Köseoğlu Emel, Tepgeç Fatih, Yetkin Mehmet Fatih, Uyguner Oya, Ekinci Ayten, Abdülrezzak Ümmühan, Hanağasi Haşmet
Department of Neurology, Erciyes University Faculty of Medicine, Kayseri, Turkey.
Department of Molecular Genetics, İstanbul University Faculty of Medicine, İstanbul, Turkey.
Noro Psikiyatr Ars. 2018 Mar 19;55(1):98-102. doi: 10.5152/npa.2017.19484. eCollection 2018 Mar.
The differential diagnosis of young-onset progressive dementia is an issue that requires effort. Recording the family history and careful clinical evaluation are useful tools in the diagnosis. In case of genetic bases, definitive diagnosis requires molecular analysis. We report consanguineous two patients presenting with young-onset progressive dementia characterized by behavioral changes and with bone cysts. Concomitant bone pathology and inheritance pattern directed us to investigate gene, for differential diagnosis, which resulted with the identification of a causative mutation that confirmed the diagnosis of Nasu Hakola disease. The mutation (c.113A>G) is the same for a Turkish family with Nasu Hakola disease reported before. But the presence of bone cysts and absence of epilepsy in our patients are the different findings. Molecular analysis should be considered in patients with young age onset behavioral and cognitive deficits, with white matter lesions in brain magnetic resonance imaging, if especially associated with cystic bone lesions.
早发型进行性痴呆的鉴别诊断是一个需要下功夫的问题。记录家族史和进行仔细的临床评估是诊断中的有用工具。对于有遗传基础的情况,明确诊断需要进行分子分析。我们报告了两名近亲结婚的患者,他们表现为早发型进行性痴呆,其特征为行为改变并伴有骨囊肿。伴随的骨骼病变和遗传模式指导我们调查相关基因以进行鉴别诊断,结果鉴定出一个致病突变,从而确诊为纳苏-哈科拉病。该突变(c.113A>G)与之前报道的一个患有纳苏-哈科拉病的土耳其家族相同。但我们患者中存在骨囊肿且无癫痫发作是不同的表现。对于年龄较轻、出现行为和认知缺陷、脑磁共振成像显示有白质病变,尤其是伴有囊性骨病变的患者,应考虑进行分子分析。