Pantothenate Kinase-Associated Neurodegeneration – a Case Report
Authors:
D. Petrleničová 1; K. Gmitterová 1; I. Uhrín 2; J. Benetin 3; P. Valkovič 1,4
Authors place of work:
II. Neurologická klinika LF UK a UN Bratislava
1; Pracovisko magnetickej rezonancie, Medicína Nové Zámky, s. r. o.
2; Neurologická klinika SZU a UN Bratislava
3; Ústav normálnej a patologickej fyziológie SAV, Bratislava
4
Published in the journal:
Cesk Slov Neurol N 2011; 74/107(2): 201-204
Category:
Case Report
Summary
Pantothenate kinase-associated neurodegeneration is a rare autosomal-recessive hereditary disorder that is characterized by accumulation of brain iron. PKAN has a diverse phenotypic expression with childhood or adult onset. It manifests typically with speech disturbances and combinations of motor symptoms such as dystonia, parkinsonism, corticospinal tract and//or retinopathy. This disorder is also associated with neurobehavioural changes. We present a case of a 25-year-old man with a speech defect and anxiety that proceeded to progressive tremor and clumsiness of the left upper extremity. Physical examination revealed signs of extrapyramidal dysfunction and corticospinal tract involvement. T2-weighted brain MRI images disclosed focal changes in the globus pallidus typical of PKAN in (“eye of the tiger sign”). Molecular genetic analysis confirmed the homozygous mutation in the gene for pantothenate-kinase 2 (PANK2). Detailed clinical examination associated with cranial imaging techniques results in appropriate genetic analysis.
Key words:
neurodegeneration – pantothenate-kinase – brain iron accumulation
Zdroje
1. Pearce JMS. Neurodegeneration with Brain Iron Accumulation: A cautionary tale. Eur Neurol 2006; 56(1): 66–68
2. Gregory A, Polster BJ, Hayflick SJ. Clinical and genetic delineation of neurodegeneration with brain iron accumulation. J Med Genet 2009; 46(2): 73–80.
3. Hayflick SJ. Unraveling the Hallervorden-Spatz syndrome: pantothenate kinase-associated neurodegeneration is the name. Curr Opin Pediatr 2003; 15(6): 572–577.
4. Schneider SA, Hardy J, Bhatia KP. Iron accumulation in syndromes of neurodegeneration with brain 1 and 2: causative or consequential? J Neurol Neurosurg Psychiatry 2009; 80(6): 589–590.
5. Gregory A, Hayflick SJ. Neurodegeneration with brain iron accumulation. Folia Neuropathol 2005; 43(4): 286–296.
6. Sachin S, Goyal V, Shukla G, Sharma MC, Gaikwed S, Behari M. Clinical spectrum of Hallervorden-Spatz syndrome in India. J Clin Neurosci 2009; 16(2): 253–258.
7. Oner O, Oner P, Deda G, Içağasioğlu D. Psychotic disorder in a case with Hallervorden-Spatz disease. Acta Psychiatr Scand 2003; 108(5): 394–398.
8. Middleton FA, Strick PL. Basal ganglia and cerebellar loops: motor and cognitive circuits. Brain Res Rev 2000; 31(2–3): 236–250.
9. Sunwoo YK, Lee JS, Kim WH, Shin YB, Lee MJ, Cho IH et al. Psychiatric disorder in two siblings with Hallervorden-Spatz disease. Psychiatry Invest 2009; 6(3): 226–229.
10. Zhou B, Westaway SK, Levinson B, Johnson MA, Gitschier J, Hayflick SJ. A novel pantothenate kinase gene (PANK2) is defective in Hallervorden-Spatz syndrome. Nat Genet 2001; 28(4): 345–349.
11. Koeppen AH, Dickson AC. Iron in the Hallervorden-Spatz syndrome. Pediatr Neurol 2001; 25(2): 148–155.
12. Hayflick SJ, Westaway SK, Levinson B, Zhou B, Johnson MA, Ching KH et al. Genetic, clinical and radiographic delineation of Hallervorden-Spatz syndrome. N Engl J Med 2003; 348(1): 33–40.
13. Egan RA, Weleber RG, Hogarth P, Gregory A, Coryell J, Westaway SK, et al. Neuro-ophtalmologic and electroretinographic findings in pantothenate kinase associated neurodegeneration (formerly Hallervorden-Spatz syndrome). Am J Ophthalmol 2005; 140(2): 267–274.
14. Guillerman RP. The eye-of-the-tiger sign. Radiology 2000; 217(3): 895–896.
15. McNeill A, Birchall D, Hayflick SJ, Gregory A, Schenk JF, Zimmerman EA et al. T2 and FSE MRI distinguishes four subtypes of neurodegeneration with brain iron accumulation. Neurology 2008; 70(18): 1614–1619.
16. Klempíř J, Mikulenková D, Písačka M, Klempířová O. Diferenciální diagnostika neuroakantocytóz. Cesk Slov Neurol N 2009; 72/105(1): 24–29.
17. Gregory A, Hayflick SJ. Pantothenate Kinase-Associated Neurodegeneration. In: Pagon RA, Bird TC, Dolan CR, Stephens K (eds). GeneReviews. Seattle (WA): University of Washington, Seattle 1993–2002.
18. Seo HJ, Song SK, Lee PH. A Novel PANK2 Mutation in a Patient with Atypical Pantothenate-Kinase-Associated Neurodegeneration Presenting with Adult-Onset Parkinsonism. J Clin Neurol 2009; 5(4): 192–194.
19. Justesen CR, Penn RD, Kroin JS, Egel RT. Stereotactic pallidotomy in a child with Hallervorden-Spatz disease. J Neurosurg 1999; 90(3): 551–554.
20. Balas I, Kovacs N, Hollody K. Staged bilateral stereotactic pallidothalamotomy for life-threatening dystonia in a child with Hallervorden-Spatz disease. Mov Disord 2006; 21(1): 82–85.
21. Timmermann L, Pauls KA, Wieland K, Jech R, Kurlemann G, Sharma N et al. Dystonia in neurodegeneration with brain iron accumulation: outcome of bilateral pallidal stimulation. Brain 2010; 133(3): 701–712.
Štítky
Paediatric neurology Neurosurgery NeurologyČlánok vyšiel v časopise
Czech and Slovak Neurology and Neurosurgery
2011 Číslo 2
- Memantine Eases Daily Life for Patients and Caregivers
- Metamizole at a Glance and in Practice – Effective Non-Opioid Analgesic for All Ages
- Advances in the Treatment of Myasthenia Gravis on the Horizon
- Metamizole vs. Tramadol in Postoperative Analgesia
Najčítanejšie v tomto čísle
- Restless Legs Syndrome
- Treatment of Peroneal Nerve Injury by Operation
- Sudden Dyspnoea as a First Symptom Leading to a Diagnosis of Amyotrophic Lateral Sclerosis – a Case Report
- Invasive Fungal Sinusitis