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Chorea-acanthocytosis in monozygotic twins: clinical findings and neuropathological changes as detected by diffusion tensor imaging, FDG-PET and 123I-β-CIT-SPECT

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Abstract

We report on two 33 years old monozygotic twins with chorea-acanthocytosis (ChAc) misdiagnosed as schizophrenia and Tourette syndrome, respectively. Although the patients shared several clinical similarities, there were also some clear differences: twin 1 presented initially with an acute episode of a paranoid schizophrenia, while twin 2 suffered from generalized epileptic seizures. In both twins, MRI demonstrated caudate nucleus atrophy and an increased apparent diffusion coefficient (ADC) in the striatum bilaterally with right sided predominance. 18F-FDG PET showed bilaterally reduced glucose utilization in the striatum with clearly pronounced reduction on the right side compared to the left and in twin 1 compared to twin 2. Ratios of binding to striatal dopamine transporters (DAT) and serotonin transporters in the hypothalamus midbrain area as determined using 123I-β-CIT-SPECT fell within the normal ranges. However, in twin 1 a significant difference in binding to presynaptic DAT with marked reduction on the right hemisphere was observed. Right hemispheric accentuated changes measured by MRI, FDG-PET, and 123I-β-CITSPECT correspond to more severe hyperkinetic movements on the left part of the body in both twins. Different neuro-psychiatric features in this monocygotic twin pair suggest that not only genetic but also environmental factors contribute to the clinical symptomatology. Our findings suggest that the main neuropathological process in ChAc is located in the striatum, involving microstructural alterations, and disturbance of metabolism and dopaminergic neurotransmission.

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Authors and Affiliations

  1. Dept. of Clinical Psychiatry and Psychotherapy, Medical School Hannover, Carl-Neuberg-Str. 1, D-30625, Hannover, Germany

    Kirsten R. Müller-Vahl MD, Hinderk M. Emrich MD & Thomas Peschel MD

  2. Dept. of Nuclear Medicine, Medical School Hannover, Hannover, Germany

    Georg Berding MD

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  1. Kirsten R. Müller-Vahl MD
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  2. Georg Berding MD
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  3. Hinderk M. Emrich MD
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  4. Thomas Peschel MD
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Correspondence to Kirsten R. Müller-Vahl MD.

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Müller-Vahl, K.R., Berding, G., Emrich, H.M. et al. Chorea-acanthocytosis in monozygotic twins: clinical findings and neuropathological changes as detected by diffusion tensor imaging, FDG-PET and 123I-β-CIT-SPECT. J Neurol 254, 1081–1088 (2007). https://doi.org/10.1007/s00415-006-0492-5

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  • DOI: https://doi.org/10.1007/s00415-006-0492-5

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