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一例伴无菌性脑膜炎的 CLCN2 相关性脑白质病,具有“亮树”外观。

A case of CLCN2-related leukoencephalopathy with bright tree appearance during aseptic meningitis.

机构信息

Department of Child Neurology, National Center of Neurology and Psychiatry, Japan.

Department of Child Neurology, National Center of Neurology and Psychiatry, Japan.

出版信息

Brain Dev. 2020 Jun;42(6):462-467. doi: 10.1016/j.braindev.2020.02.008. Epub 2020 Mar 12.

Abstract

CLCN2-related leukoencephalopathy (CC2L) is a rare autosomal recessive disorder caused by variants in CLCN2. We report a boy whose brain MRI during an episode of aseptic meningitis at the age of 6 years revealed wide areas of restriction on diffusion-weighted images (DWI) in the cerebral subcortical white matter called bright tree appearance (BTA). In addition to the BTA, high intensity signals were also observed bilaterally in the posterior limbs of the internal capsules, cerebral peduncles, middle cerebellar peduncles, cerebellar white matter, and brain stem (longitudinal pontine bundle) along with low apparent diffusion coefficient values in the same areas. The BTA was transient, seen only during the acute phase of the aseptic meningitis. With the resolution of the infection, his meningitis symptoms completely resolved, but abnormal brain MRI findings remained, other than BTA, which disappeared. At age 13 years, whole exome sequencing revealed a homozygous variant (c.61dupC, p.(Leu21Profs*27)) of CLCN2. He had no intellectual disability or neurological abnormalities. The transient DWI high-intensity signals in the subcortical white matter and the T2 high-intensity signals in the white matter could reflect varying degrees of water imbalance in the extracellular space in myelin sheaths in CC2L.

摘要

CLCN2 相关的脑白质病(CC2L)是一种由 CLCN2 变异引起的罕见常染色体隐性疾病。我们报告了一名男孩,他在 6 岁时发生无菌性脑膜炎的发作期间进行的脑部 MRI 显示,大脑皮质下白质的弥散加权图像(DWI)上出现广泛的限制区域,称为亮树外观(BTA)。除了 BTA,还在双侧内囊后肢、大脑脚、小脑上脚、小脑白质和脑干(纵向桥脑束)中观察到高强度信号,同时在相同区域还观察到低表观扩散系数值。BTA 是一过性的,仅在无菌性脑膜炎的急性期出现。随着感染的消退,他的脑膜炎症状完全缓解,但异常的脑部 MRI 发现仍然存在,除了 BTA,它已经消失。在 13 岁时,全外显子组测序发现 CLCN2 的纯合变异(c.61dupC,p.(Leu21Profs*27))。他没有智力障碍或神经异常。皮质下白质中的弥散加权图像高信号和白质中的 T2 高信号可能反映了 CC2L 中髓鞘细胞外空间中不同程度的水失衡。

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