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Brain MR patterns in inherited disorders of monoamine neurotransmitters: An analysis of 70 patients

O. Kuseyri Hübschmann, A. Mohr, J. Friedman, F. Manti, G. Horvath, E. Cortès-Saladelafont, S. Mercimek-Andrews, Y. Yildiz, R. Pons, J. Kulhánek, M. Oppebøen, JA. Koht, I. Podzamczer-Valls, R. Domingo-Jimenez, S. Ibáñez, O. Alcoverro-Fortuny, T....

. 2021 ; 44 (4) : 1070-1082. [pub] 20210128

Jazyk angličtina Země Spojené státy americké

Typ dokumentu časopisecké články, práce podpořená grantem

Perzistentní odkaz   https://www.medvik.cz/link/bmc22012366

Inherited monoamine neurotransmitter disorders (iMNDs) are rare disorders with clinical manifestations ranging from mild infantile hypotonia, movement disorders to early infantile severe encephalopathy. Neuroimaging has been reported as non-specific. We systematically analyzed brain MRIs in order to characterize and better understand neuroimaging changes and to re-evaluate the diagnostic role of brain MRI in iMNDs. 81 MRIs of 70 patients (0.1-52.9 years, 39 patients with tetrahydrobiopterin deficiencies, 31 with primary disorders of monoamine metabolism) were retrospectively analyzed and clinical records reviewed. 33/70 patients had MRI changes, most commonly atrophy (n = 24). Eight patients, six with dihydropteridine reductase deficiency (DHPR), had a common pattern of bilateral parieto-occipital and to a lesser extent frontal and/or cerebellar changes in arterial watershed zones. Two patients imaged after acute severe encephalopathy had signs of profound hypoxic-ischemic injury and a combination of deep gray matter and watershed injury (aromatic l-amino acid decarboxylase (AADCD), tyrosine hydroxylase deficiency (THD)). Four patients had myelination delay (AADCD; THD); two had changes characteristic of post-infantile onset neuronal disease (AADCD, monoamine oxidase A deficiency), and nine T2-hyperintensity of central tegmental tracts. iMNDs are associated with MRI patterns consistent with chronic effects of a neuronal disorder and signs of repetitive injury to cerebral and cerebellar watershed areas, in particular in DHPRD. These will be helpful in the (neuroradiological) differential diagnosis of children with unknown disorders and monitoring of iMNDs. We hypothesize that deficiency of catecholamines and/or tetrahydrobiopterin increase the incidence of and the CNS susceptibility to vascular dysfunction.

1st Department of Pediatrics of the University of Athens Aghia Sofia Hospital Athens Greece

Child Neurology and Developmental Pediatrics 1st Department of Pediatrics Aristotle University of Thessaloniki Thessaloniki Greece

Children's Department Division of Child Neurology Oslo University Hospital Rikshospitalet Oslo Norway

Department of Child Neurology and Metabolic Disorders University Children's Hospital Heidelberg Germany

Department of Human Neuroscience Sapienza University of Rome Rome Italy

Department of Neurology Neurometabolic Unit and Synaptic Metabolism Laboratory Hospital Sant Joan de Déu Esplugues de Llobregat Barcelona Spain

Department of Neurology Oslo University Hospital Oslo Norway

Department of Neuroradiology University Hospital Heidelberg Heidelberg Germany

Department of Pediatric Neurology Hospital Gregorio Marañón Madrid Spain

Department of Pediatric Neurology Hospital Virgen de la Arrixaca Murcia Madrid Spain

Department of Pediatrics and Inherited Metabolic Disorders 1st Faculty of Medicine Charles University and General University Hospital Prague Prague Czech Republic

Department of Pediatrics UKE Hamburg

Division of Clinical and Metabolic Genetics Department of Pediatrics University of Toronto The Hospital for Sick Children Toronto Ontario Canada

Faculty of Medicine Department of Pediatrics Section of Metabolism Hacettepe University Ankara Turkey

IMIB Arrixaca Murcia CIBERER ISCIII Madrid Spain

Inborn Errors of Metabolism Unit Department of Neurology Institut de Recerca Sant Joan de Déu and CIBERER ISCIII Barcelona Spain

Pediatric Neurology Unit Department of Pediatrics University Hospital Reina Sofía IMIBIC and CIBERER Córdoba Spain

Rady Children's Hospital Division of Neurology Rady Children's Institute for Genomic Medicine San Diego California USA

Service of Psychiatry Hospital Benito Menni Hospital General de Granollers Barcelona Spain

UCSD Departments of Neuroscience and Pediatrics

Unit of Child Neurology and Psychiatry Department of Human Neuroscience Sapienza University of Rome Rome Italy

Unit of Pediatric Neurology and Metabolic Disorders Department of Pediatrics Hospital Germans Trias i Pujol and Faculty of Medicine Universitat Autònoma de Barcelona Barcelona Spain

Universitat de Barcelona Barcelona Spain

University of British Columbia Department of Pediatrics Division of Biochemical Genetics BC Children's Hospital Vancouver British Columbia Canada

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$a Brain MR patterns in inherited disorders of monoamine neurotransmitters: An analysis of 70 patients / $c O. Kuseyri Hübschmann, A. Mohr, J. Friedman, F. Manti, G. Horvath, E. Cortès-Saladelafont, S. Mercimek-Andrews, Y. Yildiz, R. Pons, J. Kulhánek, M. Oppebøen, JA. Koht, I. Podzamczer-Valls, R. Domingo-Jimenez, S. Ibáñez, O. Alcoverro-Fortuny, T. Gómez-Alemany, P. de Castro, C. Alfonsi, DI. Zafeiriou, E. López-Laso, P. Guder, R. Santer, T. Honzík, GF. Hoffmann, SF. Garbade, HS. Sivri, V. Leuzzi, K. Jeltsch, A. García-Cazorla, T. Opladen, International Working Group on Neurotransmitter Related Disorders (iNTD), I. Harting
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$a Inherited monoamine neurotransmitter disorders (iMNDs) are rare disorders with clinical manifestations ranging from mild infantile hypotonia, movement disorders to early infantile severe encephalopathy. Neuroimaging has been reported as non-specific. We systematically analyzed brain MRIs in order to characterize and better understand neuroimaging changes and to re-evaluate the diagnostic role of brain MRI in iMNDs. 81 MRIs of 70 patients (0.1-52.9 years, 39 patients with tetrahydrobiopterin deficiencies, 31 with primary disorders of monoamine metabolism) were retrospectively analyzed and clinical records reviewed. 33/70 patients had MRI changes, most commonly atrophy (n = 24). Eight patients, six with dihydropteridine reductase deficiency (DHPR), had a common pattern of bilateral parieto-occipital and to a lesser extent frontal and/or cerebellar changes in arterial watershed zones. Two patients imaged after acute severe encephalopathy had signs of profound hypoxic-ischemic injury and a combination of deep gray matter and watershed injury (aromatic l-amino acid decarboxylase (AADCD), tyrosine hydroxylase deficiency (THD)). Four patients had myelination delay (AADCD; THD); two had changes characteristic of post-infantile onset neuronal disease (AADCD, monoamine oxidase A deficiency), and nine T2-hyperintensity of central tegmental tracts. iMNDs are associated with MRI patterns consistent with chronic effects of a neuronal disorder and signs of repetitive injury to cerebral and cerebellar watershed areas, in particular in DHPRD. These will be helpful in the (neuroradiological) differential diagnosis of children with unknown disorders and monitoring of iMNDs. We hypothesize that deficiency of catecholamines and/or tetrahydrobiopterin increase the incidence of and the CNS susceptibility to vascular dysfunction.
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