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Diagnosis by whole exome sequencing of atypical infantile onset Alexander disease masquerading as a mitochondrial disorder.
[alexander disease]
There
are
many
similarities
,
both
clinical
and
radiological
,
between
mitochondrial
leukoencephalopathies
and
Alexander
disease
,
an
astrogliopathy
.
Clinically
,
both
can
manifest
with
a
myriad
of
symptoms
and
signs
,
arising
from
the
neonatal
period
to
adulthood
.
Radiologically
,
both
can
demonstrate
white
matter
changes
,
signal
abnormalities
of
basal
ganglia
or
thalami
,
brainstem
abnormalities
and
contrast
enhancement
of
white
matter
structures
.
Magnetic
resonance
spectroscopy
may
reveal
elevation
of
lactate
in
the
abnormal
white
matter
in
Alexander
disease
making
the
distinction
even
more
challenging
.
We
present
a
child
who
was
considered
to
have
an
infantile
onset
mitochondrial
disorder
due
to
a
combination
of
neurological
symptoms
and
signs
(
developmental
regression
,
failure
to
thrive
,
episodic
deterioration
,
abnormal
eye
movements
,
pyramidal
and
cerebellar
signs
)
,
urinary
excretion
of
3
-
methyl-glutaconic
acid
and
imaging
findings
(
extensive
white
matter
changes
and
cerebellar
atrophy
)
with
a
normal
head
circumference
.
Whole
exome
sequence
analysis
was
performed
.
The
child
was
found
to
harbor
the
R
416
W
mutation
,
one
of
the
most
prevalent
mutations
in
the
glial
fibrillary
acidic
protein
(
GFAP
)
gene
that
causes
Alexander
disease
.
Alexander
disease
should
be
considered
in
the
differential
diagnosis
of
infantile
leukoencephalopathy
,
even
when
no
macrocephaly
is
present
.
Next
generation
sequencing
is
a
useful
aid
in
unraveling
the
molecular
etiology
of
leukoencephalopathies
.
Diseases
Validation
Diseases presenting
"failure to thrive"
symptom
22q11.2 deletion syndrome
alexander disease
child syndrome
congenital diaphragmatic hernia
cystinuria
familial hypocalciuric hypercalcemia
hirschsprung disease
homocystinuria without methylmalonic aciduria
junctional epidermolysis bullosa
kabuki syndrome
kindler syndrome
krabbe disease
neonatal adrenoleukodystrophy
omenn syndrome
papillon-lefèvre syndrome
pyruvate dehydrogenase deficiency
triple a syndrome
wolf-hirschhorn syndrome
zellweger syndrome
This symptom has already been validated