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Childhood presentation of COL4A1 mutations
Author(s) -
SHAH SIDDHARTH,
ELLARD SIAN,
KNEEN RACHEL,
LIM MING,
OSBORNE NIGEL,
RANKIN JULIA,
STOODLEY NEIL,
VAN DER KNAAP MARJO,
WHITNEY ANDREA,
JARDINE PHILIP
Publication year - 2012
Publication title -
developmental medicine and child neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.658
H-Index - 143
eISSN - 1469-8749
pISSN - 0012-1622
DOI - 10.1111/j.1469-8749.2011.04198.x
Subject(s) - spastic quadriplegia , porencephaly , pediatrics , medicine , presentation (obstetrics) , epileptic spasms , white matter , epilepsy , magnetic resonance imaging , stroke (engine) , dysgenesis , family history , microcephaly , cerebral palsy , pathology , surgery , radiology , physical therapy , psychiatry , anatomy , mechanical engineering , engineering
Aim To describe the clinical and radiological features of four new families with a childhood presentation of COL4A1 mutation. Method We retrospectively reviewed the clinical presentation. Investigations included radiological findings and COL4A1 mutation analysis of the four cases. Affected family members were identified. COL4A1 mutation analysis was performed in all index cases and, where possible, in affected family members. Results The three male and one female index cases presented with recurrent childhood‐onset stroke, infantile hemiplegia/spastic quadriplegia, and infantile spasms. Additional features such as congenital cataracts and anterior segment dysgenesis were present. Microcephaly and developmental delay/learning difficulties were present in three cases. Three cases had one or more family member affected in multiple generations, with a total of 11 such individuals identified. The clinical features showed a wide intrafamilial variation. Magnetic resonance imaging (MRI) showed bilateral white matter change in all cases, except in one mutation‐positive family member. Unilateral or bilateral porencephaly was present in cases with infantile hemiplegia, and a diagnosis of clinical stroke was supported by the presence of intracerebral haemorrhage. The age at diagnosis was between 1 year and 6 years for the children with presentation in infancy and 12 months after stroke in a 14‐year‐old male. Three new pathogenic mutations were identified in the COL4A1 gene. Interpretation COL4A1 mutations can present in children with infantile hemiplegia/quadriplegia, stroke or epilepsy, and a motor disorder. The presence of eye features and white matter change on MRI in childhood can help point towards the diagnosis. Once the diagnosis is made, a careful search can identify affected family members.