[A patient with bilateral lesion in the striatum and slowly progressive dystonia secondary to T14487C mutation in the ND6 gene of complex I of the mitochondrial respiratory chain].
BACKGROUND
A large number of diseases present as bilateral striatal lesion syndrome (BSLS). Clinical manifestations, course and prognosis of these diseases are extremely variable. On the basis of their evolutive course, they can be separated into two major groups: acute, which include toxic, infectious or parainfectious causes, and subacute or chronic, in which inborn errors of metabolism, especially mitochondrial disorders, are the main causes.


METHODS
We report a detailed clinical follow-up of a 18 years old Caucasian male who, at the age of four, presented with BSLS. A respiratory chain defect was suspected on the basis of slowly progressive dystonia and cognitive impairment, changes in serial MRI studies, and the finding of 'trabecular fibers' as well as a 50% decrease of the complex I activity in striated-skeletal muscle specimen. Blood, urine and CSF markers classically associated with respiratory chain diseases were normal. Molecular studies identified a new pathogenetic mutation (T14487C) in the mitochondrial ND6 gene of the respiratory chain complex I.


CONCLUSIONS
Mitochondrial metabolism disorders should be ruled out in patients presenting with a subacute or chronic form of BSLS even in the absence of other common mitochondrial disease markers.
Raspall-Chaure
M
M
Hospital Universitari Vall d'Hebron, Barcelona, Spain.
Solano
A
A
Vázquez
E
E
Macaya-Ruiz
A
A
del Toro-Riera
M
M
Cabezuelo-Briones
A
A
Montoya
J
J
Andreu
A
A
Roig-Quilis
M
M
D000293:Adolescent; D002540:Cerebral Cortex / Q000473:pathology*; D002675:Child, Preschool; D004252:DNA Mutational Analysis; D004272:DNA, Mitochondrial; D004421:Dystonia / Q000175:diagnosis / Q000209:etiology* / Q000235:genetics* / Q000473:pathology; D004579:Electron Transport / Q000502:physiology; D042967:Electron Transport Complex I / Q000235:genetics*; D006801:Humans; D008297:Male; D028361:Mitochondrial Diseases / Q000175:diagnosis / Q000235:genetics / Q000473:pathology / Q000503:physiopathology; D018482:Muscle, Skeletal / Q000378:metabolism / Q000473:pathology; D009154:Mutation; D009422:Nervous System Diseases / Q000175:diagnosis / Q000235:genetics / Q000473:pathology / Q000503:physiopathology
D004272:DNA, Mitochondrial; D042967:Electron Transport Complex I