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Reddy N, Calloni SF, Vernon HJ, Boltshauser E, Huisman TAGM, Soares BP. Neuroimaging Findings of Organic Acidemias and Aminoacidopathies. Radiographics 2018; 38:912-931. [PMID: 29757724 DOI: 10.1148/rg.2018170042] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Although individual cases of inherited metabolic disorders are rare, overall they account for a substantial number of disorders affecting the central nervous system. Organic acidemias and aminoacidopathies include a variety of inborn errors of metabolism that are caused by defects in the intermediary metabolic pathways of carbohydrates, amino acids, and fatty acid oxidation. These defects can lead to the abnormal accumulation of organic acids and amino acids in multiple organs, including the brain. Early diagnosis is mandatory to initiate therapy and prevent permanent long-term neurologic impairments or death. Neuroimaging findings can be nonspecific, and metabolism- and genetics-based laboratory investigations are needed to confirm the diagnosis. However, neuroimaging has a key role in guiding the diagnostic workup. The findings at conventional and advanced magnetic resonance imaging may suggest the correct diagnosis, help narrow the differential diagnosis, and consequently facilitate early initiation of targeted metabolism- and genetics-based laboratory investigations and treatment. Neuroimaging may be especially helpful for distinguishing organic acidemias and aminoacidopathies from other more common diseases with similar manifestations, such as hypoxic-ischemic injury and neonatal sepsis. Therefore, it is important that radiologists, neuroradiologists, pediatric neuroradiologists, and clinicians are familiar with the neuroimaging findings of organic acidemias and aminoacidopathies. ©RSNA, 2018.
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Affiliation(s)
- Nihaal Reddy
- From the Division of Pediatric Radiology and Pediatric Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science (N.R., S.F.C., T.A.G.M.H., B.P.S.), and McKusick-Nathans Institute of Genetic Medicine, Department of Pediatrics (H.J.V.), The Johns Hopkins University School of Medicine, Charlotte R. Bloomberg Children's Center Bldg, Sheikh Zayed Tower, Room 4174, 1800 Orleans St, Baltimore, MD 21287-0842; Università degli Studi di Milano, Postgraduation School in Radiodiagnostics, Milan, Italy (S.F.C.); Department of Neurogenetics, Kennedy Krieger Institute, Baltimore, Md (H.J.V.); and Department of Pediatric Neurology, University Children's Hospital of Zurich, Zurich, Switzerland (E.B.)
| | - Sonia F Calloni
- From the Division of Pediatric Radiology and Pediatric Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science (N.R., S.F.C., T.A.G.M.H., B.P.S.), and McKusick-Nathans Institute of Genetic Medicine, Department of Pediatrics (H.J.V.), The Johns Hopkins University School of Medicine, Charlotte R. Bloomberg Children's Center Bldg, Sheikh Zayed Tower, Room 4174, 1800 Orleans St, Baltimore, MD 21287-0842; Università degli Studi di Milano, Postgraduation School in Radiodiagnostics, Milan, Italy (S.F.C.); Department of Neurogenetics, Kennedy Krieger Institute, Baltimore, Md (H.J.V.); and Department of Pediatric Neurology, University Children's Hospital of Zurich, Zurich, Switzerland (E.B.)
| | - Hilary J Vernon
- From the Division of Pediatric Radiology and Pediatric Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science (N.R., S.F.C., T.A.G.M.H., B.P.S.), and McKusick-Nathans Institute of Genetic Medicine, Department of Pediatrics (H.J.V.), The Johns Hopkins University School of Medicine, Charlotte R. Bloomberg Children's Center Bldg, Sheikh Zayed Tower, Room 4174, 1800 Orleans St, Baltimore, MD 21287-0842; Università degli Studi di Milano, Postgraduation School in Radiodiagnostics, Milan, Italy (S.F.C.); Department of Neurogenetics, Kennedy Krieger Institute, Baltimore, Md (H.J.V.); and Department of Pediatric Neurology, University Children's Hospital of Zurich, Zurich, Switzerland (E.B.)
| | - Eugen Boltshauser
- From the Division of Pediatric Radiology and Pediatric Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science (N.R., S.F.C., T.A.G.M.H., B.P.S.), and McKusick-Nathans Institute of Genetic Medicine, Department of Pediatrics (H.J.V.), The Johns Hopkins University School of Medicine, Charlotte R. Bloomberg Children's Center Bldg, Sheikh Zayed Tower, Room 4174, 1800 Orleans St, Baltimore, MD 21287-0842; Università degli Studi di Milano, Postgraduation School in Radiodiagnostics, Milan, Italy (S.F.C.); Department of Neurogenetics, Kennedy Krieger Institute, Baltimore, Md (H.J.V.); and Department of Pediatric Neurology, University Children's Hospital of Zurich, Zurich, Switzerland (E.B.)
| | - Thierry A G M Huisman
- From the Division of Pediatric Radiology and Pediatric Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science (N.R., S.F.C., T.A.G.M.H., B.P.S.), and McKusick-Nathans Institute of Genetic Medicine, Department of Pediatrics (H.J.V.), The Johns Hopkins University School of Medicine, Charlotte R. Bloomberg Children's Center Bldg, Sheikh Zayed Tower, Room 4174, 1800 Orleans St, Baltimore, MD 21287-0842; Università degli Studi di Milano, Postgraduation School in Radiodiagnostics, Milan, Italy (S.F.C.); Department of Neurogenetics, Kennedy Krieger Institute, Baltimore, Md (H.J.V.); and Department of Pediatric Neurology, University Children's Hospital of Zurich, Zurich, Switzerland (E.B.)
| | - Bruno P Soares
- From the Division of Pediatric Radiology and Pediatric Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science (N.R., S.F.C., T.A.G.M.H., B.P.S.), and McKusick-Nathans Institute of Genetic Medicine, Department of Pediatrics (H.J.V.), The Johns Hopkins University School of Medicine, Charlotte R. Bloomberg Children's Center Bldg, Sheikh Zayed Tower, Room 4174, 1800 Orleans St, Baltimore, MD 21287-0842; Università degli Studi di Milano, Postgraduation School in Radiodiagnostics, Milan, Italy (S.F.C.); Department of Neurogenetics, Kennedy Krieger Institute, Baltimore, Md (H.J.V.); and Department of Pediatric Neurology, University Children's Hospital of Zurich, Zurich, Switzerland (E.B.)
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Bandaralage SPS, Farnaghi S, Dulhunty JM, Kothari A. Antenatal and postnatal radiologic diagnosis of holocarboxylase synthetase deficiency: a systematic review. Pediatr Radiol 2016; 46:357-64. [PMID: 26754537 DOI: 10.1007/s00247-015-3492-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 08/07/2015] [Accepted: 10/28/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Holocarboxylase synthetase deficiency results in impaired activation of enzymes implicated in glucose, fatty acid and amino acid metabolism. Antenatal imaging and postnatal imaging are useful in making the diagnosis. Untreated holocarboxylase synthetase deficiency is fatal, while antenatal and postnatal biotin supplementation is associated with good clinical outcomes. Although biochemical assays are required for definitive diagnosis, certain radiologic features assist in the diagnosis of holocarboxylase synthetase deficiency. OBJECTIVE To review evidence regarding radiologic diagnostic features of holocarboxylase synthetase deficiency in the antenatal and postnatal period. MATERIALS AND METHODS A systematic review of all published cases of holocarboxylase synthetase deficiency identified by a search of Pubmed, Scopus and Web of Science. RESULTS A total of 75 patients with holocarboxylase synthetase deficiency were identified from the systematic review, which screened 687 manuscripts. Most patients with imaging (19/22, 86%) had abnormal findings, the most common being subependymal cysts, ventriculomegaly and intraventricular hemorrhage. CONCLUSION Although the radiologic features of subependymal cysts, ventriculomegaly, intraventricular hemorrhage and intrauterine growth restriction may be found in the setting of other pathologies, these findings should prompt consideration of holocarboxylase synthetase deficiency in at-risk children.
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Affiliation(s)
- Sahan P Semasinghe Bandaralage
- Gold Coast Hospital and Health Service, Southport, Queensland, 4215, Australia.,School of Medicine, Griffith University, Southport, Queensland, 4215, Australia
| | - Soheil Farnaghi
- Caboolture Hospital, Caboolture, Queensland, 4510, Australia
| | - Joel M Dulhunty
- Redcliffe Hospital, Redcliffe, Queensland, 4020, Australia.,School of Medicine, The University of Queensland, Herston, Queensland, 4006, Australia
| | - Alka Kothari
- Redcliffe Hospital, Redcliffe, Queensland, 4020, Australia. .,School of Medicine, The University of Queensland, Herston, Queensland, 4006, Australia.
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Jain-Ghai S, Mishra N, Hahn C, Blaser S, Mercimek-Mahmutoglu S. Fetal onset ventriculomegaly and subependymal cysts in a pyridoxine dependent epilepsy patient. Pediatrics 2014; 133:e1092-6. [PMID: 24664088 DOI: 10.1542/peds.2013-1230] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Pyridoxine dependent epilepsy (PDE) is caused by mutations in the ALDH7A1 gene encoding α-aminoadipic semialdehyde dehydrogenase. The classic clinical presentation is neonatal seizures responsive only to pyridoxine therapy. White matter abnormalities, corpus callosum agenesis or hypoplasia, megacisterna magna, cortical dysplasia, neuronal heterotopias, intracerebral hemorrhage, and hydrocephalus in neuroimaging have been reported in patients with PDE. We report a new patient with asymmetric progressive ventriculomegaly noted on fetal sonography at 22 weeks' gestation. Postnatal brain sonography on day 1 and MRI on day 5 confirmed bilateral asymmetric ventriculomegaly caused by bilateral subependymal cysts. Intractable seizures at age 7 days initially responded to phenobarbital. Markedly elevated urinary α-aminoadipic acid semialdehyde levels and compound heterozygous mutations in the ALDH7A1 gene (c.446C>A/c.919C>T) confirmed the diagnosis of PDE caused by ALDH7A1 genetic defect. Despite the presence of structural brain malformations and subependymal cysts, PDE should always be included in the differential diagnosis of neonatal seizures that are refractory to treatment with antiepileptic drugs.
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Affiliation(s)
- Shailly Jain-Ghai
- Department of Medical Genetics, University of Alberta, Stollery Children's Hospital, Edmonton, Canada; and
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Touma E, Suormala T, Baumgartner ER, Gerbaka B, Ogier de Baulny H, Loiselet J. Holocarboxylase synthetase deficiency: report of a case with onset in late infancy. J Inherit Metab Dis 1999; 22:115-22. [PMID: 10234606 DOI: 10.1023/a:1005485500096] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A case of holocarboxylase synthetase (HCS) deficiency of late-infantile onset is presented and compared with the common manifestations in previously reported patients. Our patient had her first episode at 20 months followed by recurrent episodes of metabolic acidosis with ketolactic acidosis responding dramatically to a short trial of biotin and thiamin. The main clinical findings were metabolic acidosis with alteration in consciousness and respiration, which are in accordance with findings in earlier reported patients with both neonatal-onset and infantile-onset forms of HCS deficiency. The diagnosis of HCS deficiency was made only at the age of 5.5 years during a metabolic work-up when organic acid analysis was performed. This revealed elevated urinary excretion of the characteristics metabolites, 3-hydroxypropionate, 3-hydroxyisovalerate and methylcitrate, suggesting multiple carboxylase deficiency (MCD). MCD was demonstrated in fibroblasts of our patient, but only when the cells were grown in a medium with a very low biotin concentration of 10(-10) mol/L. Kinetics studies of reactivation of deficient propionyl-CoA carboxylase activity with biotin in intact fibroblasts revealed a midly decreased reactivation rate and only a 3-5 times higher biotin requirement as compared with controls. These findings are in accordance with a mild form of HCS deficiency. This child responded to 10 mg/day of biotin with normal lymphocyte carboxylase activities and adequate school performance at 10 years of age.
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Affiliation(s)
- E Touma
- Biochemistry and Cytogenetic Laboratory, University St. Joseph, Beirut, Lebanon
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van der Knaap MS, Jakobs C, Hoffmann GF, Nyhan WL, Renier WO, Smeitink JA, Catsman-Berrevoets CE, Hjalmarson O, Vallance H, Sugita K, Bowe CM, Herrin JT, Craigen WJ, Buist NR, Brookfield DS, Chalmers RA. D-2-Hydroxyglutaric aciduria: biochemical marker or clinical disease entity? Ann Neurol 1999; 45:111-9. [PMID: 9894884 DOI: 10.1002/1531-8249(199901)45:1<111::aid-art17>3.0.co;2-n] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
D-2-Hydroxyglutaric aciduria has been observed in patients with extremely variable clinical symptoms, creating doubt about the existence of a disease entity related to the biochemical finding. An international survey of patients with D-2-hydroxyglutaric aciduria was initiated to solve this issue. The clinical history, neuroimaging, and biochemical findings of 17 patients were studied. Ten of the patients had a severe early-infantile-onset encephalopathy characterized by epilepsy, hypotonia, cerebral visual failure, and little development. Five of these patients had a cardiomyopathy. In neuroimaging, all patients had a mild ventriculomegaly, often enlarged frontal subarachnoid spaces and subdural effusions, and always signs of delayed cerebral maturation. In all patients who underwent neuroimaging before 6 months, subependymal cysts over the head or corpus of the caudate nucleus were noted. Seven patients had a much milder and variable clinical picture, most often characterized by mental retardation, hypotonia, and macrocephaly, but sometimes no related clinical problems. Neuroimaging findings in 3 patients variably showed delayed cerebral maturation, ventriculomegaly, or subependymal cysts. Biochemical findings included elevations of D-2-hydroxyglutaric acid in urine, plasma, and cerebrospinal fluid in both groups. Cerebrospinal fluid gamma-aminobutyric acid was elevated in almost all patients investigated. Urinary citric acid cycle intermediates were variably elevated. The conclusion of the study is that D-2-hydroxyglutaric aciduria is a distinct neurometabolic disorder with at least two phenotypes.
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Affiliation(s)
- M S van der Knaap
- Department of Child Neurology, Free University Hospital, Amsterdam, The Netherlands
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