精神运动迟缓
张力减退
小头畸形
全球发育迟缓
医学
体内
先天性代谢错误
新生儿脑病
白质
儿科
磁共振成像
脑病
内科学
生物
病理
生物化学
遗传学
表型
放射科
替代医学
基因
作者
Maria Zulfiqar,Doris Lin,Marinette van der Graaf,Peter B. Barker,Jill A. Fahrner,Sandrine Marie,Éva Morava,Lonneke de Boer,Michèl A.A.P. Willemsen,Eileen P.G. Vining,Alena Horská,U.H.F. Engelke,Ron A. Wevers,Gustavo Maegawa
摘要
Abstract Adenylosuccinate lyase (ADSL) deficiency is a rare inborn error of metabolism resulting in accumulation of metabolites including succinylaminoimidazole carboxamide riboside (SAICAr) and succinyladenosine (S‐Ado) in the brain and other tissues. Patients with ADSL have progressive psychomotor retardation, neonatal seizures, global developmental delay, hypotonia, and autistic features, although variable clinical manifestations may make the initial diagnosis challenging. Two cases of the severe form of the disease are reported here: an 18‐month‐old boy with global developmental delay, intractable neonatal seizures, progressive cerebral atrophy, and marked hypomyelination, and a 3‐month‐old girl presenting with microcephaly, neonatal seizures, and marked psychomotor retardation. In both patients in vivo proton magnetic resonance spectroscopy (MRS) showed the presence of S‐Ado signal at 8.3 ppm, consistent with a prior report. Interestingly, SAICAr signal was also detectable at 7.5 ppm in affected white matter, which has not been reported in vivo before. A novel splice‐site mutation, c.IVS12 + 1/G > C, in the ADSL gene was identified in the second patient. Our findings confirm the utility of in vivo proton MRS in suggesting a specific diagnosis of ADSL deficiency, and also demonstrate an additional in vivo resonance (7.5 ppm) of SAICAr in the cases of severe disease. J. Magn. Reson. Imaging 2013;37:974–980. © 2012 Wiley Periodicals, Inc.
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