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Fetal-onset Alexander disease with radiological-neuropathological correlation

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Abstract

Alexander disease is a leukodystrophy caused by mutations in the GFAP gene, primarily affecting the astrocytes. This report describes the prenatal and post-mortem neuroimaging findings in a case of genetically confirmed, fetal-onset Alexander disease with pathological correlation after termination of pregnancy. The additional value of fetal brain magnetic resonance imaging in the third trimester as a complementary evaluation tool to neurosonography is shown for suspected cases of fetal-onset Alexander disease. Diffuse signal abnormalities of the periventricular white matter in association with thickening of the fornix and optic chiasm can point towards the diagnosis. Furthermore, the presence of atypical imaging findings such as microcephaly and cortical folding abnormalities in this case broadens our understanding of the phenotypic variability of Alexander disease.

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Authors and Affiliations

  1. Department of Radiology, University Hospitals Leuven (UZ), Herestraat 49, Louvain, 3000, Belgium

    Johannes Devos & Michael Aertsen

  2. Center for Human Genetics, University of Leuven (KU) and University Hospitals Leuven (UZ), Louvain, Belgium

    Koenraad Devriendt

  3. Department of Gynecology and Obstetrics, University Hospitals Leuven (UZ), Louvain, Belgium

    Jute Richter

  4. Department of Development and Regeneration, University Hospitals Leuven (UZ), Louvain, Belgium

    Katrien Jansen

  5. Department of Pathology, University Hospitals Leuven (UZ), Louvain, Belgium

    Marcella Baldewijns

  6. Laboratory for Neuropathology, Department of Imaging and Pathology and Leuven Brain Institute, University of Leuven (KU) and Department of Pathology, University Hospitals Leuven (UZ), Louvain, Belgium

    Dietmar R. Thal

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  1. Johannes Devos
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  2. Koenraad Devriendt
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  3. Jute Richter
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  5. Marcella Baldewijns
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  6. Dietmar R. Thal
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  7. Michael Aertsen
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Contributions

M.A. and J.D. contributed to the conception and design of the case report. J.R. and K.J. interpreted the images of the fetal (neuro-)sonography. J.D. and M.A. interpreted the magnetic resonance images. D.R.T. and M.B. performed the autopsy and analysis of the histopathological specimens. K.D. performed the genetical analysis. The first draft of the manuscript was written by J.D. and all the authors commented on subsequent versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Johannes Devos.

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Conflicts of interest

D.R.T. received speaker honorary from Novartis Pharma AG (Switzerland) and Biogen (USA) and travel reimbursement from GE-Healthcare (UK) and UCB (Belgium) and collaborated with Novartis Pharma AG (Switzerland), Probiodrug (Germany), GE-Healthcare (UK) and Janssen Pharmaceutical Companies (Belgium). D.R.T. receives grants from Fonds Wetenschappelijk Onderzoek (FWO (Vlaanderen): G0F8516N, G065721N), Stichting Alzheimer Onderzoek (SAO-FRA (Belgium): 2020/017) and KU-Leuven Internal Funding (C14/22/132; C3/20/057).

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Dietmar R. Thal and Michael Aertsen contributed equally to the manuscript as senior authors.

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Devos, J., Devriendt, K., Richter, J. et al. Fetal-onset Alexander disease with radiological-neuropathological correlation. Pediatr Radiol 53, 2149–2153 (2023). https://doi.org/10.1007/s00247-023-05710-w

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