Unusual variants of Alexander's disease.
The purpose of this study was to describe unusual variants of Alexander's disease. We studied 10 patients who did not meet previously established magnetic resonance imaging (MRI) criteria for Alexander's disease, but for whom this diagnosis was considered because of Rosenthal fibers at histological examination or presence of some MRI features suggestive of Alexander's disease. Sequence analysis of the GFAP gene was performed. In eight patients, MRI results showed predominantly posterior fossa lesions, especially multiple tumor-like brainstem lesions. One patient had asymmetrical frontal white matter abnormalities and basal ganglia abnormalities. One patient (Patient 10) developed degeneration of the frontal white matter. In nine patients, a mutation was found that was concluded to be pathogenic, because the mutation was de novo (five patients), a known mutation was found (two patients), or assembly of the glial fibrillary acidic protein was abnormal in cultured cells (two patients). In Patient 10, a DNA variation was found that was also present in the patient's clinically unaffected father and was concluded to be a polymorphism. In conclusion, DNA diagnostics is warranted in patients who display MRI features suggestive of Alexander's disease, even if they do not meet the full set of previously established MRI criteria.
van der Knaap
Marjo S
MS
Department of Child Neurology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands. ms.vanderknaap@vumc.nl
Salomons
Gajja S
GS
Li
Rong
R
Franzoni
Emilio
E
Gutiérrez-Solana
Luiz González
LG
Smit
Leo M E
LM
Robinson
Richard
R
Ferrie
Collin D
CD
Cree
Bruce
B
Reddy
Alyssa
A
Thomas
Neil
N
Banwell
Brenda
B
Barkhof
Frederik
F
Jakobs
Cornelis
C
Johnson
Anne
A
Messing
Albee
A
Brenner
Michael
M
D000293:Adolescent; D000328:Adult; D038261:Alexander Disease / Q000235:genetics* / Q000473:pathology; D001933:Brain Stem / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D004252:DNA Mutational Analysis / Q000379:methods; D005260:Female; D014644:Genetic Variation; D005904:Glial Fibrillary Acidic Protein / Q000235:genetics* / Q000378:metabolism; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male
D005904:Glial Fibrillary Acidic Protein