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Karlsson WK, Højgaard JLS, Vilhelmsen A, Crone C, Andersen B, Law I, Møller LB, Nielsen TT, Nielsen EN, Krag T, Svenstrup K, Nielsen JE. Novel Homozygous Truncating Variant Widens the Spectrum of Early-Onset Multisystemic SYNE1 Ataxia. Cerebellum 2021; 21:514-519. [PMID: 34318393 DOI: 10.1007/s12311-021-01308-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/16/2021] [Indexed: 11/28/2022]
Abstract
Pathogenic variants in the SYNE1 gene are associated with a phenotypic spectrum spanning from late-onset, slowly progressive, relatively pure ataxia to early-onset, fast progressive multisystemic disease. Since its first description in 2007 as an adult-onset ataxia in French Canadian families, subsequent identification of patients worldwide has widened the clinical spectrum and increased the number of identified pathogenic variants. We report a 20-year-old Faroese female with early-onset progressive gait problems, weakness, dysphagia, slurred speech, orthostatic dizziness, and urge incontinence. Neurological examination revealed mild cognitive deficits, dysarthria, broken slow pursuit, hypometric saccades, weakness with spasticity, hyperreflexia, absent ankle reflexes, ataxia, and wide-based, spastic gait. Magnetic resonance imaging displayed atrophy of the cerebellum, brainstem, and spinal cord. Severely prolonged central motor conduction time and lower motor neuron involvement was demonstrated electrophysiologically. Fluorodeoxyglucose-positron emission tomography (FDG-PET) scan showed hypometabolism of the cerebellum and right frontal lobe. Muscle biopsy revealed chronic neurogenic changes and near-absent immunostaining for Nesprin-1. Next-generation sequencing revealed a previously undescribed homozygous truncating, likely pathogenic variant in the SYNE1 gene. The patient's mother and paternal grandfather were heterozygous carriers of the variant. Her father's genotype was unobtainable. We expand the list of likely pathogenic variants in SYNE1 ataxia with a novel homozygous truncating variant with proximity to the C-terminus and relate it to a phenotype comprising early-onset cerebellar deficits, upper and lower motor neuron involvement and cognitive deficits. Also, we report novel findings of focally reduced frontal lobe FDG-PET uptake and motor evoked potential abnormalities suggestive of central demyelination.
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Affiliation(s)
- William Kristian Karlsson
- Department of Neurology, University of Copenhagen, Rigshospitalet, Inge Lehmanns Vej 8, 2100, Copenhagen, Denmark.
| | - Joan Lilja Sunnleyg Højgaard
- Department of Neurology, University of Copenhagen, Rigshospitalet, Inge Lehmanns Vej 8, 2100, Copenhagen, Denmark
| | - Anna Vilhelmsen
- Department of Psychiatry, National Hospital of the Faroe Islands, Tórshavn, Faroe Islands
| | - Clarissa Crone
- Department of Neurophysiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Birgit Andersen
- Department of Neurophysiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lisbeth Birk Møller
- Department of Clinical Genetics, Rigshospitalet Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Troels Tolstrup Nielsen
- Department of Neurology, University of Copenhagen, Rigshospitalet, Inge Lehmanns Vej 8, 2100, Copenhagen, Denmark.,Neurogenetics Clinic & Research Lab, Danish Dementia Research Centre, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Emilie Neerup Nielsen
- Department of Neurology, University of Copenhagen, Rigshospitalet, Inge Lehmanns Vej 8, 2100, Copenhagen, Denmark
| | - Thomas Krag
- Department of Neurology, University of Copenhagen, Rigshospitalet, Inge Lehmanns Vej 8, 2100, Copenhagen, Denmark.,Department of Neurology, Copenhagen Neuromuscular Center, University of Copenhagen, Copenhagen, Denmark
| | - Kirsten Svenstrup
- Department of Neurology, University of Copenhagen, Rigshospitalet, Inge Lehmanns Vej 8, 2100, Copenhagen, Denmark.,Department of Neurology, Copenhagen Neuromuscular Center, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen Erik Nielsen
- Department of Neurology, University of Copenhagen, Rigshospitalet, Inge Lehmanns Vej 8, 2100, Copenhagen, Denmark.,Neurogenetics Clinic & Research Lab, Danish Dementia Research Centre, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
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Wulff AB, Højgaard JLS, Hilsted L. Spectrophotometry of cerebrospinal fluid for xanthochromia is a sensitive and specific test for subarachnoid bleeding but adds little to computed tomography. Scand J Clin Lab Invest 2020; 80:681-686. [PMID: 33186071 DOI: 10.1080/00365513.2020.1846208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Subarachnoid hemorrhage (SAH) is a serious neurological event associated with high morbidity and mortality. Computed tomography of the cerebrum (CTC) is the diagnostic method of choice, but in case of negative CTC but strong suspicion of SAH, lumbar puncture with spectrophotometric analysis of cerebrospinal fluid (CSF) for xanthochromia is performed. We wanted to examine the diagnostic properties of CSF spectrophotometry for xanthochromia testing. We performed a retrospective study of the diagnostic properties of CSF analysis for xanthochromia using spectrophotometry in the diagnosis of SAH. A total of 489 CSF samples were analyzed for xanthochromia, according to international guidelines, from 2009 until 2014 and for 411 of these the patient files were retrieved and examined for final clinical diagnosis and result of CTC. One patient with SAH did not have a positive spectrophotometry report and another patient with SAH had an equivocal report. In four patients did initial CTC not correctly identify SAH. For patients with a negative CTC within six hours of symptom onset spectrophotometry for xanthochromia in the CSF had a diagnostic sensitivity of 100% and a diagnostic specificity of 98.5%. The positive predictive value was 16.7% and the negative predictive value 100%. We conclude that spectrophotometry of CSF for xanthochromia is a sensitive and specific test for diagnosing SAH. However, it seems that an initial CTC identifies almost all patients with SAH. This suggests that in our and similar diagnostic settings, lumbar puncture and testing for xanthochromia might only be relevant in very few cases, if not obsolete.
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Affiliation(s)
- Anders Berg Wulff
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | | | - Linda Hilsted
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Steglich-Arnholm H, Kondziella D, Wagner A, Cronqvist ME, Hansen K, Truelsen TC, Krarup LH, Højgaard JLS, Taudorf S, Iversen HK, Krieger DW, Holtmannspötter M. Mechanical Thrombectomy with the Embolus Retriever with Interlinked Cages in Acute Ischemic Stroke: ERIC, the New Boy in the Class. AJNR Am J Neuroradiol 2017; 38:1356-1361. [PMID: 28495947 DOI: 10.3174/ajnr.a5201] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 02/22/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE The Embolus Retriever with Interlinked Cages (ERIC) device is a novel stent retriever for mechanical thrombectomy. It consists of interlinked cages and could improve procedural benchmarks and clinical outcome compared with classic stent retrievers. This study compares the rates of recanalization, favorable clinical outcome, procedural adverse events, and benchmarks between the ERIC device and classic stent retrievers. MATERIALS AND METHODS From 545 patients treated with thrombectomy between 2012 and 2015, 316 patients were included. The mean age was 69 ±13 years, the mean baseline NIHSS score was 17 ± 5, and 174 (55%) were men. The ERIC was used as the primary thrombectomy device in 59 (19%) patients. In a propensity score matched analysis including the NIHSS score, clot location, delay to groin puncture, neurointerventionalist, and anesthetic management, 57 matched pairs were identified. RESULTS Patients treated with the ERIC device compared with classic stent retrievers showed equal rates of recanalization (86% versus 81%, P = .61), equal favorable 3-month clinical outcome (mRS 0-2: 46% versus 40%, P = .71), and procedural adverse events (28% versus 30%, P = 1.00). However, in patients treated with the ERIC device, thrombectomy procedures were less time-consuming (67 versus 98 minutes, P = .009) and a rescue device was needed less often (18% versus 39%, P = .02) compared with classic stent retrievers. CONCLUSIONS Mechanical thrombectomy with the ERIC device is effective and safe. Rates of favorable procedural and clinical outcomes are at least as good as those with classic stent retrievers. Of note, the ERIC device might be time-saving and decrease the need for rescue devices. These promising results call for replication in larger prospective clinical trials.
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Affiliation(s)
- H Steglich-Arnholm
- From the Departments of Neurology (H.S.-A., D.K., K.H., T.C.T., L.-H.K., J.L.S.H., S.T., H.K.I.)
| | - D Kondziella
- From the Departments of Neurology (H.S.-A., D.K., K.H., T.C.T., L.-H.K., J.L.S.H., S.T., H.K.I.)
| | - A Wagner
- Neuroradiology (A.W., M.E.C., M.H.), Rigshospitalet, Copenhagen, Denmark
| | - M E Cronqvist
- Neuroradiology (A.W., M.E.C., M.H.), Rigshospitalet, Copenhagen, Denmark
| | - K Hansen
- From the Departments of Neurology (H.S.-A., D.K., K.H., T.C.T., L.-H.K., J.L.S.H., S.T., H.K.I.)
| | - T C Truelsen
- From the Departments of Neurology (H.S.-A., D.K., K.H., T.C.T., L.-H.K., J.L.S.H., S.T., H.K.I.)
| | - L-H Krarup
- From the Departments of Neurology (H.S.-A., D.K., K.H., T.C.T., L.-H.K., J.L.S.H., S.T., H.K.I.)
| | - J L S Højgaard
- From the Departments of Neurology (H.S.-A., D.K., K.H., T.C.T., L.-H.K., J.L.S.H., S.T., H.K.I.)
| | - S Taudorf
- From the Departments of Neurology (H.S.-A., D.K., K.H., T.C.T., L.-H.K., J.L.S.H., S.T., H.K.I.)
| | - H K Iversen
- From the Departments of Neurology (H.S.-A., D.K., K.H., T.C.T., L.-H.K., J.L.S.H., S.T., H.K.I.)
| | - D W Krieger
- Dubai Healthcare City (D.W.K.), Clinic 2006, Dubai, UAE
| | - M Holtmannspötter
- Neuroradiology (A.W., M.E.C., M.H.), Rigshospitalet, Copenhagen, Denmark
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