Department of Neurology, University of Kyrenia Faculty of Medicine, Kyrenia, Cyprus.
Department of Neurology, Near East University Faculty of Medicine, Nicosia, Cyprus.
Neurogenetics. 2020 Jul;21(3):179-186. doi: 10.1007/s10048-020-00610-9. Epub 2020 Apr 18.
Glutaric aciduria type I (GA1; OMIM #231670) is an autosomal recessively inherited and treatable disorder characterized by the accumulation and irregular excretion of glutaric acid due to a defect in the glutaryl-CoA dehydrogenase enzyme involved in the catabolic pathways of L-lysine, L-hydroxylysine, and L-tryptophan. Glutaryl-CoA dehydrogenase is encoded by the GCDH gene (OMIM #608801), and several mutations in this gene are known to result in GA1. GA1 usually presents in the first 18-36 months of life with mild or severe acute encephalopathy, movement disorders, and striatal degeneration. Few cases of adult-onset GA1 have been described so far in the literature, often with non-specific and sometimes longstanding neurological symptoms. Since a preventive metabolic treatment is available, neurologists must be aware of this rare but likely underdiagnosed presentation, especially when typical neuroimaging features are identified. Here, we describe 35-year-old presenting with headache and subjective memory problems. There was no history of dystonic movement disorders. Neurological examination and neurocognitive tests were normal. Brain MRI scan revealed white matter abnormalities associated with subependymal nodules and mild frontotemporal hypoplasia suggestive of glutaric aciduria type 1 (GA1). Genetic testing confirmed the presence of homozygous c.1204C > T (p.R402W) variant in the GCDH gene, inherited from heterozygous parents.
I 型戊二酸尿症(GA1;OMIM#231670)是一种常染色体隐性遗传且可治疗的疾病,其特征是由于参与 L-赖氨酸、L-羟赖氨酸和 L-色氨酸分解代谢途径的谷氨酰辅酶 A 脱氢酶酶缺陷,导致戊二酸的积累和不规则排泄。谷氨酰辅酶 A 脱氢酶由 GCDH 基因(OMIM#608801)编码,该基因的几个突变已知会导致 GA1。GA1 通常在生命的前 18-36 个月出现,表现为轻度或重度急性脑病、运动障碍和纹状体变性。迄今为止,文献中已有少数成人发病 GA1 的病例描述,通常具有非特异性且有时为长期存在的神经症状。由于存在预防性代谢治疗,因此神经科医生必须意识到这种罕见但可能被低估的表现,尤其是当存在典型的神经影像学特征时。在此,我们描述了一位 35 岁的患者,表现为头痛和主观记忆问题。没有肌张力障碍运动障碍的病史。神经系统检查和神经认知测试均正常。脑 MRI 扫描显示白质异常,伴有室管膜下结节和轻度额颞叶发育不良,提示 I 型戊二酸尿症(GA1)。基因检测证实 GCDH 基因存在纯合 c.1204C>T(p.R402W)变异,该变异由杂合父母遗传。