Leukodystrophies – Clical and Radiological Findings
Authors:
M. Kolníková; P. Sýkora
Authors place of work:
Klinika detskej neurológie LF UK a DFNsP Bratislava
Published in the journal:
Cesk Slov Neurol N 2014; 77/110(5): 534-552
Category:
Minimonografie
doi:
https://doi.org/10.14735/amcsnn2014534
Poďakovanie patrí primárke KDN, MUDr. Jaroslave Payerovej za podporu pri písaní a primárovi MUDr. Dušanovi Haviarovi a kolegom z Rádiologického oddelenia DFNsP v Bratislave za poskytnutie rádiologickej dokumentácie, profesorke M. V. Knaap z univerzitného centra VU Amsterdam za možnosť konzultácie MR nálezov a genetické vyšetrenie pacienta s leukoencefalopatiou – Vanishing White Matter disease (VWM).
Summary
Myelin disorders of the central nervous system are also known as leukoencephalopathies. This term includes diseases, in which changes of the white matter are dominant, or even exclusive, while neither the pathophysiological mechanism nor the histopathological basis are decisive. This broad selection of inborn and acquired disorders includes a group of leukodystrophies characterized by primary dysfunction of myelin and myelin-producing cells. Typically, six separate clinical entities are included in this group: X-linked adrenoleukodystrophy, metachromatic leukodystrophy, Krabbe’s globoid cell leukodystrophy, Canavan disease, Pelizaeus-Merzbacher disease and Alexander disease. The group is constantly expanding as our knowledge develops. Clinical and laboratory findings, as well as MRI scans, are crucial for exact diagnosis. Accurate analysis of MRI images accelerates the diagnostic process considerably. A common feature of leukodystrophies is their progressive nature. Children exhibit rapid loss of motor and cognitive functions. In adolescent and adult patients, psychological and mental changes are the most prominent, while motor deficit has a later onset. The course of X-linked adrenoleukodystrophy, metachromatic leukodystrophy, and Krabbe’s leukodystrophy can be managed at the early or pre-clinical stages with bone marrow or stem cell transplantation. Gene and enzyme therapy are indicated at the earliest stages of metachromatic leukodystrophy. For the remaining leukodystrophies, only symptomatic therapy is available. The purpose of this paper is to summarize current information and knowledge as well as possible therapeutic options in this group of disorders.
Key words:
leukodystrophy – leukopathy – clinical findings – magnetic resonance imaging
The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.
The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.
Zdroje
1. Ambler Z, Bednařík J, Růžička E. Klinická neurologie I. část obecná. 2nd ed. Praha: Triton 2008.
2. Ganong FG. Review of Medical Physiology. 16th ed. New York: Norwalk Appleton & Lange 1993.
3. Klika E, Vacek Z, Dvořák M, Kapeller K. Histológia. 1st ed. Martin: Osveta 1988.
4. Raymond GV, Eichler F, Fatemi A, Naidu S. Leukdystrophies. London: Mac Keith Press 2011.
5. van der Knaap MS, Valk J. Magnetic Resonance of Myelination and Myelin Disorderes. 3rd ed. Berlin Heidelberg New York: Springer 2005.
6. Havrdová E a kolektív. Neuroimunologie. Praha: Maxdorf 2001.
7. Kolníková M, Sýkora P. Leukoencefalopatie – zriedkavé, ale závažné ochorenia bielej hmoty mozgu v detskom veku. Pediatr Prax 2011; 12(1): 27– 28.
8. Perlman SJ, Mar S. Leukodystrophies. Adv Exp Med Biol 2012; 724: 154– 171. doi: 10.1007/ 978‑ 1‑ 4614‑ 0653‑ 2_13.
9. Powers JM. The Leukodystrophies: overview and classification. In: Lazzarini RA (ed). Myelin Disorders and Classification. London: Elsevier/ Academic Press 2004: 663– 690.
10. Kohlschütter A, Bley A, Brockmann K, Gärtner J, Krägeloh‑ Mann I, Rolfs A et al. Leukodystrophies and other genetic metabolic leukoencephalopathies in children and adults. Brain Dev 2010; 32(2): 82– 89. doi: 10.1016/ j.braindev.2009.03.014.
11. Kohlschütter A, Eichler F. Childhood leukodystrophies: a clinical perspective. Expert Rev Neurother 2011; 11(10): 1485– 1496. doi: 10.1586/ ern.11.135.
12. Ambler Z, Bednařík J, Růžička E a kolektiv. Klinická neurologie II. část speciální. 1st ed. Praha: Triton 2010.
13. Vanderver A, Tonduti D, Schiffmann R, Schmidt J,Van der Knaap MS. Leukodystrophy Overview. Seattle: University of Washington 2014.
14. Kemp S, Berger J, Aubourg P. X‑linked adrenoleukodystrophy: clinical, metabolic, genetic and pathophysiological aspects. Biochim Biophys Acta 2012; 1822(9): 1465– 1474. doi: 10.1016/ j.bbadis.2012.03.012.
15. Kolníková M, Sýkora P, Petrovič R, Fischerová M, Chandoga J. X‑ viazaná adrenoleukodystrofia. Cesk Slov Neurol N 2013; 76/ 102(2): 197– 202.
16. Powers JM, DeCiero DP, Cox C, Richfield EK, Ito M,Moser AB et al. The dorsal root ganglia in adrenomyeloneuropathy: neuronal atrophy and abnormal mitochondria. J Neuropathol Exp Neurol 2001; 60(5): 493– 501.
17. Powers JM, DeCiero DP, Ito M, Moser AB, Moser HW. Adrenomyeloneuropathy: a neuropathologic review featuring its noninflammatory myelopathy. J Neuropathol Exp Neurol 2000; 59(2): 89– 102.
18. Powers JM, Pei ZT, Heinzer AK, Deering R, Moser AB, Moser HW et al. Adreno‑leukodystrophy: oxidative stress of mice and men. J Neropathol Exp Neurol 2005; 64(12): 1067– 1079.
19. Kemp S, Berger J, Aubourg P. X‑linked adrenoleukodystrophy: clinical, metabolic, genetic and pathophysiological aspects. Biochim Biophys Acta 2012; 1822(9): 1465– 1474. doi: 10.1016/ j.bbadis.2012.03.012.
20. Moser H, Dubey P, Fatemi A. Progress in X‑linked adrenoleukodystrophy. Curr Opin Neurol 2004; 17(3): 263– 269.
21. Kumar AJ, Köhler W, Kruse B, Naidu S, Bergin A, Edwin D et al. MR findings in adult onset adrenolekodystrophy. AJNR Am J Neuroradiol 1995; 16(6): 1227– 1237.
22. Barcovich AJ. Pediatric Neuroimaging, 4th Ed. Philadelphia: Lippincton Williams and Wilkins 2000.
23. Jangouk P, Zackowski KM, Naidu S, Raymond GV.Adrenoleukodystrophy in female heterozygotes: underrecognized and undertreated. Mol Genet Metab 2012; 105(2): 180– 185. doi: 10.1016/ j.ymgme.2011.11.001.
24. Moser HW, Raymond GV, Dubey P. Adrenoleukodystrophy: new approaches to a neurodegenerative disease. JAMA 2005; 294(24): 3131– 3134.
25. Kemp S, Wanders R. Biochemical aspects of X‑linked adrenoleukodystrophy. Brain Pathol 2010; 20(4): 831– 837. doi: 10.1111/ j.1750‑ 3639.2010.00391.x.
26. Chandoga J, Petrovič R, Futas J, Ďurovčíková D, Štofko J, Jančo S et al. X‑ viazaná adrenoleukodystrofia – najčastejšia dedičná metabolická porucha peroxizómov. Neurol Prax 2006; 2: 84– 89.
27. Melhem ER, Loes DJ, Georgiades CS, Raymond GV, Moser HW. X‑linked adrenoleukodystrophy: the role of contrast‑ enhanced MR imaging in predicting disease progression. AJNR Am J Neuroradiol 2000; 21(5): 839– 844.
28. Osborn AG, Salzman KL, Barkovich AJ et al. Diagnostic Imaging: Brain. 2nd ed. Salt Lake City: Amirsys Publishing 2010.
29. Loes DJ, Fatemi A, Melhem ER, Gupte N, Bezman L,Moser HW et al. Analysis of MRI patterns aids prediction of progression in X‑linked adrenoleukodystrophy. Neurology 2003; 61(3): 369– 374.
30. Seidl Z, Vaněčková M, Vítek T, Kron M, Dvořáková L, Zeman J. X‑adrenoleukodystrofie‑ hodnocení lézí mozku modalitou magnetické rezonance pomocí „Loes score“. Ces Radiol 2007; 61(3): 275– 278.
31. Moser H, Dubey P, Fatemi A. Progress in X‑linked adrenoleukodystrophy. Curr Opin Neurol 2004; 17(3): 263– 269.
32. Yang E, Prabhu SP. Imaging manifestations of the leukodystrophies, inherited disorders of white matter. Radiol Clin North Am 2014; 52(2): 279– 319. doi: 10.1016/ j.rcl.2013.11.008.
33. Kang EG, Jeon SJ, Choi SS, Song CJ, Yu IK. Diffusion MR imaging of hypoglycemic encephalopathy. AJNR Am J Neuroradiol 2010; 31(3): 559– 564. doi: 10.3174/ ajnr.A1856.
34. Baumann M, Korenke GC, Weddige‑ Diedrichs A, Wilichowski E, Hunneman DH, Wilken B et al. Haematopoietic stem cell transplantation in 12 patients with cerebral X‑linked adrenoleukodystrophy. Eur J Pediatr 2003; 162(1): 6– 14.
35. Moser HW, Raymond GV, Kohler W, Sokolowski P,Hanefeld F, Korenke GC et al. Evaluation of the preventive effect of glecerol trioleate‑ trieurcutae („Lorenzo’s oil“) therapy in X‑linked adrenoleukodystrophy: results of two concurrent trials. Adv Exp Med Biol 2003; 544: 369– 387.
36. Cartier N, Hacein‑Bey‑ Abina S, Bartholomae CC,Veres G, Schmidt M, Kutschera I et al.: Hematopoetic stem cell gene therapy with a lentiviral vector in X‑linked adrenoleukodystrophy. Science 2009; 326(5954): 818– 823. doi: 10.1126/ science.1171242.
37. Groeschel S, Dali CI, Clas P, Bohringer J, Duno M, Krarup C et al. Cerebral gray and white matter changes and clinical course in metachromatic leukodystrophy. Neurology 2012; 79(16): 1662– 1670. doi: 10.1212/ WNL.0b013e31826e9ad2.
38. Groeschel S, Kehrer C, Engel C, Dali CI, Bley A, Steinfeld R et al. Metachromatic leukodystrophy: natural course of cerebral MRI changes in relation to clinical course. J Inherit Metab Dis 2011; 34(5): 1095– 1102. doi: 10.1007/ s10545‑ 011‑ 9361‑ 1.
39. Gieselmann V, Krägeloh‑ Mann I. Metachromatic leukodystrophy. In: Raymond GV, Eichler F, Fatemi A,Naidu S (eds). Leukdystrophies. London: Mac Keith Press 2011: 130– 155.
40. Gieselmann V, Krägeloh‑ Mann I. Metachromatic Leukodystrophy – An Update. Neuropediatrics 2010; 41(1): 1– 6. doi: 10.1055/ s‑ 0030‑ 1253412.
41. Gieselmann V. Metachromatic leukodystrophy: genetics, pathogenesis and therapeutic options. Acta Paediatr Suppl 2008; 97(457): 15– 21. doi: 10.1111/ j.1651‑ 2227.2008.00648.x.
42. Kehrer C, Blumenstock G, Gieselmann V, Krägeloh‑ Mann I. German leukonet; The natural course of gross motor deterioration in metachromatic leukodystrophy. Dev Med Child Neurol 2011; 53: 850– 855. doi: 10.1111/ j.1469‑ 8749.2011.04028.x.
43. von Figura K, Gieselmann V, Jaeken J. Metachromatic leukodystrobphy. In: Scriver CR, Beaudet AL, Sly WS, Valle D (eds). The Metabolic and Molecular Bases of Inherited Disease. New York: McGraw Hill 2001: 3695– 3724.
44. Cameron CL, Kang PB, Burns TM, Darras BT, Jones HR jr. Multifocal slowing of nerve conduction in metachromatic leukodystrophy. Muscle Nerve 2004; 29(4): 531– 536.
45. Bindu PS, Mahadevan A, Taly AB, Christopher R, Gayathri N, Shankar SK. Peripheral neuropathy in metachromatic leucodystrophy. A study of 40 cases from south India. J Neurol Neurosurg Psychiatry 2005; 76(12): 1698– 1701.
46. Brown FR 3rd, Shimizu H, McDonald JM, Moser AB, Marquis P, Chen WW et al. Auditory evoked brainstem response and high‑performance liquid chromatography sulfatide assay as early indices of metachromatic leukodystrophy. Neurology 1981; 31(8): 980– 985.
47. Ries M, Deeg KH. Polyposis of the gallbladder associated with metachromatic leukodystrophy. Eur J Pediatr 1993; 152(5): 450– 451.
48. Rafi MA, Coppola S, Liu SL, Rao HZ, Wenger DA. Disease‑ causing mutations in cis with the common arylsulfatase A pseudodeficiency allele compound the difficulties in accurately identifying patients and carriers of metachromatic leukodystrophy. Mol Genet Metab 2003; 79(2): 83– 90.
49. Eichler F, Grodd W, Grant E. Sessa M, Biffi A, Bley A et al. Metachromatic leukodystrophy: a scoring system for brain MR imaging observations. Am J Neuroradiol 2009; 30(10): 1893– 1897.
50. Dali CI, Barton NW, Hanson LG, Krägeloh‑ Mann I, Groeschel S, Kraraup C et al. Outcome of Phase I/ II Trial of intravenous Enzyme Replacement with Recombinant Human Arylsulfatase A (rhASA) in Children with Metachromatic Leukodystrophy (MLD). Eur J Paediatr Neurol 2011; 15: 22.
51. Batzios SP, Zafeiriou DI. Developing treatment options for metachromatic leukodystrophy. Mol Genet Metab 2012; 105(1): 56– 63.
52. Biffi A, Aubourg P, Cartier N. Gene therapy for leukodystrophies. Hum Mol Genet 2011; 20(1): 42– 53. doi: 10.1093/ hmg/ ddr142.
53. Suzuki K. Globoid cell leukodystrophy (Krabbe’s disease): update. J Child Neurol 2003; 18(9): 595– 603.
54. Wenger DA. Krabbe disease. In: Raymond GV, Eichler F, Fatemi A, Naidu S (eds). Leukdystrophies. London: Mac Keith Press 2011: 90– 105.
55. Formichi P, Radi E, Battisti C, Pasqui A, Pompella G, Lazzerini PE et al. Psychosine‑induced apoptosis and cytokine activation in immune peripheral cells of Krabbe patients. J Cell Physiol 2007; 212(3): 737– 743.
56. Siddiqi ZA, Sanders DB, Massey JM. Peripheral neuropathy in Krabbe disease: electrodiagnostic findings. Neurology 2006; 67(2): 263– 267.
57. Lyon G, Hagberg B, Evrard P, Vanier M, Allaire C, Pavone L et al. Symptomatology of late onset Krabbe’s leukodystrophy: the European experience. Dev Neurosci 1991; 13: 240– 244.
58. Tada K, Taniike M, Ono J, Tsukamoto H, Inui K, Okada S. Serial magnetic resonance imaging studies in a case of late onset globoid cell leukodystrophy. Neuropediatrics 1992; 23(6): 306– 309.
59. Spiegel R, Bach G, Sury V, Mengistu G, Meidan B,Shalev S et al. A mutation in the saposin A coding region of the prosaposin gene in an infant presenting as Krabbe disease: first report of saposin A deficiency in humans. Mol Genet Metab 2005; 84(2): 160– 166.
60. De Gasperi R, Gama Sosa MA, Sartorato EL, Battistini S, MacFarlane H, Gusella JF et al. Molecular heterogeneity of late‑ onset forms of globoid‑ cell leukodystrophy. Am J Hum Genet 1996; 59(6): 1233– 1242.
61. Sasaki M, Sakuragawa N, Takashima S, Hanaoka S,Arima M. MRI and CT findings in Krabbe disease. Pediatr Neurol 1991; 7(4): 283– 288.
62. Loes DJ, Peters C, Krivit W. Globoid cell leukodystrophy: distinguishing early onset from late‑ onset disease using a brain MR imaging scoring method. Am J Neuroradiol 1999; 20(2): 316– 323.
63. Costello DJ, Eichler AF, Eichler FS. Leukodystrophies: classification, diagnosis, and treatment. Neurologist 2009; 15(6): 319– 328. doi: 10.1097/ NRL.0b013e3181b287c8.
64. Phelan JA, Lowe LH, Glasier CM. Pediatric neurodegenerative white matter processes: leukodystrophies and beyond. Pediatr Radiol 2008; 38(7): 729– 749. doi: 10.1007/ s00247‑ 008‑ 0817‑ x.
65. Matalon R. Canavan disease: diagnosis and molecular analysis. Genet Test 1997; 1(1): 21– 25.
66. Matalon R, Matalon KM. Canavan disease prenatal diagnosis and genetic counseling. Obstet Gynecol Clin North Am 2002; 29(2): 297– 304.
67. Matalon RM, Matalon KM. Spongy degeneration of the brain, Canavan disease: biochemical and molecular findings. Front Biosci 2000; 5: D307– D311.
68. Kimberlee M, Matalon R. Canavan disease. In: Raymond GV, Eichler F, Fatemi A, Naidu S (eds). Leukodystrophies. London: Mac Keith Press 2011: 156– 169.
69. van der Knaap MS, Barth PG, Vrensen GF, Valk J. Histopathology of an infantile‑ onset spongiform leukoencephalopathy with a discrepantly mild clinical course. Acta Neuropathol 1996; 92(2): 206– 212.
70. Fernandes J, Saudubray JM, Berghe G,Walter JH. Diagnostika a léčba dědičných metabolických poruch. 4th ed. Praha: Triton 2008.
71. Sreenivasan P, Purushothaman KK. Radiological clue to diagnosis of Canavan disease. Indian J Pediatr 2013; 80(1): 75– 77. doi: 10.1007/ s12098‑ 012‑ 0794‑ 9.
72. McAdams HP, Geyer CA, Done SL, Deigh D. CT and MR imaging of Canavan disease. Am J Neuroradiol 1990; 11(2): 397– 399.
73. Leone P, Shera D, McPhee SW, Francis JS, Kolodny EH, Bilaniuk LT et al. Long‑term follow‑up after gene therapy for Canavan disease. Sci Transl Med 2012; 4(165): 165– 173. doi: 10.1126/ scitranslmed.3003454.
74. Zano S, Malik R, Szucs S, Matalon R, Viola RE. Modification of aspartoacylase for potential use in enzyme replacement therapy for the treatment of Canavan disease. Mol Genet Metab 2011; 102(2): 176– 180. doi: 10.1016/ j.ymgme.2010.10.012.
75. Boespflug‑ Tanguy O. Inborn errors of brain myelin formation. Handb Clin Neurol 2013; 113: 1581– 1592. doi: 10.1016/ B978‑ 0‑ 444‑ 59565‑ 2.00027‑ 7.
76. Nave KA, Dhaunchak AS. Pelizaeus‑ Merzbacher disease: genetic model and mechanisms. In: Raymond GV, Eichler F, Fatemi A, Naidu S (eds). Leukodystrophies. London: Mac Keith Press 2011: 170– 187.
77. Hobson GM, Garbern JY. Pelizaeus‑ Merzbacher disease, Pelizaeus‑ Merzbacher‑like disease 1, and related hypomyelinating disorders. Semin Neurol 2012; 32(1): 62– 67. doi: 10.1055/ s‑ 0032‑ 1306388.
78. Kibe T, Miyahara J, Yokochi K, Iwaki A. A novel PLP mutation in a Japanese patient with mild Pelizaeus‑ Merzbacher disease. Brain Dev 2009; 31(3): 248– 251. doi: 10.1016/ j.braindev.2008.08.001.
79. Shy ME, Hobson G, Jain M, Boespflug‑ Tanguy O, Garbern J, Sperle K et al. Schwann cell expression of PLP1 but not DM20 is necessary to prevent neuropathy. Ann Neurol 2003; 53(3): 354– 365.
80. Seeman P, Kršek P, Naměstková K, Malíková M, Belšan T, Prošková M. Pelizaeus‑ Merzbacher’s Disease (PMD) – Detection of the most frequent mutation of the Proteolipid protein gene in Czech patients and famillies with the classical form of PMD. Cesk Slov Neurol N 2003; 66: 95– 104.
81. Caro PA, Marks HG. Magnetic resonance imaging and computed tomography in Pelizaeus‑ Merzbacher disease. Magn Reson Imaging 1990; 8(6): 791– 796.
82. Perlman SJ, Mar S. Leukodystrophies. Adv Exp Med Biol 2012; 724: 154– 171. doi: 10.1007/ 978‑ 1‑ 4614‑ 0653‑ 2_13.
83. Steenweg ME, Vanderver A, Blaser S, Bizzi A, de Koning TJ, Mancini GM et al. Magnetic resonance imaging pattern recognition in hypomyelinating disorders. Brain 2010; 133(10): 2971– 2982. doi: 10.1093/ brain/ awq257.
84. Messing A, Brenner M, Feany MB, Nedergaard M, Goldman JE. Alexander disease. J Neurosci 2012; 32(15): 5017– 5023. doi: 10.1523/ JNEUROSCI.5384‑ 11.2012.
85. Messing A, LaPash D, CM Hagemann TL. Strategies for treatment in Alexander disease. Neurotherapeutics 2010; 7(4): 507– 515. doi: 10.1016/ j.nurt.2010.05.013.
86. Li R, Johnson AB, Salomons GS, van der Knaap MS, Rodriguez D, Boespflug‑ Tanguy O et al. Propensity for paternal inheritance of de novo mutations in Alexander disease. Hum Genet 2006; 119(1– 2): 137– 144.
87. Russo LS jr, Aron A, Anderson PJ. Alexander’s disease: a report and reappraisal. Neurology 1976; 26(7): 607– 614.
88. Singh N, Bixby C, Etienne D, Tubbs RS, Loukas M. Alexander’s disease: reassessment of a neonatal form. Childs Nerv Syst 2012; 28(12): 2029– 2031. doi: 10.1007/ s00381‑ 012‑ 1868‑ 8.
89. Brenner M, Goldman JE, Quinlan R, Messing A. Alexander disease: a genetic disorder of astrocytes. In: Parpura V, Haydon P (eds). Astrocytes in Physiology of the Nervous System. New York: Springer 2009: 591– 648.
90. Flint D, Brenner M. Alexander disease. In: Raymond GV, Eichler F, Fatemi A, Naidu S (eds). Leukdystrophies. London: Mac Keith Press 2011: 106– 129.
91. Balbi P, Seri M, Ceccherini I, Uggetti C, Casale R, Fundarò C et al. Adult‑ onset Alexander disease: report on a family. J Neurol 2008; 255(1): 24– 30.
92. Howard KL, Hall DA, Moon M, Agarwal P, Newman E, Brenner M. Adult‑ onset Alexander disease with progressive ataxia and palatal tremor. Mov Disord 2008; 23(1): 118– 122.
93. Pareyson D, Fancellu R, Mariotti C, Romano S, Salmaggi A, Carella F et al. Adult‑ onset Alexander disease: a series of eleven unrelated cases with review of the literature. Brain 2008; 131(9): 2321– 2331. doi: 10.1093/ brain/ awn178.
94. Li R, Johnson AB, Salomons G, Goldman JE, Naidu S,Quinlan R et al. Glial fibrillary acidic protein mutations in infantile, juvenile, and adult forms of Alexander disease. Ann Neurol 2005; 57(3): 310– 326.
95. Wippold FJ 2nd, Perry A, Lennerz J. Neuropathology for the neuroradiologist: Rosenthal fibers. Am J Neuroradiol 2006; 27(5): 958– 961.
96. Sawaishi Y. Review of Alexander disease: beyond the classical concept of leukodystrophy. Brain Dev 2009; 31(7): 493– 498. doi: 10.1016/ j.braindev.2009.03.006.
97. Romano S, Salvetti M, Ceccherini I, De Simone T, Savoiardo M. Brainstem signs with progressing atrophy of medulla oblongata and upper cervical spinal cord. Lancet Neurol 2007; 6(6): 562– 570.
98. Huttner HB, Richter G, Hildebrandt M, Blümcke I, Fritscher T, Brück W et al. Acute onset of fatal vegetative symptoms: unusual presentation of adult Alexander disease. Eur J Neurol 2007; 14(11): 1251– 1255.
99. Schiffmann R, van der Knaap MS. Invited article: an MRI‑based approach to the diagnosis of white matter disorders. Neurology 2009; 72(8): 750– 759.
100. van der Knaap MS, Naidu S, Breiter SN, Blaser S, Stroink H, Springer S et al. Alexander disease: diagnosis with MR imaging. AJNR Am J Neuroradiol 2001; 22(3): 541– 552.
Štítky
Detská neurológia Neurochirurgia NeurológiaČlánok vyšiel v časopise
Česká a slovenská neurologie a neurochirurgie
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