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Case Reports
. 2014 Dec;261(12):2411-23.
doi: 10.1007/s00415-014-7516-3. Epub 2014 Sep 30.

V体育2025版 - Compound heterozygous PNPLA6 mutations cause Boucher-Neuhäuser syndrome with late-onset ataxia

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Case Reports

"VSports注册入口" Compound heterozygous PNPLA6 mutations cause Boucher-Neuhäuser syndrome with late-onset ataxia

"V体育官网入口" A Deik et al. J Neurol. 2014 Dec.

"V体育ios版" Abstract

PNPLA6 mutations, known to be associated with the development of motor neuron phenotypes, have recently been identified in families with Boucher-Neuhäuser syndrome VSports手机版. Boucher-Neuhäuser is a rare autosomal recessive syndrome characterized by the co-occurrence of cerebellar ataxia, hypogonadotropic hypogonadism, and chorioretinal dystrophy. Gait ataxia in Boucher-Neuhäuser usually manifests before early adulthood, although onset in the third or fourth decade has also been reported. However, given the recent identification of PNPLA6 mutations as the cause of this condition, the determining factors of age of symptom onset still need to be established. Here, we have identified a sporadic Boucher-Neuhäuser case with late-onset gait ataxia and relatively milder retinal changes due to compound heterozygous PNPLA6 mutations. Compound heterozygosity was confirmed by cloning and sequencing the patient's genomic DNA from coding exons 26-29. Furthermore, both mutations (one novel and one known) fell in the phospholipase esterase domain, where most pathogenic mutations seem to cluster. Taken together, we herein confirm PNPLA6 mutations as the leading cause of Boucher-Neuhäuser syndrome and suggest inquiring about a history of hypogonadism or visual changes in patients presenting with late-onset gait ataxia. We also advocate for neuroophthalmologic evaluation in suspected cases. .

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Figures

Fig. 1
Fig. 1
Fundus photography of the posterior pole of the right eye (a) and the region nasal to the optic disk in the left eye (b) demonstrates a large patch of complete retinal pigment epithelium (RPE) and choriocapillaris atrophy nasally adjacent to the optic disk in each eye. A crescent-shaped patch of partial atrophy temporal to the macula is seen in the right eye, along with pigmentary macular changes. Choroidal vessels are visible in atrophic regions in each eye. There was no pigmentary deposition or clumping. Peripapillary regions demonstrate grayish discoloration. Autofluorescence photographs of the right eye (c) and left eye (d) demonstrate crescent-shaped zones of patchy hyperfluorescence temporal to the macula and in the fovea bilaterally
Fig. 2
Fig. 2
Spectral mode OCT images through central fovea in right eye (a) and left eye (b). Note retinal thinning and loss of the outer retinal ellipsoid line temporally (arrows) corresponding to areas of hyper-autofluorescence. Spectral mode OCT images nasal to the optic disks in the right eye (c) and left eye (d). The retinas are severely thinned, with loss of the layered retinal architecture. The choriocapillaris is absent, and adjacent to the optic disks, the larger choroidal vessels are effaced as well. e Nerve fiber layer OCT shows bilateral nasal nerve fiber layer thinning
Fig. 3
Fig. 3
Goldmann visual field in the left eye (a) and right eye (b) shows large temporal defects in each eye and a tiny nasal scotoma in the left eye
Fig. 4
Fig. 4
Sagittal T1- (a) and axial T2- (b) weighted brain magnetic resonance images showing cerebellar folia prominence and marked vermian atrophy, respectively
Fig. 5
Fig. 5
a PNPLA6 protein structure showing its predicted functional domains and all described pathogenic mutations. Domains were predicted by SMART (http://smart.embl-heidelberg.de). cNMP stands for cyclic nucleotide-monophosphate binding domain and patatin represents the patatin-like phospholipase domain also known as phospholipid esterase domain. A tyrosine kinase phosphorylation site is also predicted at residues 403–410 (not shown). All mutations identified in BNS are reported above with mutations identified in this study highlighted in bold. The novel PNPLA6 mutation identified in this study is also represented within a rectangle. Below are reported mutations identified in spastic paraplegia (red), spastic ataxia (blue), and GHS (green). b Sequence chromatograms of wild-type and mutant PNPLA6 exon 29, novel mutation (p.Ser1173Arg) is highlighted with a black arrow. Conservation among other species of the novel p.Ser1173Arg mutation (red) is also shown. Of note, conservation scores (GERP++ and PhyloP) were 4.98 and 2.32 for the previously described mutation, and 1.02 and 0.469 for the novel herein described. BT Bos taurus, CL Canis lupus, DR Danio rerio, GG Gallus gallus, HS Homo sapiens, MM Mus musculus. PT Pan troglodytes, RN Rattus norvegicus

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