Cases reported "Alexander Disease"

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1/3. Infantile alexander disease: a GFAP mutation in monozygotic twins and novel mutations in two other patients.

    alexander disease (AD) is a rare disorder of cerebral white matter due to a dysfunction of astrocytes. The most common infantile form presents as a megalencephalic leukodystrophy. Recently, heterozygous de novo mutations in the glial fibrillary acidic protein gene (GFAP) have been demonstrated to be associated with AD. We report heterozygous mutations in GFAP in 5 patients, including a pair of monozygotic twins, with clinical and neuroradiological features of infantile AD. Novel mutations were detected affecting nucleotides 304 T --> C (L97 P) and 730 G --> C (R239 P) in two other patients. None of the parents of our patients carried the mutations stressing dominant de novo mutations as the cause of AD. The presence of an identical mutation 250 G --> A (R79 H) in both monozygotic twins with infantile AD points to the origin of these GFAP mutations in germ cells or very early postzygotic stages.
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keywords = astrocyte
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2/3. Early cerebral images of alexander disease: report of one case.

    alexander disease is a neurodegenerative disorder characterized pathologically by demyelination and accumulation of eosinophilic hyaline bodies (Rosenthal fibers) within astrocytes. Demonstration of Rosenthal fibers on histological examination is considered a prerequisite for a definitive diagnosis. However, the CT and MRI scans may be highly suggestive of the disorder. We describe a patient who presented with subtle seizures at the age of 4 months. On examination, he was floppy with evident head lag. There was no visual following or social smiling. At that time, the brain MRI showed abnormal findings, with more white matter involvement and a characteristic periventricular rim. A diagnosis of alexander disease was not made until he was one year old, when a repeated MRI showed the full-blown pictures typically seen in alexander disease. The images fulfilled the diagnostic criteria proposed by van der Knaap in 2001. The early brain MRI findings in alexander disease can be very characteristic and greatly different from those in the late stage.
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keywords = astrocyte
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3/3. Rosenthal fiber encephalopathy in a dog resembling alexander disease in humans.

    A young male Bernese mountain dog presented with neurologic abnormalities consisting of nonambulatory tetraparesis, generalized tremors, and depressed mental status. At necropsy only a mild enlargement of the lateral ventricles was seen. The histologic examination revealed the presence of eosinophilic deposits consistent with Rosenthal fibers (RFs) throughout the white matter of the central nervous system. There was also a marked proliferation of abnormally large astrocytes and limited myelin changes. RFs were most prominent in perivascular, subpial, and subependymal areas, where they were perpendicularly located, producing a pallisaded arrangement. Immunohistochemically, RFs were strongly positive for glial fibrillary acidic protein (GFAP), and when they were examined ultrastructurally they appeared as electron-dense amorphous masses located within the processes of astrocytes, most particularly in the perivascular feet. The histologic and immunohistochemical findings of this canine case were consistent with the published neuropathologic descriptions of alexander disease in humans and in a few dogs, a rare condition that in humans has been shown to be caused by dominant mutations in the GFAP gene.
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keywords = astrocyte
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