title: Unusual variants of Alexander's disease.
abstract: 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.
authors.affiliation: Department of Child Neurology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands. ms.vanderknaap@vumc.nl
authors.forename: Marjo S
authors.initials: MS
authors.lastname: van der Knaap
authors.forename: Gajja S
authors.initials: GS
authors.lastname: Salomons
authors.forename: Rong
authors.initials: R
authors.lastname: Li
authors.forename: Emilio
authors.initials: E
authors.lastname: Franzoni
authors.forename: Luiz González
authors.initials: LG
authors.lastname: Gutiérrez-Solana
authors.forename: Leo M E
authors.initials: LM
authors.lastname: Smit
authors.forename: Richard
authors.initials: R
authors.lastname: Robinson
authors.forename: Collin D
authors.initials: CD
authors.lastname: Ferrie
authors.forename: Bruce
authors.initials: B
authors.lastname: Cree
authors.forename: Alyssa
authors.initials: A
authors.lastname: Reddy
authors.forename: Neil
authors.initials: N
authors.lastname: Thomas
authors.forename: Brenda
authors.initials: B
authors.lastname: Banwell
authors.forename: Frederik
authors.initials: F
authors.lastname: Barkhof
authors.forename: Cornelis
authors.initials: C
authors.lastname: Jakobs
authors.forename: Anne
authors.initials: A
authors.lastname: Johnson
authors.forename: Albee
authors.initials: A
authors.lastname: Messing
authors.forename: Michael
authors.initials: M
authors.lastname: Brenner
mesh_terms: 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
chemical_list: D005904:Glial Fibrillary Acidic Protein