1/16. The site of the hearing loss in Refsum's disease.Refsum's disease is a disorder of lipid metabolism with pigmentary retinopathy, demyelinating neuropathy, ataxia, and hearing loss. Previous histological studies have located the site of hearing impairment in the inner ear, but it has never been confirmed audiologicaly in the literature. In this reported case of Refsum's disease, despite hearing loss and absence of response in ABR, robust otoacoustic emissions were measured. Together with these and other audiological findings, we conclude that our case might be the first reported case of Refsum's disease with auditory neuropathy. The site of the hearing abnormality in Refsum's disease may be 'post-outer hair cells' in some cases as in the current case. Because of their limited benefits and risk of noise-induced damage to outer hair cells, the use of hearing aids before otoacoustic emission measurements should be considered cautiously in Refsum's disease.- - - - - - - - - - ranking = 1keywords = neuropathy (Clic here for more details about this article) |
2/16. Refsum's disease may mimic familial Guillain Barre syndrome.Refsum's disease is a rare autosomal recessive disorder with clinical features including retinitis pigmentosa, anosmia, deafness, chronic sensory-motor neuropathy, ataxia and the accumulation of phytanic acid in blood plasma and body tissues. We report the occurrence of Refsum's disease in two sisters, both presenting with acute demyelinating polyneuropathy mimicking the familial Guillain Barre syndrome. Thus, when GBS is suspected, particularly in cases of familial recurrence as well as in atypical cases of acute polyneuropathy, the diagnosis of Refsum's disease should be considered, looking for other features of the disease and, if appropriate, testing plasma phytanic acid levels.- - - - - - - - - - ranking = 1.5keywords = neuropathy (Clic here for more details about this article) |
3/16. plasma exchange in the treatment of Refsum's disease (heredopathia atactica polyneuritiformis).Five cases of heredopathia atactica polyneuritiformis (HAP--Refsum's disease) were treated by serial plasma exchanges. In all patients a reduction in calorie intake and body weight had been associated with a rise in plasma phytanic acid, followed by an exacerbation of the ataxia and neuropathy. Lowering the plasma phytanic acid by plasma exchange produced a rapid clinical improvement. The main indication for plasma exchange in HAP is a severe or rapidly worsening clinical condition. A lesser indication is failure of dietary management to reduce a high plasma phytanic acid level.- - - - - - - - - - ranking = 0.5keywords = neuropathy (Clic here for more details about this article) |
4/16. Heredopathia atactica polyneuritiformis (Refsum's disease).A female patient started to develop deafness and vertigo at the age of 29. In the following years she became atactic and retinitis pigmentosa was discovered. The diagnosis of Refsum's disease was reached on the grounds of the high concentration of phytanic acid in plasma. The patient died 23 years after onset of the first symptoms. Liver, spleen and kidney showed lipofuscinosis and pigment-laden macrophages. The retina was atrophic and its pigment discontinuous. The meninges contained lipid-laden macrophages. The nerve cells in brain and spinal cord as well as the astrocytes and perivascular macrophages stored substances weakly PAS-positive and sudanophilic. The nerve cells accumulated lysosomes and residual bodies. In the astrocytes, the residual bodies were extremely polymorphous and contained inclusions with bilamellar ribbon-like structures. In the oligodendroglia the residual bodies displayed high electron density and finger print-like pattern. peroxisomes were found in glial cells and microperoximes in neurons. The ultrastructural findings in the present case demonstrate that in terminal stages phytanic acid can reach the brain parenchyma passing through the BBB. Further autopsy studies will be necessary to determine whether these changes are consistent findings in Refsum's disease.- - - - - - - - - - ranking = 0.17614958783257keywords = nerve (Clic here for more details about this article) |
5/16. Heredopathia atactica polyneuritiformis: Refsum's disease.Seven patients with Heredopathia Atactica Polyneuritiformis are described. There were 3 groups of clinical characteristics: first, congenital abnormalities such as skeletal deformities, unrelated to phytanic acid levels; second, signs and symptoms such as retinitis pigmentosa which come on slowly and are not directly related to the plasma phytanic acid level; third, lesions such as the neuropathy, rash and cardiac arrhythmias which can change quickly and are linked to the plasma phytanic acid level. Exacerbations of the signs in the third group are precipitated by a low calorie intake and mobilisation of phytanic acid from the adipose tissue. Poor vision is due not only to retinitis but also to small pupils which fail to dilate in the dark. The use of plasma exchange is discussed. With good dietary supervision it is possible to produce a considerable clinical recovery for the neuropathy.- - - - - - - - - - ranking = 1keywords = neuropathy (Clic here for more details about this article) |
6/16. Infantile Refsum's disease: a generalized peroxisomal disorder. Case report with postmortem examination.Infantile Refsum's disease (IRD) is a peroxisomal deficiency disease which is closely related to neonatal adrenoleukodystrophy (NALD) and the zellweger syndrome (ZS). Recent observations suggest that NALD and ZS are separate genetic disorders but the delimitation towards IRD remains uncertain. We present here the first autopsy report of a patient who was clinically and biochemically diagnosed as having IRD, and we compare the findings with those from NALD and ZS. The main gross and microscopic findings comprised micronodular liver cirrhosis, small hypoplastic adrenals without degenerative changes, and large groups of lipid macrophages in liver, lymph nodes and certain areas of the cerebral white matter. The brain showed no malformations except for a severe hypoplasia of the cerebellar granule layer and ectopic location of the purkinje cells in the molecular layer. A mild and diffuse reduction of axons and myelin was found in the corpus callosum and periventricular white matter, the corticospinal tracts, and the optic nerves. Large numbers of perivascular macrophages were present in the same areas but there was no active demyelination. The retina and cochlea showed severe degenerative changes. peripheral nerves, skeletal system and kidneys were normal. Electron microscopy showed characteristic cytoplasmic inclusions with bilamellar profiles in macrophages in the liver, lymph nodes and brain but not in the adrenals. Similar inclusions were found in liver cells and astrocytes. The findings differ from ZS which shows cortical renal cysts, skeletal changes, liver changes, cerebral micropolygyria, neuronal heterotopias, and demyelination of the white matter. Cases with NALD show mild cerebral malformations, active demyelination, degenerative changes of the adrenals, liver changes, and bilamellar electromicroscopic inclusions in macrophages. Our cases thus resembled NALD but lacked active demyelination, cerebral cortical malformations and adrenal degenerative changes. Further autopsy studies will be necessary to determine whether these changes are consistent findings in IRD.- - - - - - - - - - ranking = 0.17614958783257keywords = nerve (Clic here for more details about this article) |
7/16. The effect of prednisolone in Refsum's disease.A 16 year old schoolgirl with an established peripheral neuropath (motor conduction velocity in peroneal nerve of 5 metres/sec., absent sural nerve potential and CSF protein of 160 mg%) presented with a progressive worsening to the point of physical incapacitation over the course of 23 days. serum phytanic acid was 33 mg/100 ml. Following the exhibition of prednisolone she was discharged walking well after 5 days. After 3 weeks the steroid medication was stopped and a phytanic acid free diet instituted. Despite continued abnormal electrophysiological findings, (e.g. motor conduction velocity in peroneal nerve 3 metres/sec., and in ulnar nerve 8 metres/sec), she remains well three years later. It is probable that the steroid medication had a pronounced beneficial effect, though the mechanism of action remains unexplained.- - - - - - - - - - ranking = 0.35229917566513keywords = nerve (Clic here for more details about this article) |
8/16. Atypical phenotype of Refsum's disease: clinical, biochemical, neurophysiological and pathological study.The authors describe the clinical, biochemical, electrophysiological and ultrastructural study of a case of Refsum's disease whose phenotype suggested other hereditary ataxias. Due to the presence of Babinski sign and optic atrophy and the absence of retinitis pigmentosa, this case can be considered atypical. Electrophysiological and ultrastructural findings confirm the variability of peripheral lesions in this hereditary polyneuropathy.- - - - - - - - - - ranking = 0.5keywords = neuropathy (Clic here for more details about this article) |
9/16. Refsum's disease: management by diet and plasmapheresis.A case of Refsum's disease treated by serial plasma exchanges together with a moderate low phytanate diet is reported. Serial plasma exchanges determined a rapid significant clinical improvement (neuropathy and cerebellar ataxia) that allowed immediate return to full-time employment. The initial improvement could be maintained by intermittent serial plasmapheresis despite partial failure of the initially introduced low phytanate diet bringing 20 mg phytanic acid daily. A new dietary regimen bringing 10 mg phytanic acid was later introduced that was well tolerated. No liquid formula was used. The clinical improvement was clearly correlated to a fall in serum phytanic acid from 45.3 to 16.2 mg/100 ml.- - - - - - - - - - ranking = 0.5keywords = neuropathy (Clic here for more details about this article) |
10/16. Rud syndrome: congenital ichthyosis, hypogonadism, mental retardation, retinitis pigmentosa and hypertrophic polyneuropathy.Rud syndrome consists in the association of oligophrenia and hypogonadism with congenital ichthyosis; in the majority of cases, epilepsy, short stature or delayed in growth are also found. We described a child with such a syndrome. In addition to the classical findings, the patient had retinitis pigmentosa and hypertrophic polyneuropathy. Histological studies, including ultrastructural findings of a sural nerve biopsy, showed signs of a chronic demyelinative neuropathy with onion bulb formation. The world literature was reviewed and only nine other cases fulfilled our criteria for inclusion in Rud syndrome. This case represents the one with the most extensive neurological involvement ever reported.- - - - - - - - - - ranking = 3.0880747939163keywords = neuropathy, nerve (Clic here for more details about this article) |
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