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Chen L, Xu Y, Fang MJ, Shi YG, Zhang J, Zhang LL, Wang Y, Han YZ, Hu JY, Yang RM, Yu XE. Case report: A Chinese patient with spinocerebellar ataxia finally confirmed as Gerstmann-Sträussler-Scheinker syndrome with P102L mutation. Front Neurol 2023; 14:1187813. [PMID: 37602242 PMCID: PMC10435367 DOI: 10.3389/fneur.2023.1187813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/13/2023] [Indexed: 08/22/2023] Open
Abstract
Gerstmann-Sträussler-Scheinker syndrome (GSS) is a rare genetic prion disease caused by a mutation in the prion protein (PRNP) gene. It is typically characterized by progressive cerebellar ataxia and slowly progressive dementia. We present a case study of the GSS from China in which a 45-year-old male with a progressive gait and balance disorder developed cerebellar ataxia onset but was misdiagnosed as spinocerebellar ataxia (SCA) for 2 years. The patient's clinical, electrophysiological, and radiological data were retrospectively analyzed. Examination revealed ataxia, dysarthria, muscle weakness, areflexia in lower limbs, including a pyramidal sign, whereas cognitive decline was insignificant. His late mother had a similar unsteady gait. An electroencephalogram (EEG) showed normal findings, and 14-3-3 protein was negative. A brain MRI was performed for global brain atrophy and ventricular enlargement. Positron emission tomography-computed tomography (PET-CT) (18F-fluoro-2-deoxy-d-glucose, FDG) images showed mild to moderate decreased glucose metabolism in the left superior parietal lobe and left middle temporal lobe. According to genetic testing, his younger brother also had the P102L variant in the PRNP gene. This single case adds to the clinical and genetic phenotypes of GSS.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Xu-en Yu
- Department of Neurology, The Affiliated Hospital of Institute of Neurology, Anhui University of Chinese Medicine, Hefei, China
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Shin M, Kim D, Heo YJ, Baek JW, Yun S, Jeong HW. Gerstmann-Sträussler-Scheinker Disease: A Case Report. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:745-749. [PMID: 37325010 PMCID: PMC10265248 DOI: 10.3348/jksr.2022.0089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/07/2022] [Accepted: 10/02/2022] [Indexed: 06/17/2023]
Abstract
Gerstmann-Sträussler-Scheinker (GSS) disease is a rare hereditary prion disease which is clinically characterized by a progressive cerebellar ataxia followed by cognitive impairment. We report a rare case of GSS disease in a 39-year-old male patient who complained of a progressive gait disturbance followed by dysarthria with cognitive impairment, after five months from the onset of initial symptom. His brain MRI scan revealed multifocal symmetric diffusion restricted lesions with T2/FLAIR hyperintensities in bilateral cerebral cortices, basal ganglia, and thalami. His family members also manifested similar symptoms in their 40-50s, suggesting the possibility of a genetic disease. Finally, he was genetically diagnosed with GSS disease by real-time quaking-induced conversion and prion protein (PRNP) gene sequencing test.
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Rudenskaya GE, Konovalov FA, Illarioshkin SN, Shchagina OA. [Gerstmann-Sträussler disease: a familial case with common PRNP mutation and atypical features]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:138-143. [PMID: 36843471 DOI: 10.17116/jnevro2023123021138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
Gerstmann-Sträussler disease (GSD) is a very rare autosomal dominant late-onset neurodegenerative disorder related to prion protein gene PRNP. Mutation p.Pro102Leu produces about 80% of cases, which are often named GSD-102. DNA testing provides exact diagnosis. In the presented Russian family there were 3 patients: a female index case, age 32 years, her brother, age 37 years (age of onset in both is 27 years) and their deceased father (onset in 35 years, death in 44 years). GSD was not suspected until whole exome sequencing in the female detected PRNP mutation p.Pro102Leu confirmed in her and in the brother by Sanger sequencing. Atypical features of the case are: early onset in siblings, absence of mental and behavioral problems in the female and in the father and mild disturbances in the brother; epilepsy in the brother; atypical onset with transient signs in the brother. Other intrafamilial differences are prevailing spastic paraparesis in the female in contrast to predominant ataxia in the brother and dysarthria absence in the female. The case illustrates GSD-102 variability, complicating clinical diagnostics.
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Affiliation(s)
| | - F A Konovalov
- Genomed Ltd, Moscow, Russia.,Laboratory of Clinical Bioinformatics, Moscow, Russia
| | | | - O A Shchagina
- Research Centre for Medical Genetics, Moscow, Russia
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Nuzhnyi EP, Abramycheva NY, Fedotova EY, Illarioshkin SN. Gerstmann–Sträussler–Scheinker syndrome with early-onset spinocerebellar ataxia phenotype. NEUROLOGY, NEUROPSYCHIATRY, PSYCHOSOMATICS 2022. [DOI: 10.14412/2074-2711-2022-6-63-66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Viral and Prion Infections Associated with Central Nervous System Syndromes in Brazil. Viruses 2021; 13:v13071370. [PMID: 34372576 PMCID: PMC8310075 DOI: 10.3390/v13071370] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/05/2021] [Accepted: 05/11/2021] [Indexed: 12/12/2022] Open
Abstract
Virus-induced infections of the central nervous system (CNS) are among the most serious problems in public health and can be associated with high rates of morbidity and mortality, mainly in low- and middle-income countries, where these manifestations have been neglected. Typically, herpes simplex virus 1 and 2, varicella-zoster, and enterovirus are responsible for a high number of cases in immunocompetent hosts, whereas other herpesviruses (for example, cytomegalovirus) are the most common in immunocompromised individuals. Arboviruses have also been associated with outbreaks with a high burden of neurological disorders, such as the Zika virus epidemic in Brazil. There is a current lack of understanding in Brazil about the most common viruses involved in CNS infections. In this review, we briefly summarize the most recent studies and findings associated with the CNS, in addition to epidemiological data that provide extensive information on the circulation and diversity of the most common neuro-invasive viruses in Brazil. We also highlight important aspects of the prion-associated diseases. This review provides readers with better knowledge of virus-associated CNS infections. A deeper understanding of these infections will support the improvement of the current surveillance strategies to allow the timely monitoring of the emergence/re-emergence of neurotropic viruses.
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Mbizvo GK, Ziso B, Larner AJ. Epilepsy and prion diseases: A narrative review. Epilepsy Behav 2021; 115:107630. [PMID: 33309427 DOI: 10.1016/j.yebeh.2020.107630] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/03/2020] [Accepted: 11/06/2020] [Indexed: 12/26/2022]
Abstract
Epileptic seizures have been described as one feature of prion diseases, but are an unusual clinical presentation. The aim of this narrative Review was to summarize current knowledge of epileptic seizures in the various forms of prion diseases, from a clinical perspective. Examination of the published literature identified no systematic studies; the evidence base is largely anecdotal, consisting mainly of case studies and small case series. Hence, uncertainty prevails as to seizure frequency, semiology, treatment, and pathogenesis in prion diseases. Seizures probably occur in around 10% of sporadic cases but less frequently in iatrogenic and familial forms, with the possible exception of the E200K mutation. The literature suggests a predominance of focal motor and nonconvulsive status epilepticus. Electroencephalographic accompaniments include periodic lateralized or generalized periodic epileptiform discharges (PLEDs, GPEDs), sometimes predating the more typical periodic sharp wave complexes. There are no convincing accounts of successful antiepileptic drug therapy. The underlying mechanisms of epileptogenesis in prion diseases may include loss of cellular prion protein function (PrPc) and aggregation of abnormally folded prion protein (PrPSc). The need for systematic studies and clinical trials to expand the evidence base surrounding epilepsy and prion diseases is evident.
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Affiliation(s)
- Gashirai K Mbizvo
- Cognitive Function Clinic, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom.
| | - Besa Ziso
- Cognitive Function Clinic, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Andrew J Larner
- Cognitive Function Clinic, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
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Tesar A, Matej R, Kukal J, Johanidesova S, Rektorova I, Vyhnalek M, Keller J, Eliasova I, Parobkova E, Smetakova M, Musova Z, Rusina R. Clinical Variability in P102L Gerstmann-Sträussler-Scheinker Syndrome. Ann Neurol 2019; 86:643-652. [PMID: 31397917 DOI: 10.1002/ana.25579] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 08/05/2019] [Accepted: 08/07/2019] [Indexed: 12/22/2022]
Abstract
Gerstmann-Sträussler-Scheinker syndrome (GSS) with the P102L mutation is a rare genetic prion disease caused by a pathogenic mutation at codon 102 in the prion protein gene. Cluster analysis encompassing data from 7 Czech patients and 87 published cases suggests the existence of 4 clinical phenotypes (typical GSS, GSS with areflexia and paresthesia, pure dementia GSS, and Creutzfeldt-Jakob disease-like GSS); GSS may be more common than previously estimated. In making a clinical diagnosis or progression estimates of GSS, magnetic resonance imaging and real-time quaking-induced conversion may be helpful, but the results should be evaluated with respect to the overall clinical context. ANN NEUROL 2019;86:643-652.
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Affiliation(s)
- Adam Tesar
- The Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University, and General University Hospital, Prague
| | - Radoslav Matej
- Department of Pathology and Molecular Medicine, Third Faculty of Medicine, Charles University, and Thomayer Hospital, Prague.,Department of Pathology, First Faculty of Medicine, Charles University, and General University Hospital, Prague.,Department of Pathology, Third Faculty of Medicine, Charles University, and Kralovske Vinohrady University Hospital, Prague
| | - Jaromir Kukal
- Faculty of Nuclear Sciences and Physical Engineering, Czech Technical University, Prague
| | - Silvie Johanidesova
- Department of Neurology, Third Faculty of Medicine, Charles University, and Thomayer Hospital, Prague
| | - Irena Rektorova
- Applied Neuroscience Research Group, Central European Institute of Technology, Masaryk University, Brno.,Department of Neurology, Faculty of Medicine, Masaryk University, and Saint Anne's University Hospital, Brno
| | - Martin Vyhnalek
- Department of Neurology, Second Faculty of Medicine, Charles University, and Motol University Hospital, Prague.,International Clinical Research Center, St Anne's University Hospital Brno, Brno
| | - Jiri Keller
- The Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University, and General University Hospital, Prague.,Department of Radiology, Na Homolce Hospital, Prague
| | - Ilona Eliasova
- Applied Neuroscience Research Group, Central European Institute of Technology, Masaryk University, Brno.,Department of Neurology, Faculty of Medicine, Masaryk University, and Saint Anne's University Hospital, Brno
| | - Eva Parobkova
- Department of Pathology and Molecular Medicine, Third Faculty of Medicine, Charles University, and Thomayer Hospital, Prague.,Department of Pathology, Third Faculty of Medicine, Charles University, and Kralovske Vinohrady University Hospital, Prague
| | - Magdalena Smetakova
- Department of Pathology and Molecular Medicine, Third Faculty of Medicine, Charles University, and Thomayer Hospital, Prague.,Department of Pathology, Third Faculty of Medicine, Charles University, and Kralovske Vinohrady University Hospital, Prague
| | - Zuzana Musova
- Department of Biology and Medical Genetics, Second Faculty of Medicine, Charles University, and Motol University Hospital, Prague, Czech Republic
| | - Robert Rusina
- The Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University, and General University Hospital, Prague.,Department of Neurology, Third Faculty of Medicine, Charles University, and Thomayer Hospital, Prague
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Ghetti B, Piccardo P, Zanusso G. Dominantly inherited prion protein cerebral amyloidoses - a modern view of Gerstmann-Sträussler-Scheinker. HANDBOOK OF CLINICAL NEUROLOGY 2018; 153:243-269. [PMID: 29887140 DOI: 10.1016/b978-0-444-63945-5.00014-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Among genetically determined neurodegenerative diseases, the dominantly inherited prion protein cerebral amyloidoses are characterized by deposition of amyloid in cerebral parenchyma or blood vessels. Among them, Gerstmann-Sträussler-Scheinker disease has been the first to be described. Their clinical, neuropathologic, and molecular phenotypes are distinct from those observed in Creutzfeldt-Jakob disease (CJD) and related spongiform encephalopathies. It is not understood why specific mutations in the prion protein gene (PRNP) cause cerebral amyloidosis and others cause CJD. A significant neurobiologic event in these amyloidoses is the frequent coexistence of prion amyloid with tau neurofibrillary pathology, a phenomenon suggesting that similar pathogenetic mechanisms may be shared among different diseases in the sequence of events occurring in the cascade from amyloid formation to tau aggregation. This chapter describes the clinical, neuropathologic, and biochemical phenotypes associated with each of the PRNP mutations causing an inherited cerebral amyloidosis and emphasizes the variability of phenotypes.
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Affiliation(s)
- Bernardino Ghetti
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, United States.
| | - Pedro Piccardo
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Roslin, Midlothian, United Kingdom
| | - Gianluigi Zanusso
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Araújo AQC. Unveiling the mysteries of hereditary prion diseases in Brazil. ARQUIVOS DE NEURO-PSIQUIATRIA 2017; 75:329-330. [PMID: 28658399 DOI: 10.1590/0004-282x20170057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 05/04/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Abelardo Q C Araújo
- Universidade Federal do Rio de Janeiro, Instituto de Neurologia Deolindo Couto, Rio de Janeiro RJ, Brasil
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro RJ, Brasil
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