RESUMO
Neuropathology and neuroimaging of long-term survival cases of arginase deficiency are rarely reported. The magnetic resonance imaging (MRI) of our case showed severe multicystic white matter lesions with cortical atrophy, which were more severe compared with previous reports. In this patient, low-protein diet successfully reduced hyperammonemia, but hyperargininemia persisted. These severe neurological and MRI findings may be explained by a compound heterozygote, inheriting both of severe mutant alleles from her parents.
Assuntos
Hiperargininemia/genética , Hiperargininemia/patologia , Imageamento por Ressonância Magnética/métodos , Mutação , Fibras Nervosas Mielinizadas/patologia , Adulto , Atrofia/patologia , Encéfalo/patologia , Proteínas Alimentares/efeitos adversos , Feminino , Humanos , Hiperamonemia/sangue , Hiperamonemia/dietoterapia , Hiperamonemia/patologia , Hiperamonemia/fisiopatologia , Hiperargininemia/sangue , Hiperargininemia/fisiopatologiaRESUMO
We report a rare case of facial features of holoprosencephaly associated with hydranencephaly, with a de novo proximal interstitial deletion of the long arm of chromosome 14, specifically, del(14)(q13q21). She was born at 37 weeks of gestation and transferred to our institution at 3 years of age. The patient had midline facial anomalies consisting of cleft palate, defective nasal septum, and hypotelorism, together with endocrine abnormalities such as diabetes insipidus and hypothyroidism. Cranial computed tomography revealed the near-total loss of all cerebral tissue, with a frontal part of the cerebral falx lacking. None of the few reports of holoprosencephaly with 14q- chromosomal abnormality describe holoprosencephaly in association with hydranencephaly. The partial deletion of chromosome 14, del(14)(q13q21), may underlie the association of facial features of holoprosencephaly and hydranencephaly.