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Neuroacanthocytosis - Clinical variability (a report on six cases)

Dulski, J.; Soltan, W.; Schinwelski, M.; Sitek, E. J.; Rudzinska, Monika; Wójcik-Pedziwiatr, M.; Wictor, L. LU ; Schön, F.; Puschmann, A. LU and Klempir, J., et al. (2014) Eighteenth International Congress of Parkinson's Disease and Movement Disorders In Movement Disorders 29(Suppl 1). p.194-194
Abstract
Objective: To provide clinical clues to differential diagnosis in patients with chorea and other movement disorders with blood acanthocytes. Background: Neuroacanthocytosis (NA) is an umbrella term for neurological conditions associated with acanthocytosis. Core NA syndromes, with basal ganglia involvement and in which acanthocytosis is a frequent finding, include autosomal recessive choreaacanthocytosis (Ch-Ac) and X-linked McLeod syndrome (MLS). Due to the very low prevalence, scarcity of data and high clinical variability they may be underdiagnosed. Methods: Six male patients (pts), three diagnosed with Ch-Ac: 33-y.o.(no.1), 35-y.o.(no.2), 42-y.o.(no.3), two diagnosed with MLS: 52-y.o.(no.4), 60-y.o.(no.5) and one 62-y.o.(no.6), a... (More)
Objective: To provide clinical clues to differential diagnosis in patients with chorea and other movement disorders with blood acanthocytes. Background: Neuroacanthocytosis (NA) is an umbrella term for neurological conditions associated with acanthocytosis. Core NA syndromes, with basal ganglia involvement and in which acanthocytosis is a frequent finding, include autosomal recessive choreaacanthocytosis (Ch-Ac) and X-linked McLeod syndrome (MLS). Due to the very low prevalence, scarcity of data and high clinical variability they may be underdiagnosed. Methods: Six male patients (pts), three diagnosed with Ch-Ac: 33-y.o.(no.1), 35-y.o.(no.2), 42-y.o.(no.3), two diagnosed with MLS: 52-y.o.(no.4), 60-y.o.(no.5) and one 62-y.o.(no.6), a brother of no.5, with clinical suspicion of MLS. The patients had an unremarkable family history and were asymptomatic until adulthood. Pts no.1,2,4,5,6 developed generalized chorea and patient no.3 had predominant bradykinesia. Pts no.1,2,3 had phonic and motor tics, additionally pts no.1 and 2 exhibited peculiar oromandibular dystonia with tongue thrusting. In pts no.2 and 3 dystonic supination of feet was observed, patient no.3 subsequently developed bilateral foot drop. Pts no. 2 and 4 had signs of muscle atrophy. Tendon reflexes were decreased or absent and electroneurography demonstrated sensorimotor neuropathy in patients no. 1,2,3,4,5, except no. 6. Generalized seizures were seen in patients no.2,3,5,6 and myoclonic jerks in patient no 1. Cognitive deterioration was reported in patients no.1,2,3,5,6. Serum creatine kinase levels were elevated in all six patients. Results: Peripheral blood smears revealed acanthocytosis in patients no.1,2,3,5,6, except no. 4. In patients no. 1 and 3 reduced expression of chorein was detected on Western blot. In patient no. 2 genetic testing showed mutations in VPS13A gene and in no.4 and 5 genetic analysis confirmed mutations in XK gene (MLS). The time from the onset of symptoms till establishing the diagnosis in patients no. 1,2,3,4,5 was 11,5,7,6,32 years respectively. Patient no.4 suddenly developed multiple organ failure and died of cardiac arrhythmia at the age of 52. Conclusions: We highlight the variability of clinical presentation of NA syndromes and the long time from the onset to diagnosis with the need to screen the blood smears in uncertain cases, however, as in one of our cases acanthocytes may even be not found. (Less)
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neuroacanthocytosis, motor dysfunction, Parkinson disease, human, patient, acanthocytosis, hospital patient, chorea, blood smear, diagnosis, mutation, blood, gene, basal ganglion, bradykinesia, differential diagnosis, adulthood, Western blotting, genetic screening, genetic analysis, tic, autosomal recessive inheritance, tongue, family history, prevalence, oromandibular dystonia, mental deterioration, tonic clonic seizure, sensorimotor neuropathy, McLeod syndrome, electroneurography, tendon reflex, creatine kinase blood level, muscle atrophy, peroneus nerve paralysis, body posture, multiple organ failure, heart arrhythmia, male
in
Movement Disorders
volume
29
issue
Suppl 1
pages
194 - 194
publisher
John Wiley & Sons
conference name
Eighteenth International Congress of Parkinson's Disease and Movement Disorders
external identifiers
  • scopus:84929506388
ISSN
0885-3185
DOI
10.1002/mds.25914
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English
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yes
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64b3e949-9172-421f-9903-f64b05cf508d
date added to LUP
2017-07-04 15:59:13
date last changed
2017-08-27 06:46:28
@misc{64b3e949-9172-421f-9903-f64b05cf508d,
  abstract     = {Objective: To provide clinical clues to differential diagnosis in patients with chorea and other movement disorders with blood acanthocytes. Background: Neuroacanthocytosis (NA) is an umbrella term for neurological conditions associated with acanthocytosis. Core NA syndromes, with basal ganglia involvement and in which acanthocytosis is a frequent finding, include autosomal recessive choreaacanthocytosis (Ch-Ac) and X-linked McLeod syndrome (MLS). Due to the very low prevalence, scarcity of data and high clinical variability they may be underdiagnosed. Methods: Six male patients (pts), three diagnosed with Ch-Ac: 33-y.o.(no.1), 35-y.o.(no.2), 42-y.o.(no.3), two diagnosed with MLS: 52-y.o.(no.4), 60-y.o.(no.5) and one 62-y.o.(no.6), a brother of no.5, with clinical suspicion of MLS. The patients had an unremarkable family history and were asymptomatic until adulthood. Pts no.1,2,4,5,6 developed generalized chorea and patient no.3 had predominant bradykinesia. Pts no.1,2,3 had phonic and motor tics, additionally pts no.1 and 2 exhibited peculiar oromandibular dystonia with tongue thrusting. In pts no.2 and 3 dystonic supination of feet was observed, patient no.3 subsequently developed bilateral foot drop. Pts no. 2 and 4 had signs of muscle atrophy. Tendon reflexes were decreased or absent and electroneurography demonstrated sensorimotor neuropathy in patients no. 1,2,3,4,5, except no. 6. Generalized seizures were seen in patients no.2,3,5,6 and myoclonic jerks in patient no 1. Cognitive deterioration was reported in patients no.1,2,3,5,6. Serum creatine kinase levels were elevated in all six patients. Results: Peripheral blood smears revealed acanthocytosis in patients no.1,2,3,5,6, except no. 4. In patients no. 1 and 3 reduced expression of chorein was detected on Western blot. In patient no. 2 genetic testing showed mutations in VPS13A gene and in no.4 and 5 genetic analysis confirmed mutations in XK gene (MLS). The time from the onset of symptoms till establishing the diagnosis in patients no. 1,2,3,4,5 was 11,5,7,6,32 years respectively. Patient no.4 suddenly developed multiple organ failure and died of cardiac arrhythmia at the age of 52. Conclusions: We highlight the variability of clinical presentation of NA syndromes and the long time from the onset to diagnosis with the need to screen the blood smears in uncertain cases, however, as in one of our cases acanthocytes may even be not found.},
  articleno    = {517},
  author       = {Dulski, J. and Soltan, W. and Schinwelski, M. and Sitek, E. J. and Rudzinska, Monika and Wójcik-Pedziwiatr, M. and Wictor, L. and Schön, F. and Puschmann, A. and Klempir, J. and Tilley, L. and Roth, J and Tacik, P. and Fujioka, Shinsuke and Traynor, S. and Wszolek, Z K and Drozdowski, W. and Slawek, Jaroslaw},
  issn         = {0885-3185},
  keyword      = {neuroacanthocytosis,motor dysfunction,Parkinson disease,human,patient,acanthocytosis,hospital patient,chorea,blood smear,diagnosis,mutation,blood,gene,basal ganglion,bradykinesia,differential diagnosis,adulthood,Western blotting,genetic screening,genetic analysis,tic,autosomal recessive inheritance,tongue,family history,prevalence,oromandibular dystonia,mental deterioration,tonic clonic seizure,sensorimotor neuropathy,McLeod syndrome,electroneurography,tendon reflex,creatine kinase blood level,muscle atrophy,peroneus nerve paralysis,body posture,multiple organ failure,heart arrhythmia,male},
  language     = {eng},
  month        = {05},
  note         = {Conference Abstract},
  number       = {Suppl 1},
  pages        = {194--194},
  publisher    = {John Wiley & Sons},
  series       = {Movement Disorders},
  title        = {Neuroacanthocytosis - Clinical variability (a report on six cases)},
  url          = {http://dx.doi.org/10.1002/mds.25914},
  volume       = {29},
  year         = {2014},
}