title: Fumaric aciduria: clinical and imaging features.
abstract: Fumaric aciduria (fumaric acidemia, fumarase deficiency) is a rare inborn error of metabolism caused by deficient activity of fumarate hydratase, one of the constituent enzymes of the Krebs tricarboxylic acid cycle. We describe the clinical and imaging features of this disease arising from a consanguineous pedigree in 8 patients in the southwestern United States. Thirteen patients have been previously described in the medical literature. Our patients presented with an early infantile encephalopathy with profound developmental retardation and hypotonia, and most experienced seizures. Previously unreported characteristics described here include structural brain malformations, dysmorphic facial features, and neonatal polycythemia. Magnetic resonance imaging showed multiple abnormalities, including diffuse polymicrogyria, decreased cerebral white matter, large ventricles, and open opercula. Fumaric aciduria should be included in the differential diagnosis of inborn errors of metabolism that cause cerebral malformations and dysmorphic features. The possibility that inborn errors of energy metabolism may cause structural malformations deserves increased recognition.
authors.affiliation: Section of Child Neurology, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA.
authors.forename: J F
authors.initials: JF
authors.lastname: Kerrigan
authors.forename: K A
authors.initials: KA
authors.lastname: Aleck
authors.forename: T J
authors.initials: TJ
authors.lastname: Tarby
authors.forename: C R
authors.initials: CR
authors.lastname: Bird
authors.forename: R A
authors.initials: RA
authors.lastname: Heidenreich
mesh_terms: D000015:Abnormalities, Multiple; D001921:Brain / Q000002:abnormalities; D002648:Child; D002675:Child, Preschool; D003241:Consanguinity; D005260:Female; D005649:Fumarate Hydratase / Q000172:deficiency* / Q000652:urine; D006801:Humans; D007223:Infant; D008607:Intellectual Disability / Q000150:complications; D008279:Magnetic Resonance Imaging; D008297:Male; D008661:Metabolism, Inborn Errors / Q000175:diagnosis* / Q000201:enzymology* / Q000453:epidemiology; D009123:Muscle Hypotonia / Q000150:complications; D010375:Pedigree; D011086:Polycythemia / Q000150:complications; D012640:Seizures / Q000150:complications; D014481:United States / Q000453:epidemiology
chemical_list: D005649:Fumarate Hydratase