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|Year : 2022 | Volume
| Issue : 2 | Page : 820-821
Neuroimaging in 3-methyl-crotonylglycinuria
Poornima Nambiar1, S Vinayagamani2, Soumya Sundaram3
1 Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
2 Department of Imaging Sciences and Intervention Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
3 Pediatric Neurology and Neurodevelopmental Disorders, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
|Date of Submission||09-Jul-2019|
|Date of Decision||17-Jul-2019|
|Date of Acceptance||06-Aug-2020|
|Date of Web Publication||3-May-2022|
Dt. Soumya Sundaram
Pediatric Neurology and Neurodevelopmental Disorders, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Nambiar P, Vinayagamani S, Sundaram S. Neuroimaging in 3-methyl-crotonylglycinuria. Neurol India 2022;70:820-1
Two-year-old boy, born of second-degree consanguinity, had an uncomplicated birth and had achieved normal developmental milestones till 1½ years of age. He then presented with recurrent vomiting and altered sensorium followed by psychomotor regression and seizures without any obvious precipitating event. He was lethargic and had axial hypotonia with appendicular spasticity. His MRI brain showed T2W and FLAIR hyperintensities involving bilateral lentiform and caudate nuclei, and subcortical white matter [Figure 1]. Based on clinical and imaging findings, the differential diagnosis considered were Leigh disease, urea cycle defects, and organic acidemias. His urine spectrometric analysis revealed elevated 3-hydroxyisovaleric acid (22.45, cut off 6.10 mmol/mmol creatine) and 3-methyl-crotonylglycine (84.25, cut off 1.05 mmol/mmol creatine). The dried blood spot analysis showed high leucine/isoleucine (286.01, normal range 44–220 mmol/L) and 3-hydroxy-isovalerylcarnitine (28.31, normal range 0.03–0.65 mmol/L) levels, consistent with the diagnosis of 3-methyl-crotonylglycinuria (MCG).
|Figure 1: MRI brain in 3-methyl-crotonylglycinuria. Axial T2 weighted MRI shows (a) Bilateral symmetrical lentiform and caudate nucleus hyperintensity with sparing of thalamus (b and c) Confluent and patchy subcortical white mater hyperintensity involving frontal and parieto occipital regions, with sparing of periventricular white mater (d) FLAIR image shows white mater and deep gray nuclei hyperintensity|
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MCG is an autosomal recessive disorder of leucine metabolism due to methyl-crotonyl CoA carboxylase deficiency. This disorder has variable clinical manifestations ranging from asymptomatic to acute metabolic decompensation (precipitated by infection or high protein diet). Literature on the neuroimaging characteristics of MCG is limited. However, a few case reports of the late onset forms of MCG have shown T2W and FLAIR hyperintensities involving bilateral basal ganglia, brainstem or subcortical white mater in the acute phase, and gray and white matter atrophy with subdural hematomas on follow-up. Children with onset during the early infantile period were reported to have leukodystrophic changes with poorer prognosis.
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