title: Looking beyond the basal ganglia: the spectrum of MRI changes in methylmalonic acidaemia.
abstract: We report imaging abnormalities from 5 brain MR examinations in 4 children with methylmalonic acidaemia between the ages of 20 days and 31 months. In addition to bilateral basal ganglia lesions (pallidum) observed in 3 of 4 children, we found signs of delayed brain maturation (myelination delay, immature gyral pattern, incomplete opercularization) in all children and signs of a white matter disorder in the 3 older children. Unexpectedly, brainstem and cerebellar changes were present in all children. Reviewing the brain imaging changes reported for methylmalonic acidaemia, we discuss the findings and patterns observed in our patients. We postulate that delayed myelination and signs of a white matter disorder as well as brainstem and cerebellar involvement are common findings and may be due to a chronic neurotoxic effect on the developing and ageing brain.
authors.affiliation: Departments of Neuroradiology and General Pediatrics, University Hospital Heidelberg, Heidelberg, Germany. inga.harting@med.uni-heidelberg.de
authors.forename: I
authors.initials: I
authors.lastname: Harting
authors.forename: A
authors.initials: A
authors.lastname: Seitz
authors.forename: S
authors.initials: S
authors.lastname: Geb
authors.forename: T
authors.initials: T
authors.lastname: Zwickler
authors.forename: L
authors.initials: L
authors.lastname: Porto
authors.forename: M
authors.initials: M
authors.lastname: Lindner
authors.forename: S
authors.initials: S
authors.lastname: Kölker
authors.forename: F
authors.initials: F
authors.lastname: Hörster
mesh_terms: D000592:Amino Acid Metabolism, Inborn Errors / Q000473:pathology*; D001479:Basal Ganglia / Q000473:pathology*; D001933:Brain Stem / Q000473:pathology; D002531:Cerebellum / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008764:Methylmalonic Acid / Q000652:urine*; D014057:Tomography, X-Ray Computed
chemical_list: D008764:Methylmalonic Acid