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Review of Alexander disease: beyond the classical concept of leukodystrophy.
[alexander disease]
Alexander
disease
is
classified
as
one
of
the
leukodystrophies
,
which
are
degenerative
diseases
primarily
affecting
the
cerebral
white
matter
.
Formal
diagnosis
is
achieved
by
showing
diffuse
accumulation
of
Rosenthal
fibers
in
the
brain
by
biopsy
or
autopsy
.
Showing
a
heterozygous
mutation
in
the
glial
fibrillary
acidic
protein
(
GFAP
)
gene
is
currently
sufficient
for
diagnosis
.
The
mechanisms
of
Rosenthal
fiber
formation
remain
unclear
.
However
,
both
the
quality
and
quantity
of
GFAP
are
important
.
GFAP
-epsilon
(
rodent
homologous
GFAP
-delta
)
,
one
of
the
alternatively
spliced
GFAP
isoforms
,
may
also
play
a
modulating
role
in
aggregate
formation
.
The
current
ease
of
diagnosis
has
accelerated
the
accumulation
of
a
wide
variety
of
patients
with
Alexander
disease
along
with
the
widespread
use
of
MRI
.
In
contrast
to
the
classical
infantile
type
,
patients
with
juvenile
and
adult
types
mainly
complain
of
bulbar
symptoms
and
usually
show
progressive
atrophy
of
the
lower
brainstem
and
cervical
spinal
cord
with
mild
or
minimal
leukodystrophic
changes
.
Among
the
many
MRI
findings
of
Alexander
disease
,
periventricular
linear
lesions
with
various
names
depending
on
the
thickness
and
shape
seem
to
represent
the
unique
pathophysiology
,
because
the
subventricular
zone
of
the
adult
human
brain
includes
special
astrocytes
that
behave
as
multipotent
progenitor
cells
and
specifically
produce
GFAP
-epsilon
.
Except
for
a
few
mutations
,
no
clear
phenotype-genotype
correlation
has
been
established
for
Alexander
disease
,
although
male
preponderance
in
the
infantile
type
suggests
that
phenotypes
may
be
partly
affected
by
gender
.
Diseases
Validation
Diseases presenting
"fibrillary acidic protein"
symptom
alexander disease
canavan disease
erdheim-chester disease
hirschsprung disease
hydrocephalus with stenosis of the aqueduct of sylvius
von hippel-lindau disease
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