Sakakibara Satoko, Aiba Ikuko, Saito Yufuko, Inukai Akira, Ishikawa Kinya, Mizusawa Hidehiro
Department of Neurology, National Hospital Organization Higashi Nagoya National Hospital.
Rinsho Shinkeigaku. 2014;54(6):473-9. doi: 10.5692/clinicalneurol.54.473.
Since the discovery of spinocerebellar ataxia type 31 (SCA31) gene, we identified 6 patients whose SCA type had been unkown for a long period of time as having SCA31 in our hospital and realized that SCA31 is not a rare type of autosomal dominant spinocerebellar ataxia in this region. We examined and compared the clinical details of these six SCA31 patients and the same number of SCA6 patients, finding that some SCA31 patients had hearing loss in common while there are more wide range and complicated signs of extra cerebellum in SCA6 such as pyramidal signs, extrapyramidal signs, dizzy sensations or psychotic, mental problems. There is a significant difference in the number of extracerebellar symptoms between SCA31 and SCA6. There are differences also in MRI findings. Cerebellar atrophy starts from the upper vermis in SCA31, as well as some SCA types, whereas the 4th ventricule becomes enlarged in SCA6 even in the early stage of disease. We suggest that these differences in clinical and MRI findings can be clues for accurate diagnosis before gene analysis.
自从发现脊髓小脑共济失调31型(SCA31)基因以来,我们在我院鉴定出6例长期病因不明的共济失调患者为SCA31型,并认识到SCA31在该地区并非罕见的常染色体显性脊髓小脑共济失调类型。我们检查并比较了这6例SCA31患者和相同数量的SCA6患者的临床细节,发现一些SCA31患者有听力损失的共同症状,而SCA6患者有更广泛、更复杂的小脑外体征,如锥体束征、锥体外系征、头晕感觉或精神症状、心理问题。SCA31和SCA6患者小脑外症状的数量有显著差异。MRI表现也存在差异。SCA31患者的小脑萎缩从蚓部上部开始,一些其他类型的SCA也是如此,而SCA6患者即使在疾病早期第四脑室就会扩大。我们认为,这些临床和MRI表现的差异可以作为基因分析前准确诊断的线索。