Diffuse White Matter Disease in Three Children: An Encephalopathy with Unique Features on Magnetic Resonance Imaging and Proton Magnetic Resonance Spectroscopy

Abstract

Amongst 21 children with unclassified white matter diseases three patients could be characterised by an identical clinical picture, magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy (MRS) findings as a probably distinct entity. Following a normal early development they later showed rapidly progressive motor symptoms (ataxia, spasticity) leading to severe handicap within one or two years after onset. Later on bulbar symptoms, optic atrophy and epileptic seizures occurred. The MRI showed a diffuse homogenous hypodensity of the white matter almost identical to the signal of the ventricles. MRS revealed a near total absence of N-acetylaspartate, choline and creatine and an increase of lactate and glucose. One girl and one boy were siblings, indicating an autosomal recessive trait. Abbreviations MRI = magnetic resonance imaging MRS = magnetic resonance spectroscopy VOI = volume-of-interest Tl = spin-lattice relaxation time FLASH = fast low angle shot T2 = spin-spin relaxation time CE-FAST = contrast-enhanced Fourier acquired steady-state TE = echo time STEAM = stimulated echo acquisition mode TR = repetition time CCT= cranial computed tomography Cr = creatine and phosphocreatine Cho = choline-containing compounds Ins = myo-inositol Glc = glucose NAA = N-acetylaspartate Lac = lactate CSF = cerebro-spinal fluid VLCFA = very long chain fatty acids