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Zhang Y, Xin M, Wang C, Hu Z, Wang Y, Shao H, Liu J, Zhang C. Neuronal intranuclear inclusion disease with cerebellar white matter tau uptake and incidental meningioma. Eur J Nucl Med Mol Imaging 2024; 51:1794-1795. [PMID: 38273004 DOI: 10.1007/s00259-024-06615-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/15/2024] [Indexed: 01/27/2024]
Affiliation(s)
- Yan Zhang
- Department of Nuclear Medicine, Institute of Clinical Nuclear Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Mei Xin
- Department of Nuclear Medicine, Institute of Clinical Nuclear Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Cheng Wang
- Department of Nuclear Medicine, Institute of Clinical Nuclear Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Zhoumi Hu
- Department of Nuclear Medicine, Institute of Clinical Nuclear Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Yue Wang
- Department of Nuclear Medicine, Institute of Clinical Nuclear Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Hongda Shao
- Department of Nuclear Medicine, Institute of Clinical Nuclear Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Jianjun Liu
- Department of Nuclear Medicine, Institute of Clinical Nuclear Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China.
| | - Chenpeng Zhang
- Department of Nuclear Medicine, Institute of Clinical Nuclear Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
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2
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De Santis T, Politi LS, Valente EM, Albanese A. MRI Abnormalities Identify Neuronal Intranuclear Inclusion Disease. Ann Neurol 2024; 95:1009-1010. [PMID: 38065672 DOI: 10.1002/ana.26853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/01/2023] [Accepted: 12/06/2023] [Indexed: 12/20/2023]
Affiliation(s)
- Tiziana De Santis
- Department of Neurology, IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Letterio S Politi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Department of Neuroradiology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Enza Maria Valente
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
- Neurogenetics Research Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Alberto Albanese
- Department of Neurology, IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Neuroscience, Catholic University, Milano, Italy
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3
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Lakhani DA, Agarwal AK, Middlebrooks EH. Ultra-high-field 7-Tesla magnetic resonance imaging in fragile X tremor/ataxia syndrome (FXTAS). Neuroradiol J 2024:19714009241247464. [PMID: 38644331 DOI: 10.1177/19714009241247464] [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: 04/23/2024] Open
Abstract
Fragile X tremor/ataxia syndrome (FXTAS) is an adult-onset neurodegenerative disorder characterized by premutation expansion of fragile X mental retardation 1 (FMR1) gene. It is a common single-gene cause of tremor, ataxia, and cognitive decline in adults. FXTAS affects the central, peripheral and autonomic nervous systems, leading to a range of neurological symptoms from dementia to dysautonomia. A characteristic imaging feature of FXTAS is symmetric T2 hyperintensity in the deep white matter of the cerebellar hemispheres and middle cerebral peduncle. However, recent studies have reported additional findings on diffusion weighted images (DWI), such as a symmetric high-intensity band-like signal at the cerebral corticomedullary junction. These findings, along with the characteristic cerebellar signal alterations, overlap with imaging findings seen in adult-onset neuronal intranuclear inclusion disease (NIID). Importantly, recent pathology studies have shown that both FXTAS and NIID can manifest intranuclear inclusion bodies, posing a diagnostic challenge and potential for misdiagnosis. We describe a 58-year-old man with FXTAS who received an erroneous diagnosis based on imaging and histopathology results. We emphasize the potential pitfalls in distinguishing NIID from FXTAS and stress the importance of genetic analysis in all cases with suspected NIID and FXTAS for confirmation. Additionally, we present the 7T MRI brain findings of FXTAS.
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Affiliation(s)
- Dhairya A Lakhani
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, USA
- Department of Radiology, Mayo Clinic, USA
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4
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Liu C, Zhuo Z, Qu L, Jin Y, Hua T, Xu J, Tan G, Li Y, Duan Y, Wang T, Zhang Z, Zhang Y, Chen R, Yu P, Zhang P, Shi Y, Zhang J, Tian D, Li R, Zhang X, Shi F, Wang Y, Jiang J, Carass A, Liu Y, Ye C. DeepWMH: A deep learning tool for accurate white matter hyperintensity segmentation without requiring manual annotations for training. Sci Bull (Beijing) 2024; 69:872-875. [PMID: 38320896 DOI: 10.1016/j.scib.2024.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Affiliation(s)
- Chenghao Liu
- School of Integrated Circuits and Electronics, Beijing Institute of Technology, Beijing 100081, China
| | - Zhizheng Zhuo
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Liying Qu
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Ying Jin
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Tiantian Hua
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Jun Xu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Guirong Tan
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Yuna Li
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Yunyun Duan
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Tingting Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Zaiqiang Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Yanling Zhang
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Rui Chen
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Pinnan Yu
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Peixin Zhang
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Yulu Shi
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; Beijing Key Laboratory of Neurostimulation, Beijing 100070, China
| | - Decai Tian
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing 100070, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100070, China
| | - Runzhi Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing 100070, China
| | - Xinghu Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Fudong Shi
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing 100070, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100070, China
| | - Yanli Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100070, China
| | - Jiwei Jiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing 100070, China
| | - Aaron Carass
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore 21205, USA
| | - Yaou Liu
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.
| | - Chuyang Ye
- School of Integrated Circuits and Electronics, Beijing Institute of Technology, Beijing 100081, China.
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5
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Shen Y, Jiang K, Liang H, Xiong Y, Song Z, Wang B, Zhu M, Qiu Y, Tan D, Wu C, Deng J, Wang Z, Hong D. Encephalitis-like episodes with cortical edema and enhancement in patients with neuronal intranuclear inclusion disease. Neurol Sci 2024:10.1007/s10072-024-07492-x. [PMID: 38532189 DOI: 10.1007/s10072-024-07492-x] [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: 02/23/2024] [Accepted: 03/21/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVES Neuronal intranuclear inclusion disease (NIID) exhibited significant clinical heterogeneities. However, the clinical features, radiographic changes, and prognosis of patients with encephalitis-like NIID have yet to be systematically elucidated. METHODS Clinical data including medical history, physical examination, and laboratory examinations were collected and analyzed. Skin and sural nerve biopsies were conducted on the patient. Repeat-primed PCR (RP-PCR) and fluorescence amplicon length PCR (AL-PCR) were used to detect the expansion of CGG repeat. We also reviewed the clinical and genetic data of NIID patients with cortical enhancement. RESULTS A 54-year-old woman presented with encephalitis-like NIID, characterized by severe headache and agitative psychiatric symptoms. The brain MRI showed cortical swelling in the temporo-occipital lobes and significant enhancement of the cortical surface and dura, but without hyperintensities along the corticomedullary junction on diffusion-weighted image (DWI). A biopsy of the sural nerve revealed a demyelinating pathological change. The intranuclear inclusions were detected in nerve and skin tissues using the p62 antibody and electron microscopy. RP-PCR and AL-PCR unveiled the pathogenic expansion of CGG repeats in the NOTCH2NLC gene. A review of the literature indicated that nine out of the 16 patients with cortical lesions and linear enhancement exhibited encephalitis-like NIID. CONCLUSION This study indicated that patients with encephalitis-like NIID typically exhibited headache and excitatory psychiatric symptoms, often accompanied by cortical edema and enhancement of posterior lobes, and responded well to glucocorticoid treatment. Furthermore, some patients may not exhibit hyperintensities along the corticomedullary junction on DWI, potentially leading to misdiagnosis.
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Affiliation(s)
- Yu Shen
- Department of Neurology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Yong Wai Zheng Street 17#, Nanchang, 330006, People's Republic of China
| | - Kaiyan Jiang
- Department of Neurology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Yong Wai Zheng Street 17#, Nanchang, 330006, People's Republic of China
| | - Hanlin Liang
- Queen Mary College, Nanchang University, Nanchang, China
| | - Ying Xiong
- Department of Neurology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Yong Wai Zheng Street 17#, Nanchang, 330006, People's Republic of China
| | - Ziwei Song
- Department of Neurology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Yong Wai Zheng Street 17#, Nanchang, 330006, People's Republic of China
- Rare Disease Center, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Bo Wang
- Department of Neurology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Yong Wai Zheng Street 17#, Nanchang, 330006, People's Republic of China
- Rare Disease Center, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Min Zhu
- Department of Neurology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Yong Wai Zheng Street 17#, Nanchang, 330006, People's Republic of China
- Rare Disease Center, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Yusen Qiu
- Department of Neurology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Yong Wai Zheng Street 17#, Nanchang, 330006, People's Republic of China
- Rare Disease Center, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- Key Laboratory of Rare, Neurological Diseases of Jiangxi Provincial Health Commission, Nanchang, China
| | - Dandan Tan
- Department of Neurology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Yong Wai Zheng Street 17#, Nanchang, 330006, People's Republic of China
- Rare Disease Center, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- Key Laboratory of Rare, Neurological Diseases of Jiangxi Provincial Health Commission, Nanchang, China
| | - Chengsi Wu
- Department of Neurology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Yong Wai Zheng Street 17#, Nanchang, 330006, People's Republic of China
- Key Laboratory of Rare, Neurological Diseases of Jiangxi Provincial Health Commission, Nanchang, China
| | - Jianwen Deng
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Zhaoxia Wang
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Daojun Hong
- Department of Neurology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Yong Wai Zheng Street 17#, Nanchang, 330006, People's Republic of China.
- Rare Disease Center, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China.
- Key Laboratory of Rare, Neurological Diseases of Jiangxi Provincial Health Commission, Nanchang, China.
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Funakawa K, Kurihara M, Takahashi K, Higashihara M, Hara M, Mitsutake A, Ishiura H, Tokumaru AM, Sonoo M, Murayama S, Saito Y, Iwata A. Proximal sensory neuropathy and cerebellar ataxia as presenting symptoms of NOTCH2NLC-related neuronal intranuclear inclusion disease. J Neurol Sci 2024; 458:122915. [PMID: 38326182 DOI: 10.1016/j.jns.2024.122915] [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: 11/18/2023] [Revised: 12/21/2023] [Accepted: 02/01/2024] [Indexed: 02/09/2024]
Affiliation(s)
- Kai Funakawa
- Department of Neurology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Masanori Kurihara
- Department of Neurology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
| | - Kensuke Takahashi
- Department of Neurology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Mana Higashihara
- Department of Neurology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Manato Hara
- Department of Neuropathology (Brain Bank for Aging Research), Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Akihiko Mitsutake
- Department of Neurology, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan; Department of Neurology, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Hiroyuki Ishiura
- Department of Neurology, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan; Department of Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Aya Midori Tokumaru
- Department of Diagnostic Radiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Masahiro Sonoo
- Department of Neurology, Teikyo University School of Medicine, Tokyo, Japan
| | - Shigeo Murayama
- Department of Neuropathology (Brain Bank for Aging Research), Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan; Brain Bank for Neurodevelopmental, Neurological and Psychiatric Disorders, Molecular Research Center for Children's Mental Development, United Graduate School of Child Development, Osaka University, Osaka, Japan
| | - Yuko Saito
- Department of Neuropathology (Brain Bank for Aging Research), Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Atsushi Iwata
- Department of Neurology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
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7
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Shi Y, Cao C, Zeng Y, Ding Y, Chen L, Zheng F, Chen X, Zhou F, Yang X, Li J, Xu L, Xu G, Lin M, Ishiura H, Tsuji S, Wang N, Wang Z, Chen WJ, Yang K. CGG repeat expansion in LOC642361/NUTM2B-AS1 typically presents as oculopharyngodistal myopathy. J Genet Genomics 2024; 51:184-196. [PMID: 38159879 DOI: 10.1016/j.jgg.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/25/2023] [Accepted: 12/25/2023] [Indexed: 01/03/2024]
Abstract
CGG repeat expansions in LOC642361/NUTM2B-AS1 have recently been identified as a cause of oculopharyngeal myopathy with leukoencephalopathy. However, since only three patients from a single family were reported, it remains unknown whether their clinicopathological features are typical for CGG repeat expansions in LOC642361/NUTM2B-AS1. Here, using repeat-primed-polymerase chain reaction and long-read sequencing, we identify 12 individuals from 3 unrelated families with CGG repeat expansions in LOC642361/NUTM2B-AS1, typically presenting with oculopharyngodistal myopathy. The CGG repeat expansions range from 161 to 669 repeat units. Most of the patients present with ptosis, restricted eye movements, dysphagia, dysarthria, and diffuse limb muscle weakness. Only one patient shows T2-weighted hyperintensity in the cerebellar white matter surrounding the deep cerebellar nuclei on brain magnetic resonance imaging. Muscle biopsies from three patients show a myopathic pattern and rimmed vacuoles. Analyses of muscle biopsies suggest that CGG repeat expansions in LOC642361/NUTM2B-AS1 may deleteriously affect aggrephagic capacity, suggesting that RNA toxicity and mitochondrial dysfunction may contribute to pathogenesis. Our study thus expands the phenotypic spectrum for the CGG repeat expansion of LOC642361/NUTM2B-AS1 and indicates that this genetic variant typically manifests as oculopharyngodistal myopathy with chronic myopathic changes with rimmed vacuoles and filamentous intranuclear inclusions in muscle fibers.
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Affiliation(s)
- Yan Shi
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, Fujian 350005, China; Department of Neurology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian 350212, China
| | - Chunyan Cao
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, Fujian 350005, China; The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, Henan 471000, China
| | - Yiheng Zeng
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, Fujian 350005, China; Department of Neurology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian 350212, China
| | - Yuanliang Ding
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, Fujian 350005, China; Department of Neurology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian 350212, China
| | - Long Chen
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, Fujian 350005, China; Department of Neurology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian 350212, China
| | - Fuze Zheng
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, Fujian 350005, China; Department of Neurology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian 350212, China
| | - Xuejiao Chen
- Department of Neurology, Zhangzhou Municipal Hospital of Fujian Province and Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian 363000, China
| | - Fanggui Zhou
- Department of Neurology, Jian'ou Municipal Hospital of Fujian Province, Jian'ou, Fujian 353100, China
| | - Xiefeng Yang
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, China
| | - Jinjing Li
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, Fujian 350005, China; Department of Neurology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian 350212, China
| | - Liuqing Xu
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, Fujian 350005, China; Department of Neurology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian 350212, China
| | - Guorong Xu
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, Fujian 350005, China; Department of Neurology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian 350212, China
| | - Minting Lin
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, Fujian 350005, China; Department of Neurology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian 350212, China
| | - Hiroyuki Ishiura
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; Department of Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Shoji Tsuji
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; Institute of Medical Genomics, International University of Health and Welfare, Chiba 286-0048, Japan
| | - Ning Wang
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, Fujian 350005, China; Department of Neurology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian 350212, China
| | - Zhiqiang Wang
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, Fujian 350005, China; Department of Neurology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian 350212, China.
| | - Wan-Jin Chen
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, Fujian 350005, China; Department of Neurology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian 350212, China.
| | - Kang Yang
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, Fujian 350005, China; Department of Neurology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian 350212, China.
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8
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Wu XJ, Jiang YY, Chen LJ, Zhou GQ, Mo DC, Liu LY, Li JL, Li XL, Tang YL, Luo M. Neuronal intranuclear inclusion disease with cortical involvement in left hemisphere: a case report. Wien Klin Wochenschr 2024; 136:67-72. [PMID: 37389688 DOI: 10.1007/s00508-023-02232-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/24/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Neuronal intranuclear inclusion disease (NIID) is a rare highly heterogeneous disease. In this paper, we present a case of NIID featured in cortical involvement in left hemisphere of brain and the imaging changes in the process of the disease. CASE PRESENTATION A 57-year-old female was hospitalized due to recurrent attacks of headache with cognitive impairment and tremor for 2 years. The symptoms of headache episodes were reversible. The characteristic radiologic change was high intensity signal involving the grey matter-white matter junction on the brain diffusion-weighted imaging (DWI), which existed in the frontal lobe and then extended backwards. Atypical features on fluid-attenuated inversion recovery (FLAIR) sequences showing small patchy high signals in the cerebellar vermis. High signals and edema were detected on FLAIR images along the cortex of the left occipito-parieto-temporal lobes, expanding and gradually shrinking in the follow-up visit. Besides, cerebral atrophy and bilateral symmetrical leukoencephalopathy were also detected. Skin biopsy and genetic testing confirmed the diagnosis of NIID. CONCLUSION Except for typical radiological change strongly suggesting NIID, it is also necessary to notice the insidious symptoms of NIID combining with some atypical imaging features to make an early diagnosis. Skin biopsies or genetic testing should be carried out early in patients with highly suspected NIID.
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Affiliation(s)
- Xiao-Ju Wu
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, 530021, Nanning, China
| | - Yi-Ying Jiang
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, 530021, Nanning, China
| | - Li-Jie Chen
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, 530021, Nanning, China
| | - Guo-Qiu Zhou
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, 530021, Nanning, China
| | - Dong-Can Mo
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, 530021, Nanning, China
| | - Liu-Yu Liu
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, 530021, Nanning, China
| | - Jian-Li Li
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, 530021, Nanning, China
| | - Xiao-Ling Li
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, 530021, Nanning, China
| | - Yu-Lan Tang
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, 530021, Nanning, China.
| | - Man Luo
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, 530021, Nanning, China.
- Guangxi Key Laboratory of Precision Medicine in Cardio-cerebrovascular Diseases Control and Prevention, 530021, Nanning, China.
- Guangxi Clinical Research Center for Cardio-cerebrovascular Diseases, 530021, Nanning, China.
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9
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Zhang Z, Xu Q, Li J, Zhang C, Bai Z, Chai X, Xu K, Xiao C, Chen F, Liu T, Gu H, Xing W, Lu G, Zhang Z. MRI features of neuronal intranuclear inclusion disease, combining visual and quantitative imaging investigations. J Neuroradiol 2023:S0150-9861(23)00245-6. [PMID: 37758172 DOI: 10.1016/j.neurad.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/08/2023] [Accepted: 09/24/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE To observe the radiological characteristics of Neuronal Intranuclear Inclusion Disease (NIID) on lesion locations and diffusion property using quantitative imaging analysis. METHODS Visual inspection and quantitative analyses were performed on MRI data from 31 retrospectively included patients with NIID. Frequency heatmaps of lesion locations on T2WI and DWI were generated using voxel-wise analysis. Gray matter volume (GMV), white matter volume (WMV) and diffusion property of apparent diffusion coefficient (ADC) values of patients were voxel-wisely compared with healthy controls. Moreover, the ADC values within the DWI-detected lesion were compared with those within the adjacent cortical gray matter and white matter. Voxel-based lesion symptom mapping (VLSM) techniques, were used to determine the relationship between DWI lesion location and disease durations. RESULTS By visual inspection on the imaging findings, we proposed an "cockscomb flower sign" for describing the radiological feature of DWI hyperintensity within the corticomedullary junction. A "T2WI-DWI mismatch of spatial distribution" pattern was also revealed with visual inspection and frequency heatmaps, for describing the feature of a wider lesion distribution covering white matter shown on T2WI than that on DWI. Voxel-based morphometry comparison revealed that wildly reduced GMV and WMV, both the lesion areas detected by DWI and T2WI demonstrated ADC increase in patients. Furthermore, the ADC values within the DWI-detected lesion were intermediate between the adjacent cortex and the deep white matter with highest ADC. VLSM analysis revealed that frontal lobe, parietal lobe and internal capsule damage were associated with higher NIID durations. CONCLUSION NIID features with "cockscomb flower-like" DWI hyperintensity in area of corticomedullary junction, based on a "T2WI-DWI mismatch of spatial distribution" of lesion locations. The pathological substrate of corticomedullary junction hyperintensity on DWI, can not be explained as diffusion restriction. These typical radiological features of brain MRI would be helpful for diagnosis of NIID.
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Affiliation(s)
- Zixuan Zhang
- Department of Diagnostic Radiology, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China; School of Medical Imaging, Xuzhou Medical University, Xuzhou 221004, China
| | - Qiang Xu
- Department of Diagnostic Radiology, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Jianrui Li
- Department of Diagnostic Radiology, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Chao Zhang
- School of Medical Imaging, Xuzhou Medical University, Xuzhou 221004, China; Department of Medical Imaging, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221004, China
| | - Zhuojie Bai
- Department of Medical Imaging, Nanjing Jiangbei Hospital, Nanjing 210000, China
| | - Xue Chai
- Department of Medical Imaging, Nanjing Brain Hospital, Nanjing 210029, China
| | - Kai Xu
- School of Medical Imaging, Xuzhou Medical University, Xuzhou 221004, China; Department of Medical Imaging, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221004, China
| | - Chaoyong Xiao
- Department of Medical Imaging, Nanjing Brain Hospital, Nanjing 210029, China
| | - Feng Chen
- Department of Medical Imaging, Hainan General Hospital, Hainan 570311, China
| | - Tao Liu
- Department of Neurology, Hainan General Hospital, Haikou 570311, China
| | - Hongmei Gu
- Department of Medical Imaging, Affiliated Hospital of Nantong University, Nantong 226001, China
| | - Wei Xing
- Department of Medical Imaging, The first people's hospital of Changzhou. Changzhou 213200, China
| | - Guangming Lu
- Department of Diagnostic Radiology, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China; School of Medical Imaging, Xuzhou Medical University, Xuzhou 221004, China
| | - Zhiqiang Zhang
- Department of Diagnostic Radiology, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China; School of Medical Imaging, Xuzhou Medical University, Xuzhou 221004, China.
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Podar IV, Gutmann DAP, Harmuth F, Haack TB, Ossowski S, Hengel H, Bornemann A, Schöls L, Neuhaus O. First case of adult onset neuronal intranuclear inclusion disease with both typical radiological signs and NOTCH2NLC repeat expansions in a Caucasian individual. Eur J Neurol 2023; 30:2854-2858. [PMID: 37271829 DOI: 10.1111/ene.15905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/27/2023] [Accepted: 05/31/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND PURPOSE Adult onset neuronal intranuclear inclusion disease (NIID) is a rare neurodegenerative disorder with a heterogeneous clinical presentation that can mimic stroke and various forms of dementia. To date, it has been described almost exclusively in Asian individuals. METHODS This case presentation includes magnetic resonance imaging (MRI) of the neurocranium, histology by skin biopsy, and long-read genome sequencing. RESULTS A 75-year-old Caucasian female presented with paroxysmal encephalopathy twice within a 14-month period. Brain MRI revealed high-intensity signals at the cerebral corticomedullary junction (diffusion-weighted imaging) and the paravermal area (fluid-attenuated inversion recovery), a typical distribution observed in adult onset NIID. The diagnosis was corroborated by skin biopsy, which demonstrated eosinophilic intranuclear inclusion bodies, and confirmed by long-read genome sequencing, showing an expansion of the GGC repeat in exon 1 of NOTCH2NLC. CONCLUSIONS Our case proves adult onset NOTCH2NLC-GGC-positive NIID with typical findings on MRI and histology in a Caucasian patient and underscores the need to consider this diagnosis in non-Asian individuals.
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Affiliation(s)
- Iulian V Podar
- Department of Diagnostic and Interventional Radiology, SRH Krankenhaus Sigmaringen, Sigmaringen, Germany
| | - Daniel A P Gutmann
- Department of Diagnostic and Interventional Radiology, SRH Krankenhaus Sigmaringen, Sigmaringen, Germany
| | - Florian Harmuth
- Institute of Medical Genetics and Applied Genomics, Eberhard Karls University, Tübingen, Germany
| | - Tobias B Haack
- Institute of Medical Genetics and Applied Genomics, Eberhard Karls University, Tübingen, Germany
- Centre for Rare Diseases, Eberhard Karls University, Tübingen, Germany
| | - Stephan Ossowski
- Institute of Medical Genetics and Applied Genomics, Eberhard Karls University, Tübingen, Germany
| | - Holger Hengel
- Centre for Rare Diseases, Eberhard Karls University, Tübingen, Germany
- Department of Neurology and Hertie Institute for Clinical Brain Research, Eberhard Karls University, Tübingen, Germany
- German Centre for Neurodegenerative Diseases, Tübingen, Germany
| | - Antje Bornemann
- Department of Neuropathology, Eberhard Karls University, Tübingen, Germany
| | - Ludger Schöls
- Centre for Rare Diseases, Eberhard Karls University, Tübingen, Germany
- Department of Neurology and Hertie Institute for Clinical Brain Research, Eberhard Karls University, Tübingen, Germany
- German Centre for Neurodegenerative Diseases, Tübingen, Germany
| | - Oliver Neuhaus
- Department of Neurology, SRH Krankenhaus Sigmaringen, Sigmaringen, Germany
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11
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Nakagawa Y, Sugiyama A, Hirano S, Ishige T, Kuwabara S. Isolated paravermal T2 high-intensity lesions in dentatorubral-pallidoluysian atrophy. J Neurol Sci 2023; 451:120717. [PMID: 37385028 DOI: 10.1016/j.jns.2023.120717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/05/2023] [Accepted: 06/17/2023] [Indexed: 07/01/2023]
Affiliation(s)
- Yuki Nakagawa
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Atsuhiko Sugiyama
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan.
| | - Shigeki Hirano
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takayuki Ishige
- Division of Laboratory Medicine, Chiba University Hospital, Chiba, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
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12
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Fitrah YA, Higuchi Y, Hara N, Tokutake T, Kanazawa M, Sanpei K, Taneda T, Nakajima A, Koide S, Tsuboguchi S, Watanabe M, Fukumoto J, Ando S, Sato T, Iwafuchi Y, Sato A, Hayashi H, Ishiguro T, Takeda H, Takahashi T, Fukuhara N, Kasuga K, Miyashita A, Onodera O, Ikeuchi T. Heterogenous Genetic, Clinical, and Imaging Features in Patients with Neuronal Intranuclear Inclusion Disease Carrying NOTCH2NLC Repeat Expansion. Brain Sci 2023; 13:955. [PMID: 37371433 DOI: 10.3390/brainsci13060955] [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: 05/19/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Neuronal intranuclear inclusion disease (NIID) is a neurodegenerative disorder that is caused by the abnormal expansion of non-coding trinucleotide GGC repeats in NOTCH2NLC. NIID is clinically characterized by a broad spectrum of clinical presentations. To date, the relationship between expanded repeat lengths and clinical phenotype in patients with NIID remains unclear. Thus, we aimed to clarify the genetic and clinical spectrum and their association in patients with NIID. For this purpose, we genetically analyzed Japanese patients with adult-onset NIID with characteristic clinical and neuroimaging findings. Trinucleotide repeat expansions of NOTCH2NLC were examined by repeat-primed and amplicon-length PCR. In addition, long-read sequencing was performed to determine repeat size and sequence. The expanded GGC repeats ranging from 94 to 361 in NOTCH2NLC were found in all 15 patients. Two patients carried biallelic repeat expansions. There were marked heterogenous clinical and imaging features in NIID patients. Patients presenting with cerebellar ataxia or urinary dysfunction had a significantly larger GGC repeat size than those without. This significant association disappeared when these parameters were compared with the total trinucleotide repeat number. ARWMC score was significantly higher in patients who had a non-glycine-type trinucleotide interruption within expanded poly-glycine motifs than in those with a pure poly-glycine expansion. These results suggested that the repeat length and sequence in NOTCH2NLC may partly modify some clinical and imaging features of NIID.
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Affiliation(s)
- Yusran Ady Fitrah
- Department of Molecular Genetics, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
| | - Yo Higuchi
- Department of Molecular Genetics, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
- Department of Neurology, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
- Department of Neurology, Joetsu General Hospital, Joetsu 943-0172, Japan
| | - Norikazu Hara
- Department of Molecular Genetics, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
| | - Takayoshi Tokutake
- Department of Neurology, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
| | - Masato Kanazawa
- Department of Neurology, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
| | - Kazuhiro Sanpei
- Department of Neurology, Sado General Hospital, Sado 952-1209, Japan
| | - Tomone Taneda
- Department of Neurology, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
| | - Akihiko Nakajima
- Department of Neurology, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
| | - Shin Koide
- Department of Neurology, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
| | - Shintaro Tsuboguchi
- Department of Neurology, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
| | - Midori Watanabe
- Department of Neurology, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
| | - Junki Fukumoto
- Department of Neurology, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
| | - Shoichiro Ando
- Department of Neurology, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
| | - Tomoe Sato
- Department of Neurology, Tsubame Rosai Hospital, Tsubame 959-1228, Japan
| | - Yohei Iwafuchi
- Department of Neurology, Niigata City General Hospital, Niigata 950-1197, Japan
| | - Aki Sato
- Department of Neurology, Niigata City General Hospital, Niigata 950-1197, Japan
| | - Hideki Hayashi
- Department of Neurology, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
- Department of Neurology, Sado General Hospital, Sado 952-1209, Japan
| | - Takanobu Ishiguro
- Department of Neurology, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
- Department of Neurology, Sado General Hospital, Sado 952-1209, Japan
| | - Hayato Takeda
- Department of Neurology, Tsukuba University, Tsukuba 950-1197, Japan
| | | | - Nobuyoshi Fukuhara
- Department of Neurology, Joetsu General Hospital, Joetsu 943-0172, Japan
| | - Kensaku Kasuga
- Department of Molecular Genetics, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
| | - Akinori Miyashita
- Department of Molecular Genetics, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
| | - Osamu Onodera
- Department of Neurology, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
| | - Takeshi Ikeuchi
- Department of Molecular Genetics, Brain Research Institute, Niigata University, Niigata 951-8585, Japan
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13
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Tai H, Wang A, Zhang Y, Liu S, Pan Y, Li K, Zhao G, Wang M, Wu G, Niu S, Pan H, Chen B, Li W, Wang X, Dong G, Li W, Zhang Y, Guo S, Liu X, Li M, Liang H, Huang M, Chen W, Zhang Z. Clinical Features and Classification of Neuronal Intranuclear Inclusion Disease. NEUROLOGY GENETICS 2023; 9:e200057. [PMID: 37090934 PMCID: PMC10117695 DOI: 10.1212/nxg.0000000000200057] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/20/2022] [Indexed: 03/04/2023]
Abstract
Background and ObjectivesNeuronal intranuclear inclusion body disease (NIID) is a neurodegenerative disease with highly heterogeneous clinical manifestations. The present study aimed to characterize clinical features and propose a classification system based on a large cohort of NIID in China.MethodsThe Chinese NIID registry was launched from 2017, and participants' demographics and clinical features were recorded. Brain MRI, skin pathologies, and the number of GGC repeat expansions in the 5′ untranslated region of theNOTCH2NLCgene were evaluated in all patients.ResultsIn total, 223 patients (64.6% female) were recruited; the mean (SD) onset age was 56.7 (10.3) years. The most common manifestations were cognitive impairment (78.5%) and autonomic dysfunction (70.9%), followed by episodic symptoms (51.1%), movement disorders (50.7%), and muscle weakness (25.6%). Imaging markers included hyperintensity signals along the corticomedullary junction on diffusion-weighted imaging (96.6%), white matter lesions (98.1%), paravermis (55.0%), and focal cortical lesions (10.1%). The median size of the expanded GGC repeats in these patients was 115 (range, 70–525), with 2 patients carrying >300 GGC repeats. A larger number of GGC repeats was associated with younger age at onset (r= −0.329,p< 0.0001). According to the proposed clinical classification based on the most prominent manifestations, the patients were designated into 5 distinct types: cognitive impairment-dominant type (34.1%, n = 76), episodic neurogenic event-dominant type (32.3%, n = 72), movement disorder-dominant type (17.5%, n = 39), autonomic dysfunction-dominant type (8.5%, n = 19), and neuromuscular disease-dominant type (7.6%, n = 17). Notably, 32.3% of the episodic neurogenic event-dominant type of NIID has characteristic focal cortical lesions on brain MRI presenting localized cortical edema or atrophy. The mean onset age of the neuromuscular disease-dominant type was 47.2 (17.6) years, younger than the other types (p< 0.001). There was no significant difference in the sizes of GGC repeats among the patients in the 5 types (p= 0.547, Kruskal-Wallis test).DiscussionThis observational study of NIID establishes an overall picture of the disease regarding clinical, imaging, and genetic characteristics. The proposed clinical classification of NIID based on the most prominent manifestation divides patients into 5 types.
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Affiliation(s)
- Hongfei Tai
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
| | - An Wang
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
| | - Yumei Zhang
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
| | - Shaocheng Liu
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
| | - Yunzhu Pan
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
| | - Kai Li
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
| | - Guixian Zhao
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
| | - Mengwen Wang
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
| | - Guode Wu
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
| | - Songtao Niu
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
| | - Hua Pan
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
| | - Bin Chen
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
| | - Wei Li
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
| | - Xingao Wang
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
| | - Gehong Dong
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
| | - Wei Li
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
| | - Ying Zhang
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
| | - Sheng Guo
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
| | - Xiaoyun Liu
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
| | - Mingxia Li
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
| | - Hui Liang
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
| | - Ming Huang
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
| | - Wei'an Chen
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
| | - Zaiqiang Zhang
- Department of Neurology (H.T., A.W., S.L., Y.P., S.N., H.P., B.C., X.W., Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (H.T., A.W., Yumei Zhang, S.L., Y.P., S.N., H.P., B.C., X.W., G.D., Z.Z.), Beijing; Monogenic Disease Research Center for Neurological Disorders (Yumei Zhang), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (K.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Department of Neurology (G.Z.), Huashan Hospital, Shanghai Medical College, Fudan University; Department of Neurology (M.W.), The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou; Department of Neurology (G.W.), Lanzhou University Second Hospital; Department of Pathology (G.D.), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (W.L.), Army Medical Center of People's Liberation Army, Chongqing; Department of Neurology (Ying Zhang), The First People's Hospital of Shangqiu; Department of Neurology (S.G.), The First Affiliated Hospital of Xinxiang Medical University; Department of Neurology (X.L.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan; Department of Neurology (M.L.), The First People's Hospital of Huaihua City; Department of Neurology (H.L.), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Neurology (M.H.), Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan; and Department of Neurology (W.C.), First Affiliated Hospital of Wenzhou Medical University, China
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Ishiura H, Tsuji S, Toda T. Recent advances in CGG repeat diseases and a proposal of fragile X-associated tremor/ataxia syndrome, neuronal intranuclear inclusion disease, and oculophryngodistal myopathy (FNOP) spectrum disorder. J Hum Genet 2023; 68:169-174. [PMID: 36670296 PMCID: PMC9968658 DOI: 10.1038/s10038-022-01116-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 12/21/2022] [Accepted: 12/21/2022] [Indexed: 01/22/2023]
Abstract
While whole genome sequencing and long-read sequencing have become widely available, more and more focuses are on noncoding expanded repeats. Indeed, more than half of noncoding repeat expansions related to diseases have been identified in the five years. An exciting aspect of the progress in this field is an identification of a phenomenon called repeat motif-phenotype correlation. Repeat motif-phenotype correlation in noncoding repeat expansion diseases is first found in benign adult familial myoclonus epilepsy. The concept is extended in the research of CGG repeat expansion diseases. In this review, we focus on newly identified CGG repeat expansion diseases, update the concept of repeat motif-phenotype correlation in CGG repeat expansion diseases, and propose a clinical concept of FNOP (fragile X-associated tremor/ataxia syndrome, neuronal intranuclear inclusion disease, and oculopharyngodistal myopathy)-spectrum disorder, which shares clinical features and thus probably share some common disease pathophysiology, to further facilitate discussion and progress in this field.
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Affiliation(s)
- Hiroyuki Ishiura
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
- Department of Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
| | - Shoji Tsuji
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Institute of Medical Genomics, International University of Health and Welfare, Narita, Japan
| | - Tatsushi Toda
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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15
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The clinical and neuroimaging features of sporadic adult-onset neuronal intranuclear inclusion disease. Can J Neurol Sci 2023; 50:243-248. [PMID: 35125125 DOI: 10.1017/cjn.2021.514] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Neuronal intranuclear inclusion disease (NIID) is a rare slowly progressive neurodegenerative disorder that is characterized pathologically by the presence of eosinophilic intranuclear inclusions. NIID is a heterogeneous disease with diverse clinical manifestations, making diagnosis difficult. Here, we analyzed the clinical, pathological, and radiological features of Chinese NIID patients to improve our understanding of NIID. METHODS A total of 17 patients with sporadic NIID were recruited from the Ruijin Hospital Database between 2014 and 2021. Clinical patient information and brain MRI data were collected. All of the patients underwent standard skin biopsy procedures. RESULTS The average age of onset for symptoms was 60.18 years, and the average duration of illness was 4.06 years. All patients were diagnosed with NIID due to the presence of intranuclear inclusions confirmed by skin biopsy. Tremor was the most common initial symptom. The average ages at onset and at diagnosis were both lower in patients with tremor than in patients without tremor. NIID may be a systemic disease that affects multiple organs, for one patient had a history of chronic renal insufficiency for more than 10 years. In addition to high-intensity U-fibers signals on diffusion-weighted imaging, there were several other MRI findings, such as focal leukoencephalopathy and cortical swelling. Encephalitic episodes followed by reversible leukoencephalopathy was another important imaging feature of NIID. CONCLUSION The clinical manifestations of NIID are highly variable. Tremor may be the most common initial symptom in certain cohorts. Encephalitic episodes followed by reversible asymmetric leukoencephalopathy may also indicate this disease.
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16
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Current advances in neuronal intranuclear inclusion disease. Neurol Sci 2023; 44:1881-1889. [PMID: 36795299 DOI: 10.1007/s10072-023-06677-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/10/2023] [Indexed: 02/17/2023]
Abstract
Neuronal intranuclear inclusion disease (NIID) is a rare but probably underdiagnosed neurodegenerative disorder due to pathogenic GGC expansions in the NOTCH2NLC gene. In this review, we summarize recent developments in the inheritance features, pathogenesis, and histopathologic and radiologic features of NIID that subvert the previous perceptions of NIID. GGC repeat sizes determine the age of onset and clinical phenotypes of NIID patients. Anticipation may be absent in NIID but paternal bias is observed in NIID pedigrees. Eosinophilic intranuclear inclusions in skin tissues once considered pathological hallmarks of NIID can also present in other GGC repeat diseases. Diffusion-weighted imaging (DWI) hyperintensity along the corticomedullary junction once considered the imaging hallmark of NIID can frequently be absent in muscle weakness and parkinsonism phenotype of NIID. Besides, DWI abnormalities can appear years after the onset of predominant symptoms and may even disappear completely with disease progression. Moreover, continuous reports of NOTCH2NLC GGC expansions in patients with other neurodegenerative diseases lead to the proposal of a new concept of NOTCH2NLC-related GGC repeat expansion disorders (NRED). However, by reviewing the previous literature, we point out the limitations of these studies and provide evidence that these patients are actually suffering from neurodegenerative phenotypes of NIID.
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17
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Kurokawa R, Kurokawa M, Mitsutake A, Nakaya M, Baba A, Nakata Y, Moritani T, Abe O. Clinical and neuroimaging review of triplet repeat diseases. Jpn J Radiol 2023; 41:115-130. [PMID: 36169768 PMCID: PMC9889482 DOI: 10.1007/s11604-022-01343-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/18/2022] [Indexed: 02/04/2023]
Abstract
Triplet repeat diseases (TRDs) refer to a group of diseases caused by three nucleotide repeats elongated beyond a pathologic threshold. TRDs are divided into the following four groups depending on the pathomechanisms, although the pathomechanisms of several diseases remain unelucidated: polyglutamine disorders, caused by a pathologic repeat expansion of CAG (coding the amino acid glutamine) located within the exon; loss-of-function repeat disorders, characterized by the common feature of a loss of function of the gene within which they occur; RNA gain-of-function disorders, involving the production of a toxic RNA species; and polyalanine disorders, caused by a pathologic repeat expansion of GCN (coding the amino acid alanine) located within the exon. Many of these TRDs manifest through neurologic symptoms; moreover, neuroimaging, especially brain magnetic resonance imaging, plays a pivotal role in the detection of abnormalities, differentiation, and management of TRDs. In this article, we reviewed the clinical and neuroimaging features of TRDs. An early diagnosis of TRDs through clinical and imaging approaches is important and may contribute to appropriate medical intervention for patients and their families.
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Affiliation(s)
- Ryo Kurokawa
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan ,Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109 USA
| | - Mariko Kurokawa
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan ,Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109 USA
| | - Akihiko Mitsutake
- Department of Neurology, International University of Health and Welfare, Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo, 108-8329 Japan
| | - Moto Nakaya
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan
| | - Akira Baba
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109 USA
| | - Yasuhiro Nakata
- Department of Neuroradiology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo 183-0042 Japan
| | - Toshio Moritani
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109 USA
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan
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18
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Miyamoto Y, Okazaki T, Watanabe K, Togawa M, Adachi T, Kato A, Ochiai R, Tamai C, Sone J, Maegaki Y. First detailed case report of a pediatric patient with neuronal intranuclear inclusion disease diagnosed by NOTCH2NLC genetic testing. Brain Dev 2023; 45:70-76. [PMID: 36150977 DOI: 10.1016/j.braindev.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 07/12/2022] [Accepted: 09/06/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Neuronal intranuclear inclusion disease (NIID) is a rare neurodegenerative disease characterized clinically by eosinophilic hyaline intranuclear inclusions in neuronal and other somatic cells. Skin biopsies are reportedly useful in diagnosing NIID, and the genetic cause of NIID was identified as a GGC repeat expansion in NOTCH2NLC in recent years. The number of adult patients diagnosed via genetic testing has increased; however, there have been no detailed reports of pediatric NIID cases with GGC expansions in NOTCH2NLC. This is the first detailed report of a pediatric patient showing various neurological symptoms from the age of 10 and was ultimately diagnosed with NIID via skin biopsy and triplet repeat primed polymerase chain reaction analyses. CASE REPORT This was an 18-year-old female who developed cyclic vomiting, distal dominant muscle weakness, and sustained miosis at 10 years. Nerve conduction studies revealed axonal degeneration, and her neuropathy had slowly progressed despite several rounds of high-dose methylprednisolone and intravenous immunoglobulin therapy. At 13 years, she had an acute encephalopathy-like episode. At 15 years, brain MRI revealed slightly high-intensity lesions on diffusion-weighted and T2-weighted imaging in the subcortical white matter of her frontal lobes that expanded over time. At 16 years, esophagography, upper gastrointestinal endoscopy, and esophageal manometry revealed esophageal achalasia, and per-oral endoscopic myotomy was performed. At 18 years, we diagnosed her with NIID based on the findings of skin specimen analyses and a GGC repeat expansion in NOTCH2NLC. CONCLUSION NIID should be considered as a differential diagnosis in pediatric patients with various neurological symptoms.
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Affiliation(s)
- Yosuke Miyamoto
- Department of Pediatrics, Kyoto Prefectural University of Medicine, 465 Kajii-cho Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan; Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, 36-1 Nishi-Cho, Yonago, Tottori 683-8504, Japan.
| | - Tetsuya Okazaki
- Division of Clinical Genetics, Tottori University, 36-1 Nishi-Cho, Yonago, Tottori 683-8504, Japan
| | - Keisuke Watanabe
- Department of Pediatrics, Akita University, Graduate School of Medicine, 44-2 Hasunuma Hiroomote, Akita, Akita 010-8543, Japan
| | - Masami Togawa
- Department of Pediatrics, Tottori Prefectural Central Hospital, 730 Ezu, Tottori, Tottori 680-0901, Japan
| | - Tadashi Adachi
- Division of Neuropathology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, 36-1 Nishi-Cho, Yonago, Tottori 683-8504, Japan
| | - Ayumi Kato
- Division of Radiology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, 36-1 Nishi-Cho, Yonago, Tottori 683-8504, Japan; Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan
| | - Ryoya Ochiai
- Division of Radiology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, 36-1 Nishi-Cho, Yonago, Tottori 683-8504, Japan; Department of Radiology, National Hospital Organization Hamada Medical Center, 777-12 Asai-Cho, Hamada, Shimane 697-8511, Japan
| | - Chisato Tamai
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan
| | - Jun Sone
- Institute for Medical Science of Aging, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan; Department of Neurology, National Hospital Organization Suzuka National Hospital, 3-2-1 Kasado, Suzuka, Mie 513-8501, Japan
| | - Yoshihiro Maegaki
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, 36-1 Nishi-Cho, Yonago, Tottori 683-8504, Japan
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19
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Lou Y, Yu J, Shuai Z, Zhao T, Wang Y, Liu X. Adult-onset neuronal nuclear inclusion disease presenting with mental and behavioral disorders: A case report and literature review. Aging Med (Milton) 2022; 5:297-302. [PMID: 36606264 PMCID: PMC9805289 DOI: 10.1002/agm2.12237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 12/04/2022] [Indexed: 12/24/2022] Open
Abstract
Neuronal nuclear inclusion disease (NIID) is a rare and chronic progressive neurological degenerative disease. We presented a 68-year-old man with paroxysmal orientation disorder 1 year prior, mental and behavioral disorders for 2 days, and confirmed the diagnosis of NIID with skin biopsy. We suggest that patients with atypical clinical symptoms showed characteristic high signal in the dermatomedullary junction on DWI; NIID should be considered.
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Affiliation(s)
- Yue Lou
- Department of NeurologyZhejiang HospitalHangzhouChina
| | - Jing‐Ying Yu
- Department of NeurologyZhejiang HospitalHangzhouChina
| | | | - Ting Zhao
- Department of NeurologyZhejiang HospitalHangzhouChina
| | - Yan‐Wen Wang
- Department of NeurologyZhejiang HospitalHangzhouChina
| | - Xiao‐Li Liu
- Department of NeurologyZhejiang HospitalHangzhouChina
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20
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Li F, Wang Q, Zhu Y, Xiao J, Gu M, Yu J, Deng J, Sun W, Wang Z. Unraveling rare form of adult-onset NIID by characteristic brain MRI features: A single-center retrospective review. Front Neurol 2022; 13:1085283. [PMID: 36588885 PMCID: PMC9798416 DOI: 10.3389/fneur.2022.1085283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/30/2022] [Indexed: 12/16/2022] Open
Abstract
Adult-onset neuronal intranuclear inclusion disease (NIID) is a rare neurodegenerative disorder with high clinical heterogeneity. Previous studies indicated that the high-intensity signals in the corticomedullary junction on diffusion-weighted imaging (DWI) on brain MRI, known as the "ribbon sign," could serve as a strong diagnostic clue. Here we used the explorative approach to study the undiagnosed rate of adult-onset NIID in a single center in China via searching for the ribbon sign in picture archive and communication system (PACS) and report the clinical and radiological features of initially undiagnosed NIID patients. Consecutive brain MRI of 21,563 adult individuals (≥18 years) in the PACS database in 2019 from a tertiary hospital were reviewed. Of them, 4,130 were screened out using the keywords "leukoencephalopathy" and "white matter demyelination." Next, all 4,130 images were read by four neurologists. The images with the suspected ribbon sign were reanalyzed by two neuroradiologists. Those with the ribbon sign but without previously diagnosed NIID were invited for skin biopsy and/or genetic testing for diagnostic confirmation. The clinical features of all NIID patients were retrospectively reviewed. Five patients with high-intensity in the corticomedullary junction on DWI were enrolled. Three patients were previously diagnosed with NIID confirmed by genetic or pathological findings and presented with episodic encephalopathy or cognitive impairment. The other two patients were initially diagnosed with limb-girdle muscular dystrophy (LGMD) with rimmed vacuoles (RVs) and normal pressure hydrocephalus (NPH) in one each. Genetic analysis demonstrated GGC repeat expansion in the NOTCH2NLC gene of both, and skin biopsy of the first patient showed the presence of intranuclear hyaline inclusion bodies. Thus, five of the 21,563 adult patients (≥18 years) were diagnosed with NIID. The distinctive subcortical high-intensity signal on DWI was distributed extensively throughout the lobes, corpus callosum, basal ganglia, and brainstem. In addition, T2-weighted imaging revealed white matter hyperintensity of Fazekas grade 2 or 3, atrophy, and ventricular dilation. Distinctive DWI hyperintensity in the junction between the gray and white matter can help identify atypical NIID cases. Our findings highly suggest that neurologists and radiologists should recognize the characteristic neuroimaging pattern of NIID.
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Affiliation(s)
- Fan Li
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Qi Wang
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Ying Zhu
- Medical Imaging Department, Peking University First Hospital, Beijing, China
| | - Jiangxi Xiao
- Medical Imaging Department, Peking University First Hospital, Beijing, China
| | - Muliang Gu
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Jiaxi Yu
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Jianwen Deng
- Department of Neurology, Peking University First Hospital, Beijing, China,Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
| | - Wei Sun
- Department of Neurology, Peking University First Hospital, Beijing, China,Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China,*Correspondence: Wei Sun ✉
| | - Zhaoxia Wang
- Department of Neurology, Peking University First Hospital, Beijing, China,Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China,Zhaoxia Wang ✉
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21
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Tian Y, Zhou L, Gao J, Jiao B, Zhang S, Xiao Q, Xue J, Wang Y, Liang H, Liu Y, Ji G, Mao C, Liu C, Dong L, Zhang L, Zhang S, Yi J, Zhao G, Luo Y, Sun Q, Zhou Y, Yi F, Chen X, Zhou C, Xie N, Luo M, Yao L, Hu Y, Zhang M, Zeng Q, Fang L, Long HY, Xie Y, Weng L, Chen S, Du J, Xu Q, Feng L, Huang Q, Hou X, Wang J, Xie B, Zhou L, Long L, Guo JF, Wang J, Yan X, Jiang H, Xu H, Duan R, Tang B, Shen L. Clinical features of NOTCH2NLC-related neuronal intranuclear inclusion disease. J Neurol Neurosurg Psychiatry 2022; 93:1289-1298. [PMID: 36150844 PMCID: PMC9685690 DOI: 10.1136/jnnp-2022-329772] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/31/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Abnormal expanded GGC repeats within the NOTCH2HLC gene has been confirmed as the genetic mechanism for most Asian patients with neuronal intranuclear inclusion disease (NIID). This cross-sectional observational study aimed to characterise the clinical features of NOTCH2NLC-related NIID in China. METHODS Patients with NOTCH2NLC-related NIID underwent an evaluation of clinical symptoms, a neuropsychological assessment, electrophysiological examination, MRI and skin biopsy. RESULTS In the 247 patients with NOTCH2NLC-related NIID, 149 cases were sporadic, while 98 had a positive family history. The most common manifestations were paroxysmal symptoms (66.8%), autonomic dysfunction (64.0%), movement disorders (50.2%), cognitive impairment (49.4%) and muscle weakness (30.8%). Based on the initial presentation and main symptomology, NIID was divided into four subgroups: dementia dominant (n=94), movement disorder dominant (n=63), paroxysmal symptom dominant (n=61) and muscle weakness dominant (n=29). Clinical (42.7%) and subclinical (49.1%) peripheral neuropathies were common in all types. Typical diffusion-weighted imaging subcortical lace signs were more frequent in patients with dementia (93.9%) and paroxysmal symptoms types (94.9%) than in those with muscle weakness (50.0%) and movement disorders types (86.4%). GGC repeat sizes were negatively correlated with age of onset (r=-0.196, p<0.05), and in the muscle weakness-dominant type (median 155.00), the number of repeats was much higher than in the other three groups (p<0.05). In NIID pedigrees, significant genetic anticipation was observed (p<0.05) without repeat instability (p=0.454) during transmission. CONCLUSIONS NIID is not rare; however, it is usually misdiagnosed as other diseases. Our results help to extend the known clinical spectrum of NOTCH2NLC-related NIID.
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Affiliation(s)
- Yun Tian
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Lu Zhou
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jing Gao
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science/ Peking Union Medical College Hospital, Beijing, China
| | - Bin Jiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Sizhe Zhang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qiao Xiao
- Center for Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan, China
| | - Jin Xue
- Center for Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan, China
| | - Ying Wang
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hui Liang
- Department of Neurology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yaling Liu
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Guang Ji
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Chenhui Mao
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science/ Peking Union Medical College Hospital, Beijing, China
| | - Caiyan Liu
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science/ Peking Union Medical College Hospital, Beijing, China
| | - Liling Dong
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science/ Peking Union Medical College Hospital, Beijing, China
| | - Long Zhang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Shugang Zhang
- Department of Neurology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jiping Yi
- Department of Neurology, The First Affiliated Hospital of Xiangnan University, Chenzhou, Hunan, China
| | - Guohua Zhao
- Department of Neurology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Yingying Luo
- Department of Neurology, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qiying Sun
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yafang Zhou
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Fang Yi
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiaoyu Chen
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Chaojun Zhou
- Department of Neurology, The First People's Hospital of Changde City, Changde, Hunan, China
| | - Nina Xie
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Mengchuan Luo
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Lingyan Yao
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yacen Hu
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Mengqi Zhang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qiuming Zeng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Liangjuan Fang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hong-Yu Long
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yuanyuan Xie
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ling Weng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Si Chen
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Juan Du
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qian Xu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Li Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qing Huang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xuan Hou
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Junpu Wang
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Bin Xie
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Lin Zhou
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Lili Long
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ji-Feng Guo
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Hunan International Scientific and Technological Cooperation Base of Neurodegenerative and Neurogenetic Diseases, Changsha, Hunan, China.,Engineering Research Center of Hunan Province in Cognitive Impairment Disorders, Central South University, Changsha, Hunan, China.,Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, Hunan, China
| | - Junling Wang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Hunan International Scientific and Technological Cooperation Base of Neurodegenerative and Neurogenetic Diseases, Changsha, Hunan, China.,Engineering Research Center of Hunan Province in Cognitive Impairment Disorders, Central South University, Changsha, Hunan, China.,Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, Hunan, China
| | - Xinxiang Yan
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Hong Jiang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Hunan International Scientific and Technological Cooperation Base of Neurodegenerative and Neurogenetic Diseases, Changsha, Hunan, China.,Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, Hunan, China
| | - Hongwei Xu
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Ranhui Duan
- Center for Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan, China
| | - Beisha Tang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China .,Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Hunan International Scientific and Technological Cooperation Base of Neurodegenerative and Neurogenetic Diseases, Changsha, Hunan, China.,Engineering Research Center of Hunan Province in Cognitive Impairment Disorders, Central South University, Changsha, Hunan, China.,Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, Hunan, China
| | - Lu Shen
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China .,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Hunan International Scientific and Technological Cooperation Base of Neurodegenerative and Neurogenetic Diseases, Changsha, Hunan, China.,Engineering Research Center of Hunan Province in Cognitive Impairment Disorders, Central South University, Changsha, Hunan, China.,Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, Hunan, China
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22
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Gao X, Shao ZD, Zhu L. Typical imaging manifestation of neuronal intranuclear inclusion disease in a man with unsteady gait: A case report. World J Clin Cases 2022; 10:12388-12394. [PMID: 36483830 PMCID: PMC9724510 DOI: 10.12998/wjcc.v10.i33.12388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/25/2022] [Accepted: 11/02/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Neuronal intranuclear inclusion disease (NIID) is a rare neurological degenerative disorder with diverse manifestations and inadequate awareness. Only a few cases of NIID have been reported, and typical imaging findings can provide certain clues for the diagnosis of the disease. Furthermore, skin biopsy and genetic testing are important to confirm the diagnosis.
CASE SUMMARY An 84-year-old man presented to the Neurology Department of our hospital complaining of a progressive course of cognitive impairment and unsteady gait for 2 years. The symptoms gradually progressed and affected his daily life. The patient was initially diagnosed with Parkinson’s disease and vascular dementia. The patient did not respond to conventional treatment, such as dopasehydrazine. Therefore, magnetic resonance imaging (MRI) was performed. Based on the imaging findings, we suspected an NIID diagnosis. During the 3-year follow-up in our hospital, his clinical symptoms gradually progressed, and imaging findings became more significant. A high signal intensity along the corticomedullary junction persisted on MRI. Gene testing and skin biopsy were recommended in our hospital; however, the patient refused these procedures. NIID was also considered when he went to a superior hospital in Shanghai. The patient eventually agreed to undergo gene testing. This revealed abnormal GGC repeat expansions in the NOTCH2NLC gene.
CONCLUSION The clinical manifestations of NIID are diverse. Patients with clinical manifestations similar to Parkinson’s disease and dementia may have NIID.
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Affiliation(s)
- Xue Gao
- Department of Neurology, The Second Affiliated Hospital of Wannan Medical College, Wuhu 241000, Anhui Province, China
| | - Zhi-Ding Shao
- Department of Neurology, The Second Affiliated Hospital of Wannan Medical College, Wuhu 241000, Anhui Province, China
| | - Lei Zhu
- Department of Neurology, Huainan First People’s Hospital Affiliated to Auhui University of Science and Technology, Huainan 232000, Anhui Province, China
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23
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Wang YC, Fan Y, Yu WK, Shen S, Li JD, Gao Y, Ji Y, Li YS, Yu LL, Zhao ZC, Li SS, Ding Y, Shi CH, Xu YM. NOTCH2NLC expanded GGC repeats in patients with cerebral small vessel disease. Stroke Vasc Neurol 2022; 8:161-168. [PMID: 36207023 PMCID: PMC10176980 DOI: 10.1136/svn-2022-001631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 09/21/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE GGC repeat expansions in the human-specific NOTCH2NLC gene have been reported as the cause of neuronal intranuclear inclusion disease (NIID). Given the clinical overlap of cognitive impairment in NIID and cerebral small vessel disease (CSVD), both diseases have white matter hyperintensity on T2-fluid-attenuated inversion recovery sequences of brain MRI, and white matter hyperintensity is a primary neuroimaging marker of CSVD on MRI. Therefore, we hypothesised that the GGC repeat expansions might also contribute to CSVD. To further investigate the relationship between NOTCH2NLC GGC repeat expansions and CSVD, we performed a genetic analysis of 814 patients with the disease. METHODS We performed a comprehensive GGC repeat expansion screening in NOTCH2NLC from 814 patients with sporadic CSVD. Their Fazekas score was greater than or equal to 3 points. Repeat-primed PCR and fluorescence amplicon length analyses were performed to identify GGC repeat expansions, and whole-exome sequencing was used to detect any pathogenic mutation in previously reported genes associated with CSVD. RESULTS We identified nine (1.11%) patients with pathogenic GGC repeat expansions ranging from 41 to 98 repeats. The minor allele frequency of expanded GGC repeats in NOTCH2NLC was 0.55%. CONCLUSION Our findings suggest that intermediate-length and longer-length GGC repeat expansions in NOTCH2NLC are associated with sporadic CSVD. This provides new thinking for studying the pathogenesis of CSVD.
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Affiliation(s)
- Yun-Chao Wang
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, Zhengzhou, Henan, China
| | - Yu Fan
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, Zhengzhou, Henan, China
| | - Wen-Kai Yu
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Si Shen
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, Zhengzhou, Henan, China
| | - Jia-Di Li
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, Zhengzhou, Henan, China
| | - Yuan Gao
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, Zhengzhou, Henan, China
| | - Yan Ji
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, Zhengzhou, Henan, China
| | - Yu-Sheng Li
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, Zhengzhou, Henan, China
| | - Lu-Lu Yu
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Zi-Chen Zhao
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Shan-Shan Li
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yao Ding
- Department of Neurology, Xinxiang Medical University, Xinxiang, Henan, China
| | - Chang-He Shi
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, Zhengzhou, Henan, China
| | - Yu-Ming Xu
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, Zhengzhou, Henan, China
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24
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Sugiyama A, Sone J, Kuwabara S. Teaching NeuroImages: Paravermal Lesions in Neuronal Intranuclear Inclusion Disease. Neurology 2022; 99:484-485. [PMID: 35803724 DOI: 10.1212/wnl.0000000000200984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/03/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Atsuhiko Sugiyama
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Jun Sone
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Aichi, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
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25
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Jung NY, Lee HJ, Mizuguchi T, Matsumoto N. Genetic and Imaging Characteristics of a Family With Neuronal Intranuclear Inclusion Disease. J Clin Neurol 2022; 18:358-360. [PMID: 35589323 PMCID: PMC9163938 DOI: 10.3988/jcn.2022.18.3.358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/07/2022] [Accepted: 02/07/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Na-Yeon Jung
- Department of Neurology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
| | - Hyun Jung Lee
- Department of Pathology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Takeshi Mizuguchi
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Naomichi Matsumoto
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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26
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Liu YH, Chou YT, Chang FP, Lee WJ, Guo YC, Chou CT, Huang HC, Mizuguchi T, Chou CC, Yu HY, Yu KW, Wu HM, Tsai PC, Matsumoto N, Lee YC, Liao YC. Neuronal intranuclear inclusion disease in patients with adult-onset non-vascular leukoencephalopathy. Brain 2022; 145:3010-3021. [PMID: 35411397 DOI: 10.1093/brain/awac135] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/24/2022] [Accepted: 03/27/2022] [Indexed: 11/12/2022] Open
Abstract
Neuronal intranuclear inclusion disease (NIID), caused by an expansion of GGC repeats in the 5'-untranslated region of NOTCH2NLC, is an important but underdiagnosed cause of adult-onset leukoencephalopathies. The present study aimed to investigate the prevalence, clinical spectrum, and brain MRI characteristics of NIID in adult-onset nonvascular leukoencephalopathies and assess the diagnostic performance of neuroimaging features. One hundred and sixty-one unrelated Taiwanese patients with genetically undetermined nonvascular leukoencephalopathies were screened for the NOTCH2NLC GGC repeat expansions using fragment analysis, repeat-primed PCR, southern blot analysis and/or nanopore sequencing with Cas9-mediated enrichment. Among them, 32 (19.9%) patients had an expanded NOTCH2NLC allele and diagnosed with NIID. We enrolled another two affected family members from one patient for further analysis. The size of the expanded NOTCH2NLC GGC repeats in the 34 patients ranged from 73 to 323 repeats. Skin biopsy from five patients all showed eosinophilic, p62-positive intranuclear inclusions in the sweat gland cells and dermal adipocytes. Among the 34 NIID patents presenting with nonvascular leukoencephalopathies, the median age at symptom onset was 61 years (range, 41-78 years) and the initial presentations included cognitive decline (44.1%; 15/34), acute encephalitis-like episodes (32.4%; 11/34), limb weakness (11.8%, 4/34), and parkinsonism (11.8%; 4/34). Cognitive decline (64.7%; 22/34) and acute encephalitis-like episodes (55.9%; 19/34) were also the most common overall manifestations. Two-thirds of the patients had either bladder dysfunction or visual disturbance. Comparing the brain MRI features between the NIID patients and individuals with other undetermined leukoencephalopathies, corticomedullary junction curvilinear lesion on diffusion weighted imaging (DWI) was the best biomarker to diagnose NIID with high specificity (98.4%) and sensitivity (88.2%). However, such DWI abnormality was absent in 11.8% of the NIID patients. When only fluid-attenuated inversion recovery images were available, presence of white matter hyperintensity lesions (WMH) either in paravermis or middle cerebellar peduncles also favored the diagnosis of NIID with a specificity of 85.3% and a sensitivity of 76.5%. Among the ten patients' MRI performed within 5 days of the onset of acute encephalitis-like episodes, five showed cortical DWI hyperintense lesions and two revealed focal brain edema. In conclusion, NIID accounts for 19.9% (32/161) of patients with adult-onset genetically undiagnosed nonvascular leukoencephalopathies in Taiwan. Half of the NIID patients ever developed encephalitis-like episodes with restricted diffusion in the cortical regions at the acute stage DWI. Corticomedullary junction hyperintense lesions, WMH in paravermis or middle cerebellar peduncles, bladder dysfunction and visual disturbance are useful hints to diagnose NIID.
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Affiliation(s)
- Yi-Hong Liu
- Department of Neurology, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Ying-Tsen Chou
- Department of Neurology, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Fu-Pang Chang
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Wei-Ju Lee
- Neurological Institute, Taichung Veterans General Hospital, Taichung 40705, Taiwan.,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan.,College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
| | - Yuh-Cherng Guo
- Department of Neurology, China Medical University Hospital, Taichung 404332, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung 404333, Taiwan
| | - Cheng-Ta Chou
- Neurological Institute, Taichung Veterans General Hospital, Taichung 40705, Taiwan.,Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung 40227, Taiwan
| | - Hui-Chun Huang
- Department of Neurology, China Medical University Hospital, Taichung 404332, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung 404333, Taiwan
| | - Takeshi Mizuguchi
- Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan
| | - Chien-Chen Chou
- Department of Neurology, Taipei Veterans General Hospital, Taipei 11217, Taiwan.,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan.,Brain Research Center, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Hsiang-Yu Yu
- Department of Neurology, Taipei Veterans General Hospital, Taipei 11217, Taiwan.,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan.,Brain Research Center, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Kai-Wei Yu
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan.,Brain Research Center, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan.,Department of Radiology, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Hsiu-Mei Wu
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan.,Brain Research Center, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan.,Department of Radiology, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Pei-Chien Tsai
- Department of Life Sciences, National Chung Hsing University, Taichung 40227, Taiwan
| | - Naomichi Matsumoto
- Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan
| | - Yi-Chung Lee
- Department of Neurology, Taipei Veterans General Hospital, Taipei 11217, Taiwan.,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan.,Brain Research Center, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Yi-Chu Liao
- Department of Neurology, Taipei Veterans General Hospital, Taipei 11217, Taiwan.,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan.,Brain Research Center, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
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27
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Tokimura R, Hashimoto M, Mitsutake A, Sakai S, Suzuki F, Sugasawa K, Fujimoto C, Ishiura H, Toda T. Isolated Paravermal Hyperintensities in Neuronal Intranuclear Inclusion Disease. Neurology 2022; 98:938-939. [DOI: 10.1212/wnl.0000000000200590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/08/2022] [Indexed: 11/15/2022] Open
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28
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Boivin M, Charlet-Berguerand N. Trinucleotide CGG Repeat Diseases: An Expanding Field of Polyglycine Proteins? Front Genet 2022; 13:843014. [PMID: 35295941 PMCID: PMC8918734 DOI: 10.3389/fgene.2022.843014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 01/31/2022] [Indexed: 12/30/2022] Open
Abstract
Microsatellites are repeated DNA sequences of 3–6 nucleotides highly variable in length and sequence and that have important roles in genomes regulation and evolution. However, expansion of a subset of these microsatellites over a threshold size is responsible of more than 50 human genetic diseases. Interestingly, some of these disorders are caused by expansions of similar sequences, sizes and localizations and present striking similarities in clinical manifestations and histopathological features, which suggest a common mechanism of disease. Notably, five identical CGG repeat expansions, but located in different genes, are the causes of fragile X-associated tremor/ataxia syndrome (FXTAS), neuronal intranuclear inclusion disease (NIID), oculopharyngodistal myopathy type 1 to 3 (OPDM1-3) and oculopharyngeal myopathy with leukoencephalopathy (OPML), which are neuromuscular and neurodegenerative syndromes with overlapping symptoms and similar histopathological features, notably the presence of characteristic eosinophilic ubiquitin-positive intranuclear inclusions. In this review we summarize recent finding in neuronal intranuclear inclusion disease and FXTAS, where the causing CGG expansions were found to be embedded within small upstream ORFs (uORFs), resulting in their translation into novel proteins containing a stretch of polyglycine (polyG). Importantly, expression of these polyG proteins is toxic in animal models and is sufficient to reproduce the formation of ubiquitin-positive intranuclear inclusions. These data suggest the existence of a novel class of human genetic pathology, the polyG diseases, and question whether a similar mechanism may exist in other diseases, notably in OPDM and OPML.
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29
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Zhong S, Lian Y, Luo W, Luo R, Wu X, Ji J, Ji Y, Ding J, Wang X. Upstream open reading frame with NOTCH2NLC GGC expansion generates polyglycine aggregates and disrupts nucleocytoplasmic transport: implications for polyglycine diseases. Acta Neuropathol 2021; 142:1003-1023. [PMID: 34694469 DOI: 10.1007/s00401-021-02375-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/30/2021] [Accepted: 09/25/2021] [Indexed: 12/13/2022]
Abstract
Neuronal intranuclear inclusion disease (NIID) is neurodegenerative disease characterized by widespread inclusions. Despite the identification of GGC repeat expansion in 5'UTR of NOTCH2NLC gene in adult-onset NIIDs, its pathogenic mechanism remains unclear. Gain-of-function poly-amino-acid proteins generated by unconventional translation have been revealed in nucleotide repeat expansion disorders, inspiring us to explore the possibility of unconventional translation in NIID. Here we demonstrated that NOTCH2NLC 5'UTR triggers the translation of a polyglycine (polyG)-containing protein, N2NLCpolyG. N2NLCpolyG accumulates in p62-positive inclusions in cultured cells, mouse models, and NIID patient tissues with NOTCH2NLC GGC expansion. Translation of N2NLCpolyG is initiated by an upstream open reading frame (uORF) embedding the GGC repeats. N2NLCpolyG tends to aggregate with the increase of GGC repeat units, and displays phase separation properties. N2NLCpolyG aggregation impairs nuclear lamina and nucleocytoplasmic transport but does not necessarily cause acute death on neuronal cells. Our study suggests a similarity of pathogenic mechanisms between NIID and another GGC-repeat disease, fragile X-associated tremor ataxia syndrome. These findings expand our knowledge of protein gain-of-function in NIID, and further highlight evidence for a novel spectrum of diseases caused by aberrant polyG protein aggregation, namely the polyG diseases.
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Affiliation(s)
- Shaoping Zhong
- Department of Neurology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Yangye Lian
- Department of Neurology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Wenyi Luo
- Department of Neurology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Rongkui Luo
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaoling Wu
- Department of Neurology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Jun Ji
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuan Ji
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jing Ding
- Department of Neurology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
- CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai, China.
| | - Xin Wang
- Department of Neurology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
- Department of The State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, China.
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30
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Oda R, Fujikura M, Hayashi T, Matsuya M, Sone J, Shimohama S. [A case of neuronal intranuclear inclusion disease with serial MRI changes observed from before onset of forgetfulness]. Rinsho Shinkeigaku 2021; 61:727-732. [PMID: 34657918 DOI: 10.5692/clinicalneurol.cn-001609] [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: 11/05/2022]
Abstract
A 70-year-old woman presented with a 6-year history of cognitive dysfunction, neurogenic bladder, constipation and recurrent vomiting, and gradual worsening of symptoms. At the first admission to our department, she was also found to have hepatic encephalopathy due to intrahepatic portosystemic shunt. Head MRI revealed abnormal signal intensity at the corticomedullary junction, the splenium of the corpus callosum, and bilateral middle cerebellar peduncles on DWI. She was diagnosed with intranuclear inclusion disease (NIID) based on skin biopsy and genetic testing of NOTCH2NLC. In a retrospective review of serial head MRI findings for ten years, abnormal signal intensity at the corticomedullary junction and the splenium of the corpus callosum on MRI existed prior to the onset of cognitive dysfunction, and expanded gradually. For early diagnosis of NIID, it is important to focus not only on the characteristic high signal intensity at the corticomedullary junction, but also on the signal at the splenium of the corpus callosum from the early stage.
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Affiliation(s)
- Ryosuke Oda
- Department of Neurology, Saiseikai Otaru Hospital
| | - Mai Fujikura
- Department of Neurology, Saiseikai Otaru Hospital
| | | | | | - Jun Sone
- Department of Neurology, National Hospital Organization Suzuka National Hospital
| | - Shun Shimohama
- Department of Neurology, Sapporo Medical University School of Medicine
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31
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Ye J, Cao H, Chen L, Lei S, Liu M, Long X, Li G, Zheng H. Clinical Reasoning: A 65-Year-Old Woman With Tremor. Neurology 2021; 97:e1257-e1261. [PMID: 34039723 DOI: 10.1212/wnl.0000000000012262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Jing Ye
- From the Department of Neurology (J.Y., M.L., X.L., G.L.), the Sixth People's Hospital of Chengdu; and the West China School of Nursing/Departments of Neurosurgery (H.C.), Neurology (L.C., H.Z.), and Pathology (S.L.), West China Hospital, Sichuan University, Chengdu, China
| | - Hua Cao
- From the Department of Neurology (J.Y., M.L., X.L., G.L.), the Sixth People's Hospital of Chengdu; and the West China School of Nursing/Departments of Neurosurgery (H.C.), Neurology (L.C., H.Z.), and Pathology (S.L.), West China Hospital, Sichuan University, Chengdu, China
| | - Lizhang Chen
- From the Department of Neurology (J.Y., M.L., X.L., G.L.), the Sixth People's Hospital of Chengdu; and the West China School of Nursing/Departments of Neurosurgery (H.C.), Neurology (L.C., H.Z.), and Pathology (S.L.), West China Hospital, Sichuan University, Chengdu, China
| | - Song Lei
- From the Department of Neurology (J.Y., M.L., X.L., G.L.), the Sixth People's Hospital of Chengdu; and the West China School of Nursing/Departments of Neurosurgery (H.C.), Neurology (L.C., H.Z.), and Pathology (S.L.), West China Hospital, Sichuan University, Chengdu, China
| | - Mei Liu
- From the Department of Neurology (J.Y., M.L., X.L., G.L.), the Sixth People's Hospital of Chengdu; and the West China School of Nursing/Departments of Neurosurgery (H.C.), Neurology (L.C., H.Z.), and Pathology (S.L.), West China Hospital, Sichuan University, Chengdu, China
| | - Xiuying Long
- From the Department of Neurology (J.Y., M.L., X.L., G.L.), the Sixth People's Hospital of Chengdu; and the West China School of Nursing/Departments of Neurosurgery (H.C.), Neurology (L.C., H.Z.), and Pathology (S.L.), West China Hospital, Sichuan University, Chengdu, China
| | - Guangzong Li
- From the Department of Neurology (J.Y., M.L., X.L., G.L.), the Sixth People's Hospital of Chengdu; and the West China School of Nursing/Departments of Neurosurgery (H.C.), Neurology (L.C., H.Z.), and Pathology (S.L.), West China Hospital, Sichuan University, Chengdu, China.
| | - Hongbo Zheng
- From the Department of Neurology (J.Y., M.L., X.L., G.L.), the Sixth People's Hospital of Chengdu; and the West China School of Nursing/Departments of Neurosurgery (H.C.), Neurology (L.C., H.Z.), and Pathology (S.L.), West China Hospital, Sichuan University, Chengdu, China.
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32
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Cao L, Yan Y, Zhao G. NOTCH2NLC-related repeat expansion disorders: an expanding group of neurodegenerative disorders. Neurol Sci 2021; 42:4055-4062. [PMID: 34333668 DOI: 10.1007/s10072-021-05498-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 07/18/2021] [Indexed: 12/22/2022]
Abstract
The NOTCH2NLC gene 5' untranslated region (UTR) GGC repeat expansion mutations were identified as a genetic contributor of neuronal intranuclear inclusion disease (NIID) in 2019. Since then, the number of reported cases with NOTCH2NLC GGC repeat expansion in Asian and European populations has increased rapidly, indicating that the expanded mutation not only leads to the onset or progression of the NIID, but also may play an important role in multiple progressive neurological disorders, including Parkinson's disease, essential tremor, multiple system atrophy, Alzheimer's disease, frontotemporal dementia, amyotrophic lateral sclerosis, leukoencephalopathy, and oculopharyngodistal myopathy type 3. Nevertheless, the underlying pathogenic mechanism of the NOTCH2NLC 5' UTR region GGC repeat expansion in these disorders remains largely unknown. This review aims to present recent breakthroughs on this mutation and improve our knowledge of a newly defined spectrum of disease: NOTCH2NLC-related repeat expansion disorder.
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Affiliation(s)
- Lanxiao Cao
- Department of Neurology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, N1 Shangcheng Avenue, Yiwu, 322000, Zhejiang Province, China
| | - Yaping Yan
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Hangzhou, 310009, Zhejiang Province, China.
| | - Guohua Zhao
- Department of Neurology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, N1 Shangcheng Avenue, Yiwu, 322000, Zhejiang Province, China.
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Hangzhou, 310009, Zhejiang Province, China.
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Sugiyama A, Takeda T, Koide M, Yokota H, Mukai H, Kitayama Y, Shibuya K, Araki N, Ishikawa A, Isose S, Ito K, Honda K, Yamanaka Y, Sano T, Saito Y, Arai K, Kuwabara S. Coexistence of neuronal intranuclear inclusion disease and amyotrophic lateral sclerosis: an autopsy case. BMC Neurol 2021; 21:273. [PMID: 34243731 PMCID: PMC8268606 DOI: 10.1186/s12883-021-02306-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/29/2021] [Indexed: 11/18/2022] Open
Abstract
Background Neuronal intranuclear inclusion disease (NIID) is a rare neurodegenerative disease. Pathologically, it is characterized by eosinophilic hyaline intranuclear inclusions in the cells of the visceral organs as well as central, peripheral, and autonomic nervous system cells. Recently, a GGC repeat expansion in the NOTCH2NLC gene has been identified as the etiopathological agent of NIID. Interestingly, this GGC repeat expansion was also reported in some patients with a clinical diagnosis of amyotrophic lateral sclerosis (ALS). However, there are no autopsy-confirmed cases of concurrent NIID and ALS. Case presentation A 60-year-old Taiwanese woman reported a four-month history of progressive weakness beginning in the right foot that spread to all four extremities. She was diagnosed with ALS because she met the revised El Escorial diagnostic criteria for definite ALS with upper and lower motor neuron involvement in the cervical, thoracic, and lumbosacral regions. She died of respiratory failure at 22 months from ALS onset, at the age of 62 years. Brain magnetic resonance imaging (MRI) revealed lesions in the medial part of the cerebellar hemisphere, right beside the vermis (paravermal lesions). The subclinical neuropathy, indicated by a nerve conduction study (NCS), prompted a potential diagnosis of NIID. Antemortem skin biopsy and autopsy confirmed the coexistence of pathology consistent with both ALS and NIID. We observed neither eccentric distribution of p62-positive intranuclear inclusions in the areas with abundant large motor neurons nor cytopathological coexistence of ALS and NIID pathology in motor neurons. This finding suggested that ALS and NIID developed independently in this patient. Conclusions We describe a case of concurrent NIID and ALS discovered during an autopsy. Abnormal brain MRI findings, including paravermal lesions, could indicate the coexistence of NIID even in patients with ALS showing characteristic clinical phenotypes.
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Affiliation(s)
- Atsuhiko Sugiyama
- Department of Neurology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan.
| | - Takahiro Takeda
- Department of Neurology, National Hospital Organization Chibahigashi National Hospital, Chiba, Japan
| | - Mizuho Koide
- Department of Neurology, National Hospital Organization Chibahigashi National Hospital, Chiba, Japan
| | - Hajime Yokota
- Department of Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroki Mukai
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Yoshihisa Kitayama
- Department of Neurology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
| | - Kazumoto Shibuya
- Department of Neurology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
| | - Nobuyuki Araki
- Department of Neurology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
| | - Ai Ishikawa
- Department of Neurology, National Hospital Organization Chibahigashi National Hospital, Chiba, Japan
| | - Sagiri Isose
- Department of Neurology, National Hospital Organization Chibahigashi National Hospital, Chiba, Japan
| | - Kimiko Ito
- Department of Neurology, National Hospital Organization Chibahigashi National Hospital, Chiba, Japan
| | - Kazuhiro Honda
- Department of Neurology, National Hospital Organization Chibahigashi National Hospital, Chiba, Japan
| | - Yoshitaka Yamanaka
- Department of Neurology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan.,Urayasu Rehabilitation Education Center, Chiba University Hospital, Chiba, Japan
| | - Terunori Sano
- Department of Pathology and Laboratory Medicine, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yuko Saito
- Department of Pathology and Laboratory Medicine, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kimihito Arai
- Department of Neurology, National Hospital Organization Chibahigashi National Hospital, Chiba, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
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Tokumaru AM, Saito Y, Murayma S. Diffusion-Weighted Imaging is Key to Diagnosing Specific Diseases. Magn Reson Imaging Clin N Am 2021; 29:163-183. [PMID: 33902901 DOI: 10.1016/j.mric.2021.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This article reviews diseases for which persistent signal abnormalities on diffusion-weighted imaging are the key to their diagnosis. Specifically, updated knowledge regarding the neuroimaging patterns of the following diseases is summarized: sporadic Creutzfeldt-Jakob disease, neuronal intranuclear inclusion disease, and hereditary diffuse leukoencephalopathy with axonal spheroids-colony-stimulating factor receptors/adult-onset leukoencephalopathy with axonal spheroids and pigmented glia. In addition, their differential diagnoses; clinical manifestations; and pathologic, genetic, and imaging correlates are discussed.
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Affiliation(s)
- Aya Midori Tokumaru
- Department of Diagnostic Radiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan.
| | - Yuko Saito
- Brain Bank for Aging Research, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| | - Shigeo Murayma
- Brain Bank for Aging Research, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan; Brain Bank for Neurodevelopmental, Neurological and Psychiatric Disorders, United Graduate School of Child Development, Osaka University, 2-2, Yamadaoka, Suita-shi, Osaka-fu 565-0871, Japan
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35
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Kotani S, Fukazawa R, Takezawa H, Banba M, Sone J, Fujii A. [A comparative study of three cases of neuronal intranuclear inclusion disease (NIID)]. Rinsho Shinkeigaku 2021; 61:194-199. [PMID: 33627586 DOI: 10.5692/clinicalneurol.cn-001549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
All three patients were men in their 70s. All cases were solitary onset and the chief complaint was gait disturbance. All patients had miosis and limb and trunk ataxia, MMSE score was declined in two patients, and FAB score was declined in all patients. Head MRI showed leukoencephalopathy, cerebellar atrophy, and DWI high intensity signal in corticomedullary junction. However, two of the three patients were not followed up without further examination. Skin biopsies in all cases showed ubiquitin-positive and p62-positive intranuclear inclusions. Genetic testing showed CGG repeat expansion of NOTCH2NLC. The diagnosis of neuronal intranuclear inclusion disease (NIID) was made based on the above findings in all cases. Most patients are diagnosed with NIID due to memory loss, but sometimes they are diagnosed due to gait disturbance with ataxia. It is important to proceed with the diagnosis by skin biopsy and genetic diagnosis based on the characteristic MRI findings of the head.
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Affiliation(s)
- Saki Kotani
- Department of Neurology, Saiseikai Shiga Hospital
| | | | | | | | - Jun Sone
- Department of Neurology, National Hospital Organization Suzuka National Hospital
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36
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Neuronal intranuclear inclusion disease: recognition and update. J Neural Transm (Vienna) 2021; 128:295-303. [PMID: 33599827 DOI: 10.1007/s00702-021-02313-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 01/22/2021] [Indexed: 02/06/2023]
Abstract
Neuronal intranuclear inclusion disease (NIID) used to be considered as a neurodegenerative disease. Due to the availability of skin biopsy, the diagnostic efficiency of the disease has been greatly improved. Recently, researchers have successfully identified that the GGC repeat expansion in the 5'-untranslated region of the NOTCH2NLC gene is the causative mutation of NIID. Besides the typical phenotype of brain degeneration, peripheral neuropathy, and autonomic disturbance, the gene mutation is also associated with Alzheimer's disease, frontotemporal dementia, Parkinson's disease, multiple system atrophy, essential tremor, adult leukoencephalopathy, and oculopharyngodistal myopathy. However, it still needs more studies to elucidate whether those variable NIID phenotypes can categorize into NOTCH2NLC repeat expansion related disorders. We update the discovery milestone, clinical phenotype, laboratory examinations, as well as new insight into the diagnosis and treatment of NIID. NIID is an unusual degenerative disease that can involve multiple systems, especially involves the nervous system. Originally, it is named after the pathological characteristics with extensive intranuclear eosinophilic inclusions in central and peripheral nervous tissues, as well as in multiple other organs (Sone et al., Brain 139:3170-3186, 2016). In 2019, several research teams from China and Japan have simultaneously identified that the GGC repeat expansion in the 5'-untranslated region (5'UTR) of the NOTCH2NLC gene is the pathogenic mutation of NIID (Ishiura et al., Nat Genet 51:1222-1232, 2019; Deng et al., J Med Genet 56:758-764, 2019; Sone et al., Nat Genet 51:1215-1221, 2019; Sun et al., Brain 143:222-233, 2020; Tian et al., Am J Hum Genet 105:166-176, 2019). Since then, the number of reported NIID cases is rapidly increasing, and the spectrum of NOTCH2NLC repeat expansion related disorders is significantly broadening (Westenberger and Klein, Brain 143:5-8, 2020). However, the NIID associated with GGC repeat expansion of the NOTCH2NLC gene might be account for a part of patients, probably more frequently in the Asian population, because this expansion has not been identified in an European series with postmortem confirmed NIID cases (Chen et al., Ann Clin Transl Neurol 2020). In order to better understand of the disease, we need to revisit the current state of NIID in combination with the findings based on our experiences in recent years and update the concepts about the clinical and pathogenic progression of NIID.
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Chen H, Lu L, Wang B, Hua X, Wan B, Sun M, Xu X. Essential tremor as the early symptom of NOTCH2NLC gene-related repeat expansion disorder. Brain 2020; 143:e56. [PMID: 32449905 DOI: 10.1093/brain/awaa142] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Hao Chen
- Department of Neurology, the First Affiliated Hospital of Soochow University, Suzhou, 215000, China.,Department of Neurology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221600, China
| | - Likui Lu
- Institute for Fetology, the First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Bin Wang
- Institute of Neuroscience, Soochow University, Suzhou, 215123, China
| | - Xiaodong Hua
- Augusta University/University of Georgia Medical Partnership, Athens, GA, 30606, USA.,Medical College of Georgia, Augusta University, Augusta, GA, 30912, USA
| | - Bo Wan
- Institute of Neuroscience, Soochow University, Suzhou, 215123, China
| | - Miao Sun
- Institute for Fetology, the First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Xingshun Xu
- Department of Neurology, the First Affiliated Hospital of Soochow University, Suzhou, 215000, China.,Institute of Neuroscience, Soochow University, Suzhou, 215123, China.,Jiangsu Key Laboratory of Neuropsychiatric Diseases, Soochow University, Suzhou, Jiangsu 215123, China
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38
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Guo JJ, Wang ZY, Wang M, Jiang ZZ, Yu XF. Neuronal intranuclear inclusion disease mimicking acute cerebellitis: A case report. World J Clin Cases 2020. [DOI: 10.12998/wjcc.v8.i23.6115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Guo JJ, Wang ZY, Wang M, Jiang ZZ, Yu XF. Neuronal intranuclear inclusion disease mimicking acute cerebellitis: A case report. World J Clin Cases 2020; 8:6122-6129. [PMID: 33344613 PMCID: PMC7723690 DOI: 10.12998/wjcc.v8.i23.6122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/02/2020] [Accepted: 11/02/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Neuronal intranuclear inclusion disease (NIID) is an unusual autosomal dominant, chronic progressive neurodegenerative disease. The clinical manifestations of NIID are complex and varied, complicating its clinical diagnosis. To the best of our knowledge, this report is the first to document sporadic adult-onset NIID mimicking acute cerebellitis (AC) that was finally diagnosed by imaging studies, skin biopsy, and genetic testing.
CASE SUMMARY A 63-year-old man presented with fever, gait unsteadiness, dysarthria, and an episode of convulsion. His serum levels of white blood cells and C-reactive protein were significantly elevated. T2-weighted brain magnetic resonance imaging and fluid attenuation inversion recovery sequences showed bilateral high-intensity signals in the medial part of the cerebellar hemisphere beside the vermis. While we initially considered a diagnosis of AC, the patient’s symptoms improved significantly without special treatment, prompting our consideration of NIID. Diffusion-weighted imaging showed hyperintensity in the corticomedullary junction. Skin biopsy revealed eosinophilic inclusions positive for anti-p62 in epithelial sweat-gland cells. GGC repeat expansions in the Notch 2 N-terminal like C gene confirmed the diagnosis of NIID.
CONCLUSION For patients with clinical manifestations mimicking AC, the possibility of underlying NIID should be considered along with prompt rigorous examinations.
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Affiliation(s)
- Jiao-Jiao Guo
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Zi-Yi Wang
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Meng Wang
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Zong-Zhi Jiang
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Xue-Fan Yu
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
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40
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Ogasawara M, Iida A, Kumutpongpanich T, Ozaki A, Oya Y, Konishi H, Nakamura A, Abe R, Takai H, Hanajima R, Doi H, Tanaka F, Nakamura H, Nonaka I, Wang Z, Hayashi S, Noguchi S, Nishino I. CGG expansion in NOTCH2NLC is associated with oculopharyngodistal myopathy with neurological manifestations. Acta Neuropathol Commun 2020; 8:204. [PMID: 33239111 PMCID: PMC7690190 DOI: 10.1186/s40478-020-01084-4] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 11/18/2020] [Indexed: 12/21/2022] Open
Abstract
Oculopharyngodistal myopathy (OPDM) is a rare hereditary muscle disease characterized by progressive distal limb weakness, ptosis, ophthalmoplegia, bulbar muscle weakness and rimmed vacuoles on muscle biopsy. Recently, CGG repeat expansions in the noncoding regions of two genes, LRP12 and GIPC1, have been reported to be causative for OPDM. Furthermore, neuronal intranuclear inclusion disease (NIID) has been recently reported to be caused by CGG repeat expansions in NOTCH2NLC. We aimed to identify and to clinicopathologically characterize patients with OPDM who have CGG repeat expansions in NOTCH2NLC (OPDM_NOTCH2NLC). Note that 211 patients from 201 families, who were clinically or clinicopathologically diagnosed with OPDM or oculopharyngeal muscular dystrophy, were screened for CGG expansions in NOTCH2NLC by repeat primed-PCR. Clinical information and muscle pathology slides of identified patients with OPDM_NOTCH2NLC were re-reviewed. Intra-myonuclear inclusions were evaluated using immunohistochemistry and electron microscopy (EM). Seven Japanese OPDM patients had CGG repeat expansions in NOTCH2NLC. All seven patients clinically demonstrated ptosis, ophthalmoplegia, dysarthria and muscle weakness; they myopathologically had intra-myonuclear inclusions stained with anti-poly-ubiquitinated proteins, anti-SUMO1 and anti-p62 antibodies, which were diagnostic of NIID (typically on skin biopsy), in addition to rimmed vacuoles. The sample for EM was available only from one patient, which demonstrated intranuclear inclusions of 12.6 ± 1.6 nm in diameter. We identified seven patients with OPDM_NOTCH2NLC. Our patients had various additional central and/or peripheral nervous system involvement, although all were clinicopathologically compatible; thus, they were diagnosed as having OPDM and expanding a phenotype of the neuromyodegenerative disease caused by CGG repeat expansions in NOTCH2NLC.
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41
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Cognitive profiles in adult-onset neuronal intranuclear inclusion disease: a case series from the memory clinic. Neurol Sci 2020; 42:2487-2495. [PMID: 33140307 DOI: 10.1007/s10072-020-04864-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/27/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This study aimed to analyze the characteristics of cognitive impairment in adult-onset neuronal intranuclear inclusion disease (NIID). METHODS Seven patients with adult-onset NIID were collected consecutively from the memory clinic of Xuanwu hospital from February to December 2019. These cases were diagnosed with skin biopsy triggered by DWI high-intensity signals in corticomedullary junction on brain MRI. We used a battery of neuropsychological scales to detect the patient's performance in each cognitive domain, and made a detailed analysis on the characteristics of cognitive impairment. RESULTS All seven cases had cognitive impairment, and four of them had met the criteria for dementia. The scores of Montreal Cognitive Assessment and Frontal Assessment Battery were abnormal in all patients. The executive dysfunction was confirmed by the abnormal scores of Trail Making Test (5/7, 71%) and Clock Drawing Test (4/7, 57%). Bad performance in Auditory Verbal Learning Test (6/7, 86%) demonstrated that the memory was also a very commonly impaired cognitive domain. The low score on the animal fluency (4/7, 57%), Boston Naming Test (3/7, 43%), and Pentagon and Cube Copying Test (4/7, 57%) indicated that the language and visuospatial skills were also impaired. Fazekas scores were significantly correlated to the global cognition, executive and language functions (r = 0.788-0.906, P < 0.05). CONCLUSIONS There is obvious impairment in multiple cognitive domains in adult-onset NIID, and both the executive dysfunction and memory deficit are very common. Leukoencephalopathy may be the main course of cognitive impairment in adult-onset NIID.
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42
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De Cocker LJL, Castillo M. Distinctive diffusion-weighted imaging features in late-onset genetic leukoencephalopathies. Neuroradiology 2020; 63:153-156. [PMID: 32879996 DOI: 10.1007/s00234-020-02543-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 08/27/2020] [Indexed: 10/23/2022]
Abstract
Genetic leukoencephalopathies are inherited disorders characterized by progressive white matter involvement. Although most are paediatric conditions, late-onset adult leukoencephalopathies are being increasingly recognized. Adult leukoencephalopathies may present as neurodegenerative diseases with cognitive decline and motor symptoms. Similar to their paediatric counterparts, different adult leukoencephalopathies often have distinctive MRI appearances. In particular, DWI has been recently shown to demonstrate specific patterns of persistent diffusion restriction in several adult-onset leukoencephalopathies. As such, DWI may provide important clues to the diagnosis of adult-onset leukoencephalopathy. The purpose of this review is to discuss characteristic DWI features in some late-onset leukoencephalopathies.
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Affiliation(s)
- Laurens J L De Cocker
- Department of Radiology, AZ Maria Middelares, Buitenring Sint-Denijs 30, 9000, Ghent, Belgium.
| | - Mauricio Castillo
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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43
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Neuronal intranuclear inclusion disease: two case report and literature review. Neurol Sci 2020; 42:293-296. [PMID: 32839883 DOI: 10.1007/s10072-020-04613-0] [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: 11/25/2019] [Accepted: 07/19/2020] [Indexed: 10/23/2022]
Abstract
Neuronal intranuclear inclusion disease (NIID) is a rare and slowly progressing neurodegenerative disease characterized by the presence of eosinophilic intranuclear inclusions in the nervous system and multiple visceral organs. Sporadic NIID case was more frequently encountered than familial. In our study, we reported two adult-onset NIID patients from a family and described their clinical, imaging, and pathological features. The first patient was a 61-year-old man who only presented with non-specific headache and dizziness; however, Brain MRI with diffusion-weighted images (DWI) sequence showed high-intensity signal involving a small regional portion of corticomedullary junction in the frontal and parietal lobe. The older sister of former, a 64-year-old female, who developed sudden onset of weakness of the right limb was admitted to our neurology department. Compared with the first patient, similar DWI high-intensity signal but more extensive area in the corticomedullary junction was found in her brain MRI examination, also prominent leukoencephalopathy in T2-weighted image. Significantly, skin pathology of the first patient showed that typical inclusions with strongly positive P62 and ubiquitin antibody could be seen in the nuclei of sweat gland cells, adipocytes, and fibroblasts. FMR1 gene was negative. Although rare, adult-onset NIID should be considered when the characteristic radiology changes of high intensity signal involving the corticomedullary junction in the brain DWI sequence was found. In addition, the pathological result of skin biopsy combined with negative genetic testing FMR1 or NOTCH2NLC can contribute to the accurate diagnosis of the disease. This article aims to improve the radiologists' knowledge of NIID by our cases presentation and reviewing literature.
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44
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Okamura S, Takahashi M, Abe K, Inaba A, Sone J, Orimo S. A case of neuronal intranuclear inclusion disease with recurrent vomiting and without apparent DWI abnormality for the first seven years. Heliyon 2020; 6:e04675. [PMID: 32817896 PMCID: PMC7424193 DOI: 10.1016/j.heliyon.2020.e04675] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/21/2020] [Accepted: 08/05/2020] [Indexed: 02/06/2023] Open
Abstract
Neuronal intranuclear inclusion disease (NIID) is a rare, neurodegenerative disorder characterized by the presence of eosinophilic hyaline intranuclear inclusions, which are ubiquitin-positive and p62-positive, in neuronal and somatic cells; this can be observed on skin biopsy. Although patients with NIID present with a variety of symptoms that often make the diagnosis difficult, characteristic high-signal intensity of the corticomedullary junction on diffusion-weighted imaging (DWI) often provides a clue to the diagnosis of NIID. We present a case of NIID in a 57-year-old woman who only had recurrent vomiting for four years, which is uncommon as the presenting symptom; moreover, DWI showed no apparent abnormality until a slightly abnormal intensity lesion appeared at the right frontal corticomedullary junction seven years after the first episode of recurrent vomiting. Skin biopsies revealed multiple p62-positive nuclear inclusions, and genetic test showed GGC repeat expansion in NOTCH2NLC; this may form the genetic basis for NIID. Retrospectively, we found that abnormal cerebellar signals besides the vermis in the fluid attenuation inversion recovery (FLAIR) images were detected early-on in the disease. Periodic vomiting may be the only symptom of NIID in the early stages of the disease, and cerebellar abnormalities in FLAIR may serve as an important finding in the diagnosis of NIID, even in the absence of characteristic clinical symptoms or abnormal DWI signals at the cerebral corticomedullary junction.
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Affiliation(s)
- Shun Okamura
- Department of Neurology, Kanto Central Hospital, Tokyo, Japan
| | | | - Keisuke Abe
- Department of Neurology, Kanto Central Hospital, Tokyo, Japan
| | - Akira Inaba
- Department of Neurology, Kanto Central Hospital, Tokyo, Japan
| | - Jun Sone
- Department of Neurology, National Hospital Organization Suzuka National Hospital, Suzuka, Japan
| | - Satoshi Orimo
- Department of Neurology, Kanto Central Hospital, Tokyo, Japan
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45
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Aoyagi Y, Taya M, Ohashi M, Saitoh E. Neuronal intranuclear inclusion disease presenting with dysphagia: a report of three cases. Neurocase 2020; 26:252-257. [PMID: 32619141 DOI: 10.1080/13554794.2020.1788607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Neuronal intranuclear inclusion disease (NIID) is a rare neurodegenerative disease that is pathologically characterized by the presence of eosinophilic hyaline intranuclear inclusions in neurons, astrocytes, and specific somatic cells. Previously reported cases of NIID displayed various neurological symptoms, including dementia, muscle weakness, ataxia, etc. However, dysphagia associated with NIID have rarely been reported. Here, we report on three cases of NIID with dysphagia. Bolus mastication and transport were impaired in all three cases. Delay of the initiation of pharyngeal swallowing and silent aspiration was observed in two cases. Combined with the brain magnetic resonance imaging (MRI) findings, oropharyngeal dysphagia associated with NIID was suggested to be attributed to diffuse subcortical lesions.
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Affiliation(s)
- Yoichiro Aoyagi
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University , Toyoake, Japan
| | - Michiko Taya
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University , Toyoake, Japan
| | - Miho Ohashi
- Department of Rehabilitation, Fujita Health University Bantane Hospital , Nagoya, Japan
| | - Eiichi Saitoh
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University , Toyoake, Japan
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46
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Ng ASL, Xu Z, Chen Z, Tan YJ, Lim WK, Ting SKS, Yu WY, Cheng QH, Foo JN, Tan EK, Lim TCC. NOTCH2NLC-linked neuronal intranuclear inclusion body disease and fragile X-associated tremor/ataxia syndrome. Brain 2020; 143:e69. [PMID: 32789443 DOI: 10.1093/brain/awaa210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Adeline S L Ng
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore.,Neuroscience and Behavioral Disorders, Duke NUS Medical School, Singapore
| | - Zheyu Xu
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
| | - Zhiyong Chen
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
| | - Yi Jayne Tan
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
| | - Weng Khong Lim
- SingHealth Duke-NUS Institute of Precision Medicine, Singapore.,Cancer and Stem Cell Biology Program, Duke-NUS Medical School, Singapore
| | - Simon K S Ting
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore
| | - Wai Yung Yu
- Department of Neuroradiology, National Neuroscience Institute, Singapore
| | - Qian Hui Cheng
- Department of Neuroradiology, National Neuroscience Institute, Singapore
| | - Jia Nee Foo
- Human Genetics, Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Eng King Tan
- Neuroscience and Behavioral Disorders, Duke NUS Medical School, Singapore.,Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore
| | - Tchoyoson C C Lim
- Department of Neuroradiology, National Neuroscience Institute, Singapore.,Radiological Sciences Duke NUS Medical School, Singapore
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47
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Neuronal Intranuclear Inclusion Disease: A Rare Etiology for Rapidly Progressive Dementia. Alzheimer Dis Assoc Disord 2020; 33:359-361. [PMID: 31094708 DOI: 10.1097/wad.0000000000000312] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Neuronal intranuclear inclusion disease (NIID) is a rare neurodegenerative disorder pathologically characterized by localized neuronal loss, and presence of eosinophilic intranuclear inclusions in neurons and glial cells. CASE REPORT A 50-year-old man presented with rapidly progressive dementia, behavioral changes, gait disturbances, and incontinence of 3 months duration. His brain magnetic resonance imaging showed diffuse T2/FLAIR hyperintensity of basal ganglia, thalami, cerebral peduncles, ventral pons, and supratentorial white matter with a frontal predominance. Hyperintensity was noted along the corticosubcortical junction on diffusion-weighted images. NIID was suspected and the patient underwent triple biopsy of the sural nerve with adjacent skin and biceps biopsy. Biopsy revealed ubiquitin-positive intranuclear inclusions surrounding the myofibers, and vascular smooth muscles suggestive of NIID. CONCLUSIONS NIID is a rare neurodegenerative disorder usually diagnosed postmortem. The rectal and skin biopsy had proved helpful in antemortem diagnosis. We have increased the diagnostic armamentarium by showing the presence of intranuclear inclusions in smooth muscle cells of the muscle. Hence, a high degree of suspicion, magnetic resonance imaging features, with nerve/muscle/skin biopsy can help in diagnosis of NIID.
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48
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Sugiyama A, Sato N, Kimura Y, Fujii H, Shigemoto Y, Suzuki F, Tanei ZI, Saito Y, Sasaki M, Takahashi Y, Matsuda H, Kuwabara S. The cerebellar white matter lesions in dentatorubral-pallidoluysian atrophy. J Neurol Sci 2020; 416:117040. [PMID: 32711193 DOI: 10.1016/j.jns.2020.117040] [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: 04/10/2020] [Revised: 07/04/2020] [Accepted: 07/13/2020] [Indexed: 11/29/2022]
Abstract
Dentatorubral-pallidoluysian atrophy (DRPLA) is an autosomal dominant neurodegenerative disorder caused by a CAG nucleotide repeat expansion in atrophin 1. A previous report described cerebellar white matter lesions on magnetic resonance imaging (MRI) in elderly-onset DRPLA patients, but this finding has not been fully investigated in a total population of DRPLA patients, including juvenile or early-adult onset patients. Herein, we attempted to determine the frequency, distribution pattern, and features of the cerebellar white matter lesions in 30 consecutive DRPLA patients. We also assessed the relationships between the cerebellar white matter lesions and clinical parameters and other MRI findings. The cerebellar white matter lesions were found in 43% of the 30 DRPLA patients, and in 70% of the late adult-onset DRPLA patients. In approx. Two-thirds of the patients with cerebellar white matter lesions, the lesions were localized in the paravermal area (paravermal lesions). Multiple logistic regression analyses revealed that the Fazekas grade of 'cerebral' white matter lesions was independently associated with 'cerebellar' white matter lesions. In conclusion, cerebellar white matter lesions are one of the distinctive MRI features in DRPLA patients, especially in patients with older age at onset. Cerebellar white matter lesions, as well as cerebral white matter lesions, might originate from the disease process of DRPLA itself, and they often have a characteristic distribution of paravermal lesions.
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Affiliation(s)
- Atsuhiko Sugiyama
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan; Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Noriko Sato
- Department of Radiology, National Center of Neurology and Psychiatry, Tokyo, Japan.
| | - Yukio Kimura
- Department of Radiology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Hiroyuki Fujii
- Department of Radiology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yoko Shigemoto
- Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan; Department of Radiology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Fumio Suzuki
- Department of Radiology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Zen-Ichi Tanei
- Department of Neurology and Neuropathology (the Brain Bank for Aging Research), Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Yuko Saito
- Department of Pathology and Laboratory Medicine, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Masayuki Sasaki
- Department of Child Neurology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yuji Takahashi
- Department of Neurology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Hiroshi Matsuda
- Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
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49
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Cupidi C, Dijkstra AA, Melhem S, Vernooij MW, Severijnen LA, Hukema RK, Rozemuller AJM, Neumann M, van Swieten JC, Seelaar H. Refining the Spectrum of Neuronal Intranuclear Inclusion Disease: A Case Report. J Neuropathol Exp Neurol 2020; 78:665-670. [PMID: 31150092 DOI: 10.1093/jnen/nlz043] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Neuronal intranuclear inclusion disease (NIID) is a rare heterogeneous progressive neurodegenerative disease characterized by the presence of eosinophilic hyaline intranuclear inclusions in neuronal and glial cells of the CNS, peripheral cells of the autonomic nervous system, visceral organs and skin. The clinical presentation is broadly heterogeneous and includes limb weakness, dementia, seizures, ataxia, and parkinsonism. High-intensity signal in the corticomedullary junction on brain MRI is a characteristic finding in NIID. We describe a 65-year-old patient presenting with mild cognitive impairment, evolving in dementia with behavioral disturbances and parkinsonism. Brain MRI showed mild global cortical atrophy, more pronounced in the cingulate and temporal cortex and mild leukoaraiosis, but no high-intensity signal in corticomedullary junction on diffusion weighted imaging. Neuropathological examination showed p62- and optineurin-positive neuronal intranuclear inclusions in the hippocampus and in some subcortical structures. Glial cells did not present any intranuclear inclusions, and no spongiotic changes proximal to the U-fibers or diffuse myelin pallor were disclosed in the white matter. We report on a case with pathological features of NIID showing different neuroimaging and pathological findings. We noted an absence of typical MRI abnormalities, lack of intranuclear inclusions in glial cells, and prominent involvement of hippocampal neurons, refining the clinico-pathological spectrum of the disease.
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Affiliation(s)
- Chiara Cupidi
- Department of Neurology.,IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
| | - Anke A Dijkstra
- Department of Pathology, Amsterdam University Medical Centre, Amsterdam Neuroscience, VUmc, Amsterdam, The Netherlands
| | | | - Meike W Vernooij
- Department of Radiology and Nuclear Medicine.,Department of Epidemiology
| | - Lies-Anne Severijnen
- Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Renate K Hukema
- Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Annemieke J M Rozemuller
- Department of Pathology, Amsterdam University Medical Centre, Amsterdam Neuroscience, VUmc, Amsterdam, The Netherlands
| | - Manuela Neumann
- Department of Neuropathology, DZNE, German Center for Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
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50
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Jiao B, Zhou L, Zhou Y, Weng L, Liao X, Tian Y, Guo L, Liu X, Yuan Z, Xiao X, Jiang Y, Wang X, Yang Q, Li C, Zhu Y, Zhou L, Zhang W, Wang J, Li Y, Gu W, Yang J, Xia J, Huang Q, Yin J, Xue J, Duan R, Tang B, Shen L. Identification of expanded repeats in NOTCH2NLC in neurodegenerative dementias. Neurobiol Aging 2020; 89:142.e1-142.e7. [PMID: 32081467 DOI: 10.1016/j.neurobiolaging.2020.01.010] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/31/2019] [Accepted: 01/20/2020] [Indexed: 02/06/2023]
Abstract
repeat expansion in the NOTCH2NLC gene has been identified to be associated with neuronal intranuclear inclusion disease (NIID). Given the clinical overlap of dementia-dominant NIID with neurodegenerative dementia, we therefore hypothesized that the NOTCH2NLC repeat expansion might also contribute to these diseases. In the present study, repeat primed polymerase chain reaction (RP-PCR) and GC-rich PCR were conducted to detect the repeats of NOTCH2NLC in a cohort of 1004 patients with neurodegenerative dementias from mainland China. As a result, 4 sporadic patients were found to carry the NOTCH2NLC repeats expansion, totally accounting for 0.4% of all dementia individuals, and the accurate repeated sizes were 110, 133,120 and 76 respectively. Of 4 mutation carriers, three and one were clinically diagnosed Alzheimer's disease (AD) and frontotemporal dementia (FTD) respectively. In addition, 3 out of them revealed leukoencephalopathy in T2-Flair imaging. This study revealed that although rare, the NOTCH2NLC repeat expansions may be associated with AD or FTD-like phenotype as well as leukoencephalopathy.
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Affiliation(s)
- Bin Jiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Central South University, Changsha, China; Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China
| | - Lu Zhou
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Yafang Zhou
- National Clinical Research Center for Geriatric Disorders, Central South University, Changsha, China; Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China; Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Ling Weng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Central South University, Changsha, China; Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China
| | - Xinxin Liao
- National Clinical Research Center for Geriatric Disorders, Central South University, Changsha, China; Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China; Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Yun Tian
- National Clinical Research Center for Geriatric Disorders, Central South University, Changsha, China; Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China; Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Lina Guo
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Xixi Liu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhenhua Yuan
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Xuewen Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Yaling Jiang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Xin Wang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Qijie Yang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Chenping Li
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Yuan Zhu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Lin Zhou
- National Clinical Research Center for Geriatric Disorders, Central South University, Changsha, China; Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China; Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Weiwei Zhang
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Junling Wang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Central South University, Changsha, China; Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China
| | - Yu Li
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Wenping Gu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Jie Yang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Jian Xia
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Qing Huang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Jun Yin
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Jin Xue
- Center for Medical Genetics, School of Life Sciences, Central South University, Changsha, China
| | - Ranhui Duan
- Center for Medical Genetics, School of Life Sciences, Central South University, Changsha, China
| | - Beisha Tang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Central South University, Changsha, China; Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China
| | - Lu Shen
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Central South University, Changsha, China; Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, China; Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, China.
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