Brain lactic alkalosis in Aicardi-Goutières syndrome.
Aicardi-Goutières syndrome is a rare progressive encephalopathy characterized by acquired microcephaly, basal ganglia calcification, and chronic CSF lymphocytosis, raised levels of interferon alpha in CSF and plasma and chill-blain type lesions. A possible mechanism of injury is cytokine related microangiopathy. We report brain imaging and proton (1H) and phosphorus-31 (31P) magnetic resonance spectroscopy (MRS) findings during the first year after birth in two patients. In patient 1 the evolution of brain metabolite ratios and intracellular pH obtained from serial 1H (long TE) and 31P MRS studies are described; in patient 2 a single 1H (short TE) MRS study is described. Imaging findings included basal ganglia calcifications, cerebral atrophy, and leukodystrophy. The MRS results demonstrated that Aicardi-Goutières syndrome is associated with reduced NAA/Cr, reflecting decreased neuronal/axonal density or viability, increased myo-inositol/Cr, reflecting gliosis or osmotic stress and a persisting brain lactic alkalosis. A brain lactic alkalosis has also been observed in those infants surviving perinatal hypoxia-ischaemia but with a poor neurodevelopmental outcome. A possible mechanism leading to brain alkalosis is up-regulation of the Na+/H+ transporter by focal areas of ischaemia related to the microangiopathy or by pro-inflammatory cytokines. Such brain alkalosis may be detrimental to cell survival and may increase glycolytic rate in astrocytes leading to an increased production of lactate.
Department of Paediatrics, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, London, UK. n.robertson@ucl.ac.uk
N J
NJ
Robertson
P
P
Stafler
R
R
Battini
J
J
Cheong
M
M
Tosetti
M C
MC
Bianchi
I J
IJ
Cox
F M
FM
Cowan
G
G
Cioni
D000471:Alkalosis / Q000378:metabolism*; D001224:Aspartic Acid / Q000031:analogs & derivatives* / Q000378:metabolism; D001479:Basal Ganglia / Q000473:pathology; D001921:Brain / Q000000981:diagnostic imaging / Q000378:metabolism*; D001928:Brain Diseases, Metabolic / Q000000981:diagnostic imaging / Q000378:metabolism*; D002114:Calcinosis / Q000473:pathology; D003404:Creatinine / Q000378:metabolism; D004453:Echoencephalography; D006801:Humans; D007231:Infant, Newborn; D019344:Lactic Acid / Q000378:metabolism*; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D013577:Syndrome; D014057:Tomography, X-Ray Computed
D001224:Aspartic Acid; D019344:Lactic Acid; C000179:N-acetylaspartate; D003404:Creatinine