Megalencephalic leukoencephalopathy with subcortical cysts
Updates to Article Attributes
Megalencephalic leukoencephalopathy with subcortical cysts, also known as Van der Knaap disease, refers to a rare inherited autosomal recessive disease characterised by diffuse subcortical leukoencephalopathy associated with white matter cystic degeneration.
Epidemiology
The age at symptoms manifestations ranges from birth to 25 years, with a median age of 6 months 5.
Clinical presentation
Patients typically present with megalencephaly during the 1st year of life associated with mild motor developmental delay and seizures 5. There is also a gradual onset of ataxia, spasticity, and sometimes extrapyramidal findings. Mild mental deterioration can be observed late in life.
Pathology
It is sometimes classified as a megalencephalic leukoencephalopathy.
Genetics
It is thought to carry an autosomal recessive inheritance, and the gene locus has been mapped as MLC 1 gene at chromosome 22q 4,5.
Serology
Elevated levels of glycine have been reported in CSF 1.
Radiographic features
MRI brain
Shows a megalencephalic brain with bilateral cystic lesions of CSF intensity mainly affecting the anterior temporal lobes. There can also be a wide diffuse signal abnormality and features of swelling affecting white matter.
The hallmark of radiological diagnosis is
- subcortical white matter involved early in course of disease with involvement of the subcortical U-fibers.
- subcortical cysts especially temporal poles and frontoparietal lobes.
- the main differential diagnosis is metachromatic leukodystrophy (MLD); however, not all symmetrical leukodystrophies are MLD. If U-fibers or cysts involved, MLC is considered.
Treatment and prognosis
The disease is managed to treat the manifestations with antiepileptic drugs to control epileptic seizures and physical therapy to improve motor function.
History and etymology
Bhim Sen Singhal described a megalencephalic leukodystrophy series of cases in 1991 5. It is named after Marjo van der Knaap, a Dutch physician 4.
Differential diagnosis
-<li>other <a title="leukoencephalopathies" href="/articles/leukoencephalopathies">leukoencephalopathies </a>- +<li>other <a href="/articles/leukoencephalopathies">leukoencephalopathies </a>
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Image 2 MRI (T2) ( update )
Image 3 MRI (T2) ( update )
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