1/32. Cerebral malformation associated with metabolic disorder. A report of 2 cases.A clinical and neuropathological study is presented of two cases each of which showed neuronal heterotopia. Microgyria was also present in one case. One patient was suffering from a degenerative disorder affecting the white matter. The other was a case of Menkes' disease. It is suggested that the antenatal damage may have been caused by an imbalance of the maternal metabolism, the predisposing factor being the mother's carrier state for a metabolic defect. This is the first report of teratogenesis in a case of Menkes' disease. It is also noted that in this case there is interference with the postnatal as well as the antenatal development of the brain.- - - - - - - - - - ranking = 1keywords = brain (Clic here for more details about this article) |
2/32. Menkes disease after copper histidine replacement therapy: case report.Menkes disease (MD) is an X-linked recessive disorder of copper metabolism, characterized in its untreated state by progressive disorders of multiple systems, especially the central nervous system (CNS) and connective tissue, and death by 3 years of age. Recently, therapy with copper-histidine has modified the severity of MD and permitted survival into adolescence. Clinical response has been greater for the neurological abnormalities than for the connective tissue abnormalities. In this report, we describe the postmortem pathology of one individual who had received copper-histidine therapy and died at age 10; we believe this to be the first such pathological report. The postmortem examination demonstrated significant pathology of mesenchymal tissues, including skeletal abnormalities, vascular degeneration, and bladder diverticula. The CNS, by contrast, showed minimal pathology. The phenotype was more consistent with occipital horn syndrome, a milder allelic disorder of copper metabolism, than with classic MD. The differential sensitivity of CNS and mesenchymal tissues to copper-histidine therapy may result from heterogeneity in the response of different copper-dependent enzymes.- - - - - - - - - - ranking = 0.65140968913971keywords = central nervous system, nervous system (Clic here for more details about this article) |
3/32. Menkes' disease with a Dandy-Walker variant: case report.We report a boy with Menkes' disease in whom MRI revealed delayed myelination of the white matter, brain atrophy and tortuosity of the intracranial vessels. The characteristic MRI features of Menkes' disease were accompanied by a Dandy-Walker variant.- - - - - - - - - - ranking = 1keywords = brain (Clic here for more details about this article) |
4/32. Disturbed copper transport in humans. Part 1: mutations of the ATP7A gene lead to Menkes disease and occipital horn syndrome.Mutations of the ATP7A gene (OMIM 300011) lead to the Menkes disease (MD, OMIM 309400) involving impaired brain development, neurological degeneration, connective tissue abnormalities, and high lethality in early infancy. Occipital horn syndrome (OHS, OMIM 304150), a milder phenotype, is also caused by ATP7A gene mutations. In MD patients, an early copper-histidine treatment may prevent the neurological impairment and prolong survival leading to an OHS phenotype. To demonstrate the genotype/phenotype correlation, two male patients are reported with different ATP7A gene mutations and several phenotypes. In the first patient with the MD phenotype, a mutation within the exon 20 (Gln1288Ter) was found producing a stop codon just prior to the highly conserved ATP binding domain. The OHS phenotype of the second patient was caused by a splice site mutation involving the position 6 of intron 6 within a copper binding domain. Small amounts of correctly spliced ATP7A transcript were sufficient to develop the milder OHS phenotype in this patient (OMIM 30001.0006). In conclusion, mutations of the copper transporting P-type ATPase ATP7A gene cause distinct human diseases showing some genotype/phenotype correlation and implications for treatment.- - - - - - - - - - ranking = 1keywords = brain (Clic here for more details about this article) |
5/32. Aceruloplasminemia, an inherited disorder of iron metabolism.ceruloplasmin, a multi-copper ferroxidase that affects the distribution of tissue iron, has antioxidant effects through the oxidation of ferrous iron to ferric iron. Aceruloplasminemia is an inherited disorder of iron metabolism due to the complete lack of ceruloplasmin ferroxidase activity caused by mutations in the ceruloplasmin gene. It is characterized by iron accumulation in the brain as well as visceral organs. Clinically, the disease consists of the triad of retinal degeneration, diabetes mellitus, and neurological disease, which include ataxia, involuntary movements, and dementia. These symptoms reflect the sites of iron deposition. The unique involvement of the central nervous system distinguishes aceruloplasminemia from other inherited and acquired iron storage disorders. Twenty-one mutations in the ceruloplasmin gene have been reported in 24 families worldwide. In japan, the incidence was estimated to be approximately one per 2,000,000 in the case of non-consanguineous marriages. Excess iron functions as a potent catalyst of biologic oxidation. Previously we showed that an increased iron concentration is associated with increased levels of lipid peroxidation in the serum, cerebrospinal fluid, and erythrocyte membranes. The levels of malondialdehyde and 4-hydroxynonenals, indicators of lipid peroxidation, were also elevated in the basal ganglia and cerebral cortex. Positron emission tomography showed diminished brain metabolism of glucose and oxygen. Enzyme activities in the mitochondrial respiratory chain of the basal ganglia were reduced to approximate 45% and 42%, respectively, for complexes I and IV. These findings suggest that iron-mediated free radicals causes neuronal cell damage through lipid peroxidation and mitochondrial dysfunction in aceruloplasminemia brains.- - - - - - - - - - ranking = 3.6514096891397keywords = brain, central nervous system, nervous system (Clic here for more details about this article) |
6/32. Anaesthetic considerations in the child with Menkes' syndrome.The author presents and discusses the anaesthetic implications of a four-month-old infant with Menkes' syndrome who required tracheostomy. Menkes' syndrome is an X-linked recessive disorder of copper absorption and metabolism. Defective processing of copper results in abnormalities of several enzyme systems leading to severe dysfunction of multiple organ systems. Due to the progressive nature of this disorder and its severe effects on several different organ systems, most importantly the central nervous system, these children frequently require anaesthetic care during imaging procedures such as MRI or during various surgical operations. The high prevalence of seizure disorders, gastroesophageal reflux with the risk of aspiration, and airway complications related to poor pharyngeal muscle control are of concern to the anaesthetist. In addition, defective collagen formation, similar to that seen in ehlers-danlos syndrome, may be present. Identification of these associated conditions during the preoperative examination will guide the selection of appropriate, safe anaesthetic care for these children.- - - - - - - - - - ranking = 0.65140968913971keywords = central nervous system, nervous system (Clic here for more details about this article) |
7/32. Continuous, generalized, high-voltage fast activity and FIRDA in two children.The EEG pattern of continuous, generalized, high-voltage fast rhythms without any reaction to eye-opening/closure, photic stimulation, or the sleep-awaking cycle was previously reported to be characteristic of infantile neuroaxonal dystrophy (INAD). However, we have observed such fast activity in one child with INAD and one with Menkes' kinky-hair syndrome. They both exhibited severe psychomotor disturbance, and their EEGs also included "frontal intermittent rhythmic delta activity (FIRDA)," a nonspecific EEG finding suggestive of organic encephalopathy. Since the continuous, generalized, high-voltage fast activity had features suggestive of spindles in both children, this EEG pattern is thought to actually represent "extreme spindles," and nonspecifically to indicate widespread organic brain damage.- - - - - - - - - - ranking = 1keywords = brain (Clic here for more details about this article) |
8/32. The effects of copper-histidine therapy on brain metabolism in a patient with Menkes disease: a proton magnetic resonance spectroscopic study.We report on metabolic changes in the brain of a boy with Menkes disease. He was treated with parenteral copper (Cu)-histidine supplementation, from 5 months of age, and assessed with proton magnetic resonance spectroscopy ((1)H-MRS). The single-voxel (1)H-MRS before treatment revealed an accumulation of lactate and a reduced N-acetyl aspartate (NAA)/total creatine (tCr) ratio with a z-score of -3.0. During treatment, the lactate signal faded away, whereas the NAA signal gradually increased to a z-score of -1.5 at 120 days of treatment. The choline/tCr ratio did not deviate much initially (z-score 0.5), but the ratio increased markedly during treatment (z-score 4.8). Consequently, the Cu-histidine therapy initiated after the critical period still improved the neuronal metabolism, suggesting that some Cu was delivered to neurons. Nevertheless, the brain atrophy, impaired myelination, and severe neurological symptoms were not ameliorated.- - - - - - - - - - ranking = 6keywords = brain (Clic here for more details about this article) |
9/32. Downregulation of myelination, energy, and translational genes in Menkes disease brain.Menkes disease (MD) is an X-linked recessive neurodegenerative disorder caused by mutations in a copper-transporting p-type ATPase (ATP7A) that normally delivers copper to the central nervous system. The precise reasons for neurodegeneration in MD are poorly understood. We hypothesized that gene expression changes in a MD patient with a lethal ATP7A mutation would indicate pathophysiological cascades relevant to the effects of copper deficiency in the developing brain. To test this hypothesis, oligonucleotide probes for 12,000 genes arrayed on Affymetrix Human genome U95 GeneChips were used for expression profiling of fluorescently labeled primary cRNAs from post-mortem cerebral cortex and cerebellum of a MD patient who died at 6 months of age and a normal control brain matched for age, gender, and race. Histopathologic analysis of the proband's brain showed preservation of neuronal integrity and no hypoxic effects. However, cerebrospinal fluid and brain copper levels were subnormal, and expression profiling identified over 350 known dysregulated genes. For a subset of genes (approximately 12%) analyzed by quantitative RT-PCR, the correct cross-validation rate was 88%. Thirty known genes were altered in both cortex and cerebellum. Downregulation of genes involved in myelination, energy metabolism, and translation was the major finding. The cerebellum was more sensitive to copper deficiency.- - - - - - - - - - ranking = 8.6514096891397keywords = brain, central nervous system, nervous system (Clic here for more details about this article) |
10/32. Menkes syndrome: a case report.Menkes syndrome is caused by mutation of ATP7A gene that encode copper-binding membrane protein localized to the trans-Golgi membrane. mutation of this gene causes defective exportation of copper from the cell. Intracellular accumulation of copper does not reach the toxic state, as copper entering the body is trapped in the intestinal epithelium. copper requiring enzymes are dysfunction and cause multisystemic manifestations. The authors report a Thai boy 8 months of age who had depigmentation and kinky hair at birth. He developed myoclonic jerk at 3 months of age. He had hypopigmentation of the skin, delayed development, hypotonia, pectus excurvatum, loose skin and joints. He had anemia, very low serum copper and ceruloplasmin. X-ray showed Wormian bone of skull, osteopenia of long bones and generalized brain atrophy. The presented case has similar clinical and laboratory findings to 2 previous reports by Songkla University and Siriraj Hospital. Treatment is not effective due to unavailability of copper- histidinate and the patient already had severe brain damage. genetic counseling is important to prevent the next offspring. Biochemical and molecular diagnosis are available for confirmation and prenatal diagnosis, but these techniques have limitations in thailand.- - - - - - - - - - ranking = 2keywords = brain (Clic here for more details about this article) |
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