IMAGES IN NEUROLOGY
|Year : 2006 | Volume
| Issue : 4 | Page : 249-250
MV Vidya, Thamburaj Krishnamoorthy, Abraham Kuruvilla
Departments of Neurology and Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum - 695 011, India
M V Vidya
Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum - 695 011
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Vidya M V, Krishnamoorthy T, Kuruvilla A. Kearns-sayre syndrome. Ann Indian Acad Neurol 2006;9:249-50
A 25-year-old man presented with altered sensorium following a febrile illness. He had bilateral drooping of eyelids and ataxia from 19 years of age, mild motor developmental delay and subnormal intelligence from childhood. Examination revealed bilateral pes cavus and dorsal scoliosis. Cranial nerve examination showed bilateral ptosis with external ophthalmoplegia and mild bifacial weakness. Optic fundi revealed bilateral retinitis pigmentosa. Motor system examination revealed symmetrical distal wasting and weakness of all limbs with sluggish deep tendon reflexes. Plantar response was flexor type. There were bilateral cerebellar signs.
Magnetic resonance imaging (MRI) of the brain showed midbrain and cerebellar atrophy and periaqueductal gliosis [Figure - 1]. MR spectroscopy (MRS) showed lactate peak in the periaqueductal region [Figure - 2]. CSF showed slightly elevated proteins without any pleocytosis. His sensorium improved with treatment of respiratory infection.
| Discussion|| |
The clinical and MRI picture of our patient is consistent with Kearns-Sayre syndrome (KSS), a mitochondrial disorder. MR abnormalities described in KSS include diffuse cerebral and cerebellar atrophy, hyper intensities of the peripheral white matter and deep white matter. Deep grey matter and periaqueductal involvement has also been described in KSS., The MRI abnormality in our patient was characterized by midbrain and cerebellar atrophy with periaqueductal gliosis. MR abnormalities reflect necrosis /spongiform changes seen on histopathology. MR spectroscopy in this condition shows increased CSF and brain lactate as observed in our patient. The presence of CNS lactate correlates highly with other markers for mitochondrial dysfunction that have been used in establishing the diagnosis. In addition, some patients lacking genetic, biochemical or pathologic confirmation of the diagnosis may have increased MRS lactate levels, suggesting that MRS may be the sole laboratory marker of the disorder.
| References|| |
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[Figure - 1], [Figure - 2]