Mucopolysaccharidosis Type 1 among Children—Neuroradiological Perspective Based on Single Centre Experience and Literature Review
Abstract
1. Introduction
2. Clinical Manifestations
3. Differential Diagnosis Difficulties
4. Radiological Point of View
5. Neuroimaging
6. Patients Presentation
7. Neuroimaging—Methods
8. Brain, Head and Spine—Radiological Symptoms
Patient No | 1 | 2 | 3 | 4 | 5 | |
---|---|---|---|---|---|---|
age at exam | 4 mo | 3 yo | 1 y 2 mo | 1 y 11 mo | 3 y 2 mo | 14 yo |
radiological imaging | ||||||
WM signal abnormalities | + | + | + | |||
areas of delayed myelination | + | + | + | + | + | |
enlarged perivascular spaces | + | + | + | + | ||
narrow corpus callosum | + | +/− | + | + | ||
prominent ventricular system | +/− | + | +/− | + | + | |
arachnoid cyst | + | + | ||||
optic nerve sheath enlargement | + | + | ||||
J-shaped sella turcica | + | + | + | +/− | + | +/− |
craniocervical junction distortion | + | +/− | + | + | ||
posterior fossa horns | + | + | + | + | ||
fluid effusion temporal bone | + | + | + | + | +/− | |
closed sagittal suture | + | + | + | |||
vertebral bodies deformity | + | + | ||||
intervertebral disc anomalies | + | + |
9. Discussion
10. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
CC | corpus callosum |
CSF | cerebrospinal fluid |
DQ | developmental quotient |
ERT | enzyme replacement therapy |
GAGs | glycosaminoglycans |
HSCT | hematopoietic stem cell transplantation |
HSPC | hematopoietic stem and progenitor cell |
IDUA | alpha-L-iduronidase |
IHOMS | internal hypertrophy of the occipitomastoid suture |
MPS 1 | Mucopolysaccharidosis type 1 |
MRI | magnetic resonance imaging |
MRS | magnetic resonance spectroscopy |
PVS | perivascular spaces |
WM | white matter |
WMA | white matter abnormalities |
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System Affected | Problem |
---|---|
General appearance | coarse facies short stature |
Musculoskeletal | dysostosis multiplex gibbus kyphosis scoliosis hip dysplasia genu valgum joint stiffness and contractures odontoid hypoplasia |
Neurological | cognitive impairment hydrocephalus carpal tunnel hearing loss |
Respiratory/ENT | recurrent respiratory infections otitis media |
Cardiovascular | valvular disease heart failure arrhythmias |
Ophthalmology | corneal clouding glaucoma retinal changes |
Gastrointestinal | hepatomegaly splenomegaly inguinal/umbilical hernia IBS/diarrhoea * |
Skin lesions (non-specific) | thickened skin excessive hair growth extensive melanocytosis |
Dysostosis Multiplex | |
---|---|
skull | shape changes of sella turcica craniosynostosis macrocephaly thickened calvarium oral and dental abnormalities |
spine | craniocervical junction anomalies cord compression spinal deformities |
other bones | inadequate modelling of long bones clavicles with widened ends “oar shaped” ribs metacarpals deformation flared iliac bones with flattened acetabulum bilateral coxa valga deformity increased risk of osteoporosis/osteopenia |
Neuroimaging Findings—Main Changes |
---|
white matter signal abnormalities enlarged perivascular spaces brain atrophy hydrocephalus spinal canal stenosis involvement of corpus callosum |
Patient No | 1 | 2 | 3 | 4 | 5 |
---|---|---|---|---|---|
diagnosis age current age sex | 4 mo 8 mo F | 2 y 10 mo 10 y 5 mo F | 1 y 2 mo 1 y 3 mo F | 2 y 4 mo 3 y 10 mo F | 1 y 10 mo 15 y 5 mo M |
clinical features | |||||
level of urinary GAGs at diagnosis | 462 mg/g creatinine (N: 90.0–208.0) | 459.95 mg/g creatinine (N: 90.0–208.0) | 179.2 mg/mmol creatinine (N: 9.52–26.9) | 745 mg/g creatinine (N: 90.0–208.0) | 509 mg/g creatinine (N: 83.0–161.0) |
alpha-L-iduro- nidase activity at diagnosis | 0 umol/L/h * (cut-off value > 1.5) | 0.01 nmol/mg protein/18 h ** (N: 88.5–169.5) | 0.2 umol/L/h * (cut-off value > 1.5) | 0.3 umol/L/h * (cut-off value > 1.5) | 0.01 nmol/mg protein/18 h ** (N: 88.5–169.5) |
mutations in the alpha-L-iduronidase gene | p.Gln63Ter and p.Arg621Ter | p.Gln63Ter and p.Arg621Ter | in progress | homozygous c.1045_1047delGAC/p.(Asp349del) | not done |
family history | MPS type 1 in older sister | MPS type 1 in younger sister | unencumbered | suspicion of multiple sclerosis in father | unencumbered |
developmental stages at psychomotor skills | wide range (asymmetrical body muscle tone) | correct physical and delayed mental and speech development | delayed (sitting from 11 mo, does not walk alone, words 13 mo) | delayed (walk from 2 y 4 mo, words 12 mo, halted speech development) | wide range (walk from 15 mo, words 12 mo, sentences 3 yo) |
treatment | ERT since 5 mo old, qualified for HSCT | ERT 3 to 5 yo; HSCT at 4 y 4 mo | qualified for ERT | ERT since 2 y 6 mo old, qualified for HSCT | ERT since 2 years old until now |
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Machnikowska-Sokołowska, M.; Myszczuk, A.; Wieszała, E.; Wieja-Błach, D.; Jamroz, E.; Paprocka, J. Mucopolysaccharidosis Type 1 among Children—Neuroradiological Perspective Based on Single Centre Experience and Literature Review. Metabolites 2023, 13, 209. https://doi.org/10.3390/metabo13020209
Machnikowska-Sokołowska M, Myszczuk A, Wieszała E, Wieja-Błach D, Jamroz E, Paprocka J. Mucopolysaccharidosis Type 1 among Children—Neuroradiological Perspective Based on Single Centre Experience and Literature Review. Metabolites. 2023; 13(2):209. https://doi.org/10.3390/metabo13020209
Chicago/Turabian StyleMachnikowska-Sokołowska, Magdalena, Aleksandra Myszczuk, Emilia Wieszała, Dominika Wieja-Błach, Ewa Jamroz, and Justyna Paprocka. 2023. "Mucopolysaccharidosis Type 1 among Children—Neuroradiological Perspective Based on Single Centre Experience and Literature Review" Metabolites 13, no. 2: 209. https://doi.org/10.3390/metabo13020209
APA StyleMachnikowska-Sokołowska, M., Myszczuk, A., Wieszała, E., Wieja-Błach, D., Jamroz, E., & Paprocka, J. (2023). Mucopolysaccharidosis Type 1 among Children—Neuroradiological Perspective Based on Single Centre Experience and Literature Review. Metabolites, 13(2), 209. https://doi.org/10.3390/metabo13020209