TY - JOUR
T1 - Early-onset LBSL
T2 - How severe does it get?
AU - Steenweg, M. E.
AU - Van Berge, L.
AU - Van Berkel, C. G M
AU - De Coo, I. F M
AU - Temple, I. K.
AU - Brockmann, K.
AU - Mendonça, C. I P
AU - Vojta, S.
AU - Kolk, A.
AU - Peck, D.
AU - Carr, L.
AU - Uziel, G.
AU - Feigenbaum, A.
AU - Blaser, S.
AU - Scheper, G. C.
AU - Van Der Knaap, M. S.
PY - 2012
Y1 - 2012
N2 - AimLeukoencephalopathy with brainstem and spinal cord involvement and lactate elevation (LBSL) is known as a relatively mild leukoencephalopathy. We investigated the occurrence of severe variants of LBSL with extensive brain magnetic resonance imaging (MRI) abnormalities. MethodMRIs of approximately 3,000 patients with an unknown leukoencephalopathy were retrospectively reviewed for extensive signal abnormalities of the cerebral and cerebellar white matter, posterior limb of the internal capsule, cerebellar peduncles, pyramids, and medial lemniscus. Clinical data were retrospectively collected. ResultsEleven patients fulfilled the MRI criteria (six males); six had DARS2 mutations. Clinical and laboratory findings did not distinguish between patients with and without DARS2 mutations, but MRI did. Patients with DARS2 mutations more often had involvement of structures typically affected in LBSL, including decussatio of the medial lemniscus, anterior spinocerebellar tracts, and superior and inferior cerebellar peduncles. Also, involvement of the globus pallidus was associated with DARS2 mutations. Earliest disease onset was neonatal; earliest death at 20 months. InterpretationThis study confirms the occurrence of early infantile, severe LBSL, extending the known phenotypic range of LBSL. Abnormality of specific brainstem tracts and cerebellar peduncles are MRI findings that point to the correct diagnosis.
AB - AimLeukoencephalopathy with brainstem and spinal cord involvement and lactate elevation (LBSL) is known as a relatively mild leukoencephalopathy. We investigated the occurrence of severe variants of LBSL with extensive brain magnetic resonance imaging (MRI) abnormalities. MethodMRIs of approximately 3,000 patients with an unknown leukoencephalopathy were retrospectively reviewed for extensive signal abnormalities of the cerebral and cerebellar white matter, posterior limb of the internal capsule, cerebellar peduncles, pyramids, and medial lemniscus. Clinical data were retrospectively collected. ResultsEleven patients fulfilled the MRI criteria (six males); six had DARS2 mutations. Clinical and laboratory findings did not distinguish between patients with and without DARS2 mutations, but MRI did. Patients with DARS2 mutations more often had involvement of structures typically affected in LBSL, including decussatio of the medial lemniscus, anterior spinocerebellar tracts, and superior and inferior cerebellar peduncles. Also, involvement of the globus pallidus was associated with DARS2 mutations. Earliest disease onset was neonatal; earliest death at 20 months. InterpretationThis study confirms the occurrence of early infantile, severe LBSL, extending the known phenotypic range of LBSL. Abnormality of specific brainstem tracts and cerebellar peduncles are MRI findings that point to the correct diagnosis.
KW - childhood white matter disorder
KW - MRI pattern recognition
KW - phenotypic variation
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U2 - 10.1055/s-0032-1329395
DO - 10.1055/s-0032-1329395
M3 - Article
C2 - 23065766
AN - SCOPUS:84870243651
VL - 43
SP - 332
EP - 338
JO - Neuropediatrics
JF - Neuropediatrics
SN - 0174-304X
IS - 6
ER -