (ADC) data were obtained from specific white matter tracts including the corticospinal tracts (CST), corpus callosum (CC), optic radiations (OR), and middle cerebellar peduncle (MCP). Analysis of the MRS was performed. DTI parameters and MRS results were correlated with the neuropathological findings described for GAN. No significant difference between the FA of the CC of the patient and the control group was found. However, there was a significant difference between the FA of the CST, OR, and MCP of the patient and the control group. The ADC values for all tracts of the patient were significantly increased. N-acetylaspartate to creatine (NAA/Cr) and N-acetylaspartate to choline (NAA-Cho) (choline) metabolite ratios were slightly decreased and choline to creatine (Cho/Cr) and myo-inositol to creatine (Ins/Cr) metabolite ratios were increased in the parietal gray and white matter of the patient as compared to the control group. Cerebellar involvement was less evident. The DTI and MRS findings suggest myelin and axonal damage.
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Affiliation(s)
- Christiana Brenner
- Diagnostic Imaging Department, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada.
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Allen E, Ding J, Wang W, Pramanik S, Chou J, Yau V, Yang Y. Gigaxonin-controlled degradation of MAP1B light chain is critical to neuronal survival. Nature 2005; 438:224-8. [PMID: 16227972 DOI: 10.1038/nature04256] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2005] [Accepted: 09/28/2005] [Indexed: 11/08/2022]
Abstract
Giant axonal neuropathy (GAN) is a devastating sensory and motor neuropathy caused by mutations in the GAN gene, which encodes the ubiquitously expressed protein gigaxonin. Cytopathological features of GAN include axonal degeneration, with accumulation and aggregation of cytoskeletal components. Little is currently known about the molecular mechanisms underlying this recessive disorder. Here we show that gigaxonin controls protein degradation, and is essential for neuronal function and survival. We present evidence that gigaxonin binds to the ubiquitin-activating enzyme E1 through its amino-terminal BTB domain, while the carboxy-terminal kelch repeat domain interacts directly with the light chain (LC) of microtubule-associated protein 1B (MAP1B). Overexpression of gigaxonin leads to enhanced degradation of MAP1B-LC, which can be antagonized by proteasome inhibitors. Ablation of gigaxonin causes a substantial accumulation of MAP1B-LC in GAN-null neurons. Moreover, we show that overexpression of MAP1B in wild-type cortical neurons leads to cell death characteristic of GAN-null neurons, whereas reducing MAP1B levels significantly improves the survival rate of null neurons. Our results identify gigaxonin as a ubiquitin scaffolding protein that controls MAP1B-LC degradation, and provide insight into the molecular mechanisms underlying human neurodegenerative disorders.
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Affiliation(s)
- Elizabeth Allen
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, 1201 Welch Road, Stanford, California 94305-5489, USA
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Demir E, Bomont P, Erdem S, Cavalier L, Demirci M, Kose G, Muftuoglu S, Cakar AN, Tan E, Aysun S, Topcu M, Guicheney P, Koenig M, Topaloglu H. Giant axonal neuropathy: clinical and genetic study in six cases. J Neurol Neurosurg Psychiatry 2005; 76:825-32. [PMID: 15897506 PMCID: PMC1739689 DOI: 10.1136/jnnp.2003.035162] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Giant axonal neuropathy (GAN) is a severe recessive disorder characterised by variable combination of progressive sensory motor neuropathy, central nervous system (CNS) involvement, and "frizzly" hair. The disease is caused by GAN gene mutations on chromosome 16q24.1. AIMS To search for GAN gene mutations in Turkish patients with GAN and characterise the phenotype associated with them. METHODS Linkage and mutation analyses were performed in six affected patients from three consanguineous families. These patients were also investigated by cranial magnetic resonance imaging (MRI) and electroencephalography (EEG). Electromyography (EMG) was performed in heterozygous carriers from family 1 and family 3. RESULTS Linkage to 16q24.1 was confirmed by haplotype analysis. GAN mutations were identified in all families. Family 1 had the R293X mutation, previously reported in another Turkish family. Families 2 and 3, originating from close geographical areas, shared a novel mutation, 1502+1G>T, at the donor splice site of exon 9. All patients displayed a common phenotype, including peripheral neuropathy, cerebellar ataxia, and frizzly hair. Cranial MRI showed diffuse white matter abnormalities in two patients from family 1 and the patient from family 3, and minimal white matter involvement in the patient from family 2. EMG of a heterozygous R293X mutation carrier showed signs of mild axonal neuropathy, whereas a 1502+1G>T mutation carrier had normal EMG. EEG abnormalities were found in three patients. CONCLUSION These findings highlight the association of CNS involvement, in particular white matter abnormalities, with peripheral neuropathy in GAN. The phenotypical consequences of both mutations (when homozygous) were similar.
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Affiliation(s)
- E Demir
- Hacettepe Cocuk Hastahanesi, Cocuk Noroloji Bolumu, 06100, Ankara, Turkey
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Di Rocco M, Biancheri R, Rossi A, Filocamo M, Tortori-Donati P. Genetic disorders affecting white matter in the pediatric age. Am J Med Genet B Neuropsychiatr Genet 2004; 129B:85-93. [PMID: 15274047 DOI: 10.1002/ajmg.b.30029] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Pediatric white matter disorders can be distinguished into well-defined leukoencephalopathies, and undefined leukoencephalopathies. The first category may be subdivided into: (a) hypomyelinating disorders; (b) dysmyelinating disorders; (c) leukodystrophies; (d) disorders related to cystic degeneration of myelin; and (e) disorders secondary to axonal damage. The second category, representing up to 50% of leukoencephalopathies in childhood, requires a multidisciplinar approach in order to define novel homogeneous subgroups of patients, possibly representing "new genetic disorders" (such as megalencephalic leukoencepahlopathy with subcortical cysts and vanishing white matter disease that have recently been identified). In the majority of cases, pediatric white matter disorders are inherited diseases. An integrated description of the clinical, neuroimaging and pathophysiological features is crucial for categorizing myelin disorders and better understanding their genetic basis. A review of the genetic disorders affecting white matter in the pediatric age, including some novel entities, is provided.
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Affiliation(s)
- Maja Di Rocco
- Second Unit of Pediatrics, Istituto G. Gaslini, Genova, Italy.
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Alkan A, Kutlu R, Sigirci A, Baysal T, Altinok T, Yakinci C. Giant Axonal Neuropathy: MRS Findings. J Neuroimaging 2003. [DOI: 10.1111/j.1552-6569.2003.tb00208.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Brockmann K, Pouwels PJW, Dechent P, Flanigan KM, Frahm J, Hanefeld F. Cerebral proton magnetic resonance spectroscopy of a patient with giant axonal neuropathy. Brain Dev 2003; 25:45-50. [PMID: 12536033 DOI: 10.1016/s0387-7604(02)00154-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Magnetic resonance imaging of a girl with giant axonal neuropathy revealed a progressive white matter disease. In close agreement with histopathological features reported previously, localized proton magnetic resonance spectroscopy at 9 and 12 years of age indicated a specific damage or loss of axons (reduced N-acetylaspartate and N-acetylaspartylglutamate) accompanied by acute demyelination (elevated choline-containing compounds, myo-inositol, and lactate) in white matter as well as a generalized proliferation of glial cells (elevated choline-containing compounds and myo-inositol) in both gray and white matter.
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Affiliation(s)
- Knut Brockmann
- Department of Pediatrics and Neuropediatrics, Georg-August-Universität, Children's Hospital, Robert-Koch-Strasse 40, 37075 Goettingen, Germany.
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Zemmouri R, Azzedine H, Assami S, Kitouni N, Vallat JM, Maisonobe T, Hamadouche T, Kessaci M, Mansouri B, Le Guern E, Grid D, Tazir M. Charcot-Marie-Tooth 2-like presentation of an Algerian family with giant axonal neuropathy. Neuromuscul Disord 2000; 10:592-8. [PMID: 11053687 DOI: 10.1016/s0960-8966(00)00141-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Giant axonal neuropathy is a rare autosomal recessive childhood disorder characterized by a peripheral neuropathy and features of central nervous system involvement. We describe four patients belonging to a consanguineous Algerian family with late onset (6-10 years) slowly progressive autosomal recessive giant axonal neuropathy. The propositus presented with a Charcot-Marie-Tooth 2-like phenotype with foot deformity, distal amyotrophy of lower limbs, areflexia and distal lower limb hypoesthesia. Central nervous system involvement occurred 10 years later with mild cerebellar dysarthria and nystagmus in the propositus and 16 years after onset, a spastic paraplegia in the oldest patient. The two youngest patients (13 and 8 years old) do not present any signs of central nervous involvement. Magnetic resonance imaging showed cerebellar atrophy in the two older. Nerve biopsy showed moderate axonal loss with several giant axons filled with neurofilaments. Genetic study established a linkage to chromosome 16q locus. This clinical presentation differs from the classical form of giant axonal neuropathy.
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Affiliation(s)
- R Zemmouri
- Service de Neurologie, CHU Mustapha, Alger Centre, Alger 16000, Algeria
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Malandrini A, Dotti MT, Battisti C, Villanova M, Capocchi G, Federico A. Giant axonal neuropathy with subclinical involvement of the central nervous system: case report. J Neurol Sci 1998; 158:232-5. [PMID: 9702697 DOI: 10.1016/s0022-510x(98)00123-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The case of a 17-year-old girl with slowly progressive sensory-motor neuropathy is described. Sural nerve biopsy showed abnormally enlarged exons filled with neurofilaments. Neurofilament accumulation was limited to the axons and was not found in other cells of the skin or peripheral nerve. The patient showed EEG and brain MRI abnormalities, but there was no clinical evidence of central nervous system involvement. Although these findings suggest an atypical attenuated form of giant axonal neuropathy, a new nosological entity cannot be excluded.
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Affiliation(s)
- A Malandrini
- Laboratory of Neuropathology, University of Siena, Italy
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Hoffman WH, Carroll JE, Perry GY, Hartlage PL, Kaminer SJ, Flowers NC, Oh SJ, Kelly DR. Giant axonal neuropathy in a child with insulin-dependent diabetes mellitus. J Child Neurol 1995; 10:250-3. [PMID: 7642902 DOI: 10.1177/088307389501000322] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Bonnaure-Mallet M, Tricot-Doleux S, Le Berre C. Gingival biopsy in the diagnosis of giant axonal neuropathy. J Oral Pathol Med 1995; 24:89-92. [PMID: 7745548 DOI: 10.1111/j.1600-0714.1995.tb01145.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We report the case of a 4-year-old child presenting with a diagnosis of giant axonal neuropathy. This rare condition was diagnosed when the child was 15 months old and was confirmed using a gingival sample removed during a dental examination. Structural and ultrastructural analyses demonstrated the presence of numerous unmyelinated fibres with distended axons and the accumulation of intermediate filaments in Schwann cells, in fibroblasts and in endothelial cells. Cytological examination of connective tissue revealed the presence of mitochondria-like particles. Scanning electron microscopic examination of hair revealed the presence of a longitudinal groove along the shaft. These characteristic features of giant axonal neuropathy demonstrate that gingival tissue can be used as an aid in its diagnosis.
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Affiliation(s)
- M Bonnaure-Mallet
- Université de Rennes I-UFR Odontologie, Service de Soins Dentaires et Péridentaires, France
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Venkatesh S, Coulter DL, Kemper TD. Neuroaxonal dystrophy at birth with hypertonicity and basal ganglia mineralization. J Child Neurol 1994; 9:74-6. [PMID: 8151089 DOI: 10.1177/088307389400900119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A full-term male infant exhibited rigidity of all extremities with hyperreflexia beginning soon after birth and lasting until his death at age 6 months. Head circumference remained at the 25th to 50th percentile. Distinct sleep-wake cycles and responsiveness to visual, auditory, and tactile stimuli developed. Metabolic studies, skin biopsy, electroencephalography, and electromyography produced normal results. Head computed tomographic and magnetic resonance imaging scans revealed mineralization of the basal ganglia and thalamus. Muscle and nerve biopsy results were consistent with axonal dystrophy. Autopsy showed widespread neuronal loss, with reactive gliosis, marked in the globus pallidus and brainstem reticulate core; spheroids in globus pallidus, nucleus cuneatus, and upper cervical cord; and mineralized neurons in the inner division of globus pallidus and thalamus. Neonatal hypertonia, rapid progression, and mineralization of the basal ganglia are unusual features of neuroaxonal dystrophy exhibited in this case.
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Affiliation(s)
- S Venkatesh
- Department of Neurology, Boston City Hospital, Boston University School of Medicine, MA 02118
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