Skip to main content

Advertisement

Log in

Posterior fossa involvement in the diagnosis of adult-onset inherited leukoencephalopathies

  • Review
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

Adult-onset genetic leukoencephalopathies are increasingly recognized. They are heterogeneous groups of disorders that commonly have distinct pathologic mechanisms but they share the presence of supratentorial bilateral and symmetric white matter hyperintensities. Although these abnormalities are usually non-specific, some specific MRI findings exist and sometimes help to distinguish these disorders. In this review, our aim is to describe posterior fossa abnormalities seen in the main adult-onset genetic leukoencephalopathies enabling clinicians to perform oriented genetic/metabolic screening.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Bonkowsky JL, Nelson C, Kingston JL, Filloux FM, Mundorff MB, Srivastava R (2010) The burden of inherited leukodystrophies in children. Neurology 75(8):718–725

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Ayrignac X, Carra-Dalliere C, Menjot de Champfleur N, Denier C, Aubourg P, Bellesme C et al (2015) Adult-onset genetic leukoencephalopathies: a MRI pattern-based approach in a comprehensive study of 154 patients. Brain J Neurol 138(Pt 2):284–292

    Article  Google Scholar 

  3. Verdura E, Hervé D, Scharrer E, Amador MDM, Guyant-Maréchal L, Philippi A et al (2015) Heterozygous HTRA1 mutations are associated with autosomal dominant cerebral small vessel disease. Brain J Neurol 138(Pt 8):2347–2358

    Article  Google Scholar 

  4. Lynch DS, Jaunmuktane Z, Sheerin UM, Phadke R, Brandner S, Milonas I, et al. (2015 ) Hereditary leukoencephalopathy with axonal spheroids: a spectrum of phenotypes from CNS vasculitis to parkinsonism in an adult onset leukodystrophy series. J Neurol Neurosurg Psychiatry jnnp-2015-310788. doi:10.1136/jnnp-2015-310788

  5. Ahmed RM, Murphy E, Davagnanam I, Parton M, Schott JM, Mummery CJ et al (2014) A practical approach to diagnosing adult onset leukodystrophies. J Neurol Neurosurg Psychiatry 85(7):770–781

    Article  CAS  PubMed  Google Scholar 

  6. Labauge P, Carra-Dalliere C, de Champfleur NM, Ayrignac X, Boespflug-Tanguy O (2014) MRI pattern approach of adult-onset inherited leukoencephalopathies. Neurol Clin Pract. 4(4):287–295

    Article  Google Scholar 

  7. Chabriat H, Levy C, Taillia H, Iba-Zizen MT, Vahedi K, Joutel A et al (1998) Patterns of MRI lesions in CADASIL. Neurology 51(2):452–457

    Article  CAS  PubMed  Google Scholar 

  8. van den Boom R, Lesnik Oberstein SAJ, Ferrari MD, Haan J, van Buchem MA (2003) Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy: MR imaging findings at different ages—3rd–6th decades. Radiology 229(3):683–690

    Article  PubMed  Google Scholar 

  9. Chabriat H, Mrissa R, Levy C, Vahedi K, Taillia H, Iba-Zizen MT et al (1999) Brain stem MRI signal abnormalities in CADASIL. Stroke J Cereb Circ 30(2):457–459

    Article  CAS  Google Scholar 

  10. Liem MK, Lesnik Oberstein SAJ, Haan J, van der Neut IL, van den Boom R, Ferrari MD et al (2008) Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy: progression of MR abnormalities in prospective 7-year follow-up study. Radiology 249(3):964–971

    Article  PubMed  Google Scholar 

  11. Viswanathan A, Guichard J-P, Gschwendtner A, Buffon F, Cumurcuic R, Boutron C et al (2006) Blood pressure and haemoglobin A1c are associated with microhaemorrhage in CADASIL: a two-centre cohort study. Brain J Neurol 129(Pt 9):2375–2383

    Article  Google Scholar 

  12. Singhal S, Rich P, Markus HS (2005) The spatial distribution of MR imaging abnormalities in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy and their relationship to age and clinical features. AJNR Am J Neuroradiol 26(10):2481–2487

    PubMed  Google Scholar 

  13. Lanfranconi S, Markus HS (2010) COL4A1 mutations as a monogenic cause of cerebral small vessel disease: a systematic review. Stroke J Cereb Circ. 41(8):e513–e518

    Article  Google Scholar 

  14. Shah S, Ellard S, Kneen R, Lim M, Osborne N, Rankin J et al (2012) Childhood presentation of COL4A1 mutations. Dev Med Child Neurol 54(6):569–574

    Article  PubMed  Google Scholar 

  15. Vahedi K, Boukobza M, Massin P, Gould DB, Tournier-Lasserve E, Bousser M-G (2007) Clinical and brain MRI follow-up study of a family with COL4A1 mutation. Neurology 69(16):1564–1568

    Article  CAS  PubMed  Google Scholar 

  16. Alamowitch S, Plaisier E, Favrole P, Prost C, Chen Z, Van Agtmael T et al (2009) Cerebrovascular disease related to COL4A1 mutations in HANAC syndrome. Neurology 73(22):1873–1882

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Vahedi K, Alamowitch S (2011) Clinical spectrum of type IV collagen (COL4A1) mutations: a novel genetic multisystem disease. Curr Opin Neurol 24(1):63–68

    Article  CAS  PubMed  Google Scholar 

  18. De Stefano N, Dotti MT, Mortilla M, Federico A (2001) Magnetic resonance imaging and spectroscopic changes in brains of patients with cerebrotendinous xanthomatosis. Brain J Neurol 124(Pt 1):121–131

    Article  Google Scholar 

  19. Barkhof F, Verrips A, Wesseling P, van Der Knaap MS, van Engelen BG, Gabreëls FJ et al (2000) Cerebrotendinous xanthomatosis: the spectrum of imaging findings and the correlation with neuropathologic findings. Radiology 217(3):869–876

    Article  CAS  PubMed  Google Scholar 

  20. Androdias G, Vukusic S, Gignoux L, Boespflug-Tanguy O, Acquaviva C, Zabot M-T et al (2012) Leukodystrophy with a cerebellar cystic aspect and intracranial atherosclerosis: an atypical presentation of cerebrotendinous xanthomatosis. J Neurol 259(2):364–366

    Article  PubMed  Google Scholar 

  21. Loes DJ, Fatemi A, Melhem ER, Gupte N, Bezman L, Moser HW et al (2003) Analysis of MRI patterns aids prediction of progression in X-linked adrenoleukodystrophy. Neurology 61(3):369–374

    Article  CAS  PubMed  Google Scholar 

  22. Elenein RA, Naik S, Kim S, Punia V, Jin K (2013) Teaching neuroimages: cerebral adrenoleukodystrophy: a rare adult form. Neurology 80(6):e69–e70

    Article  PubMed  Google Scholar 

  23. Suda S, Komaba Y, Kumagai T, Yamazaki M, Katsumata T, Kamiya T et al (2006) Progression of the olivopontocerebellar form of adrenoleukodystrophy as shown by MRI. Neurology 66(1):144–145

    Article  CAS  PubMed  Google Scholar 

  24. Kusaka H, Imai T (1992) Ataxic variant of adrenoleukodystrophy: MRI and CT findings. J Neurol 239(6):307–310

    Article  CAS  PubMed  Google Scholar 

  25. Debs R, Froissart R, Aubourg P, Papeix C, Douillard C, Degos B et al (2013) Krabbe disease in adults: phenotypic and genotypic update from a series of 11 cases and a review. J Inherit Metab Dis 36(5):859–868

    Article  PubMed  Google Scholar 

  26. Eichler F, Grodd W, Grant E, Sessa M, Biffi A, Bley A et al (2009) Metachromatic leukodystrophy: a scoring system for brain MR imaging observations. AJNR Am J Neuroradiol 30(10):1893–1897

    Article  CAS  PubMed  Google Scholar 

  27. Steenweg ME, Salomons GS, Yapici Z, Uziel G, Scalais E, Zafeiriou DI et al (2009) L-2-Hydroxyglutaric aciduria: pattern of MR imaging abnormalities in 56 patients. Radiology 251(3):856–865

    Article  PubMed  Google Scholar 

  28. van der Knaap MS, Kamphorst W, Barth PG, Kraaijeveld CL, Gut E, Valk J (1998) Phenotypic variation in leukoencephalopathy with vanishing white matter. Neurology 51(2):540–547

    Article  PubMed  Google Scholar 

  29. van der Knaap MS, Leegwater PAJ, van Berkel CGM, Brenner C, Storey E, Di Rocco M et al (2004) Arg113His mutation in eIF2Bepsilon as cause of leukoencephalopathy in adults. Neurology 62(9):1598–1600

    Article  PubMed  Google Scholar 

  30. Carra-Dalliere C, Scherer C, Ayrignac X, Menjot de Champfleur N, Bellesme C, Labauge P et al (2013) Adult-onset cerebral X-linked adrenoleukodystrophy with major contrast-enhancement mimicking acquired disease. Clin Neurol Neurosurg 115(9):1906–1907

    Article  PubMed  Google Scholar 

  31. van der Knaap MS, Pronk JC, Scheper GC (2006) Vanishing white matter disease. Lancet Neurol 5(5):413–423

    Article  PubMed  Google Scholar 

  32. Labauge P, Horzinski L, Ayrignac X, Blanc P, Vukusic S, Rodriguez D et al (2009) Natural history of adult-onset eIF2B-related disorders: a multi-centric survey of 16 cases. Brain J Neurol 132(Pt 8):2161–2169

    Article  Google Scholar 

  33. Finnsson J, Sundblom J, Dahl N, Melberg A, Raininko R (2015) LMNB1-related autosomal-dominant leukodystrophy: clinical and radiological course. Ann Neurol 78(3):412–425

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Melberg A, Hallberg L, Kalimo H, Raininko R (2006) MR characteristics and neuropathology in adult-onset autosomal dominant leukodystrophy with autonomic symptoms. AJNR Am J Neuroradiol 27(4):904–911

    CAS  PubMed  Google Scholar 

  35. Brussino A, Vaula G, Cagnoli C, Panza E, Seri M, Di Gregorio E et al (2010) A family with autosomal dominant leukodystrophy linked to 5q23.2-q23.3 without lamin B1 mutations. Eur J Neurol 17(4):541–549

    Article  CAS  PubMed  Google Scholar 

  36. Tzoulis C, Tran GT, Gjerde IO, Aasly J, Neckelmann G, Rydland J et al (2012) Leukoencephalopathy with brainstem and spinal cord involvement caused by a novel mutation in the DARS2 gene. J Neurol 259(2):292–296

    Article  PubMed  Google Scholar 

  37. Labauge P, Dorboz I, Eymard-Pierre E, Dereeper O, Boespflug-Tanguy O (2011) Clinically asymptomatic adult patient with extensive LBSL MRI pattern and DARS2 mutations. J Neurol 258(2):335–337

    Article  PubMed  Google Scholar 

  38. Dallabona C, Diodato D, Kevelam SH, Haack TB, Wong L-J, Salomons GS et al (2014) Novel (ovario) leukodystrophy related to AARS2 mutations. Neurology 82(23):2063–2071

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Farina L, Pareyson D, Minati L, Ceccherini I, Chiapparini L, Romano S et al (2008) Can MR imaging diagnose adult-onset Alexander disease? AJNR Am J Neuroradiol 29(6):1190–1196

    Article  CAS  PubMed  Google Scholar 

  40. Graff-Radford J, Schwartz K, Gavrilova RH, Lachance DH, Kumar N (2014) Neuroimaging and clinical features in type II (late-onset) Alexander disease. Neurology 82(1):49–56

    Article  PubMed  PubMed Central  Google Scholar 

  41. Namekawa M, Takiyama Y, Honda J, Shimazaki H, Sakoe K, Nakano I (2010) Adult-onset Alexander disease with typical « tadpole » brainstem atrophy and unusual bilateral basal ganglia involvement: a case report and review of the literature. BMC Neurol 10:21

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Mochel F, Schiffmann R, Steenweg ME, Akman HO, Wallace M, Sedel F et al (2012) Adult polyglucosan body disease: natural history and key magnetic resonance imaging findings. Ann Neurol 72(3):433–441

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Hellmann MA, Kakhlon O, Landau EH, Sadeh M, Giladi N, Schlesinger I et al (2015) Frequent misdiagnosis of adult polyglucosan body disease. J Neurol 262(10):2346–2351

    Article  PubMed  Google Scholar 

  44. Brunberg JA, Jacquemont S, Hagerman RJ, Berry-Kravis EM, Grigsby J, Leehey MA et al (2002) Fragile X premutation carriers: characteristic MR imaging findings of adult male patients with progressive cerebellar and cognitive dysfunction. AJNR Am J Neuroradiol 23(10):1757–1766

    PubMed  Google Scholar 

  45. Renaud M, Perriard J, Coudray S, Sévin-Allouet M, Marcel C, Meissner WG et al (2015) Relevance of corpus callosum splenium versus middle cerebellar peduncle hyperintensity for FXTAS diagnosis in clinical practice. J Neurol 262(2):435–442

    Article  PubMed  Google Scholar 

  46. Finsterer J, Zarrouk Mahjoub S (2012) Leukoencephalopathies in mitochondrial disorders: clinical and MRI findings. J Neuroimaging Off J Am Soc Neuroimaging 22(3):e1–e11

    Article  Google Scholar 

  47. Wray SH, Provenzale JM, Johns DR, Thulborn KR (1995) MR of the brain in mitochondrial myopathy. AJNR Am J Neuroradiol 16(5):1167–1173

    CAS  PubMed  Google Scholar 

  48. Ito S, Shirai W, Asahina M, Hattori T (2008) Clinical and brain MR imaging features focusing on the brain stem and cerebellum in patients with myoclonic epilepsy with ragged-red fibers due to mitochondrial A8344G mutation. AJNR Am J Neuroradiol 29(2):392–395

    Article  CAS  PubMed  Google Scholar 

  49. Millar WS, Lignelli A, Hirano M (2004) MRI of five patients with mitochondrial neurogastrointestinal encephalomyopathy. AJR Am J Roentgenol 182(6):1537–1541

    Article  PubMed  Google Scholar 

  50. Synofzik M, Srulijes K, Godau J, Berg D, Schöls L (2012) Characterizing POLG ataxia: clinics, electrophysiology and imaging. Cerebellum Lond Engl 11(4):1002–1011

    Article  Google Scholar 

  51. Sidiropoulos C, Moro E, Lang AE (2013) Extensive intracranial calcifications in a patient with a novel polymerase γ-1 mutation. Neurology 81(2):197–198

    Article  PubMed  PubMed Central  Google Scholar 

  52. Depienne C, Bugiani M, Dupuits C, Galanaud D, Touitou V, Postma N et al (2013) Brain white matter oedema due to ClC-2 chloride channel deficiency: an observational analytical study. Lancet Neurol 12(7):659–668

    Article  CAS  PubMed  Google Scholar 

  53. Di Bella D, Pareyson D, Savoiardo M, Farina L, Ciano C, Caldarazzo S et al (2014) Subclinical leukodystrophy and infertility in a man with a novel homozygous CLCN2 mutation. Neurology 83(13):1217–1218

    Article  PubMed  Google Scholar 

  54. Inui T, Kawarai T, Fujita K, Kawamura K, Mitsui T, Orlacchio A et al (2013) A new CSF1R mutation presenting with an extensive white matter lesion mimicking primary progressive multiple sclerosis. J Neurol Sci 334(1–2):192–195

    Article  CAS  PubMed  Google Scholar 

  55. Sundal C, Baker M, Karrenbauer V, Gustavsen M, Bedri S, Glaser A et al (2015) Hereditary diffuse leukoencephalopathy with spheroids with phenotype of primary progressive multiple sclerosis. Eur J Neurol 22(2):328–333

    Article  CAS  PubMed  Google Scholar 

  56. Biancheri R, Rossi D, Cassandrini D, Rossi A, Bruno C, Santorelli FM (2010) Cavitating leukoencephalopathy in a child carrying the mitochondrial A8344G mutation. AJNR Am J Neuroradiol 31(9):E78–E79

    Article  CAS  PubMed  Google Scholar 

  57. Mazzeo A, Di Leo R, Toscano A, Muglia M, Patitucci A, Messina C et al (2008) Charcot-Marie-Tooth type X: unusual phenotype of a novel CX32 mutation. Eur J Neurol 15(10):1140–1142

    Article  CAS  PubMed  Google Scholar 

  58. Paulson HL, Garbern JY, Hoban TF, Krajewski KM, Lewis RA, Fischbeck KH et al (2002) Transient central nervous system white matter abnormality in X-linked Charcot-Marie-Tooth disease. Ann Neurol 52(4):429–434

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

We would like to thank Dr Yann Nadjar (Département des Maladies du Système Nerveux CHU Paris-Hôpital Pitié Salpêtrière, Paris) for his participation.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Xavier Ayrignac.

Ethics declarations

Conflicts of interest

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ayrignac, X., Boutiere, C., Carra-dalliere, C. et al. Posterior fossa involvement in the diagnosis of adult-onset inherited leukoencephalopathies. J Neurol 263, 2361–2368 (2016). https://doi.org/10.1007/s00415-016-8131-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-016-8131-2

Keywords

Navigation