Lopes Tânia, Coelho Margarida, Bordalo Diana, Bandeira António, Bandeira Anabela, Vilarinho Laura, Fonseca Paula, Carvalho Sónia, Martins Cecília, Oliveira José Gonçalves
Centro Hospitalar do Médio Ave, Nova de Famalicão, Portugal.
Centro Hospitalar do Porto, Porto, Portugal.
Rev Paul Pediatr. 2018 Oct-Dec;36(4):519-523. doi: 10.1590/1984-0462/;2018;36;4;00003. Epub 2018 Oct 29.
Leigh syndrome is a neurodegenerative disorder with an incidence of 1:40,000 live births. It presents wide clinical, biochemical, and genetic heterogeneity, but with homogenous neuropatoradiological alterations. There is no specific treatment, and the prognosis is reserved. This case report aimed familiarize health professionals with the disease.
A 16-month-hold girl who was followed in outpatient clinic due to axial hypotonia and delayed psychomotor development. Karyotype, auditory evoked potentials and ophthalmologic evaluation were normal. Evidence of hyperlactacidemia and hypocitrullinemia was detected in the patient. After performing brain magnetic resonance under anesthesia, hypotonia got worse, and the patient was hospitalized after an episode of cyanosis and apnea. The electroencephalogram showed no epileptiform activity. Neuroimaging revealed bilateral lenticular hyperintensity, especially in the putamen and in the left globus pallidus regions. Molecular analysis revealed an 8993T>G (MT-ATP6) mutation in the mitochondrial DNA.
Between 10 and 30% of individuals with Leigh syndrome have mitochondrial DNA mutations. The decompensation after anesthetic intercurrences is typically associated with neurological deterioration and, in this case, increased the diagnosis suspicion. It is important to alert for similar cases and to reduce invasive diagnostic tests if the diagnosis is suspected.
Leigh综合征是一种神经退行性疾病,活产发病率为1:40000。它表现出广泛的临床、生化和遗传异质性,但神经影像学改变具有同质性。目前尚无特异性治疗方法,预后不佳。本病例报告旨在让卫生专业人员熟悉该疾病。
一名16个月大的女童因轴向肌张力减退和精神运动发育迟缓在门诊接受随访。核型、听觉诱发电位和眼科评估均正常。患者检测到高乳酸血症和低瓜氨酸血症证据。在麻醉下进行脑磁共振成像后,肌张力减退加重,患者在一次发绀和呼吸暂停发作后住院。脑电图显示无癫痫样活动。神经影像学显示双侧豆状核高信号,尤其是壳核和左侧苍白球区域。分子分析显示线粒体DNA存在8993T>G(MT-ATP6)突变。
10%至30%的Leigh综合征患者存在线粒体DNA突变。麻醉并发疾病后的失代偿通常与神经功能恶化有关,在本病例中增加了诊断怀疑度。警惕类似病例并在怀疑诊断时减少侵入性诊断测试很重要。