Intracerebral large artery disease in Aicardi-Goutières syndrome implicates SAMHD1 in vascular homeostasis

Venkateswaran Ramesh, Bruno Bernardi, Altin Stafa, Caterina Garone, Emilio Franzoni, Mario Abinun, Patrick Mitchell, Dipayan Mitra, Mark Friswell, John Nelson, Stavit A. Shalev, Gillian I. Rice, Hannah Gornall, Marcin Szynkiewicz, François Aymard, Vijeya Ganesan, Julie Prendiville, John H. Livingston, Yanick J. Crow

Research output: Contribution to journalArticlepeer-review


Aim: To describe a spectrum of intracerebral large artery disease in Aicardi-Goutières syndrome (AGS) associated with mutations in the AGS5 gene SAMHD1. Method: We used clinical and radiological description and molecular analysis. Results: Five individuals (three males, two females) were identified as having biallelic mutations in SAMHD1 and a cerebral arteriopathy in association with peripheral vessel involvement resulting in chilblains and ischaemic ulceration. The cerebral vasculopathy was primarily occlusive in three patients (with terminal carotid occlusion and basal collaterals reminiscent of moyamoya syndrome) and aneurysmal in two. Three of the five patients experienced intracerebral haemorrhage, which was fatal in two individuals. Post-mortem examination of one patient suggested that the arteriopathy was inflammatory in origin. Interpretation: Mutations in SAMHD1 are associated with a cerebral vasculopathy which is likely to have an inflammatory aetiology. A similar disease has not been observed in patients with mutations in AGS1 to AGS4, suggesting a particular role for SAMHD1 in vascular homeostasis. Our report raises important questions about the management of patients with mutations in SAMHD1.

Original languageEnglish
Pages (from-to)725-732
Number of pages8
JournalDevelopmental Medicine and Child Neurology
Issue number8
Publication statusPublished - Aug 2010

ASJC Scopus subject areas

  • Clinical Neurology
  • Pediatrics, Perinatology, and Child Health
  • Developmental Neuroscience


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