Late onset adrenoleukodystrophy: A review related clinical case report
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Our objective is to review the initial presentation, evolution, progression, final stage, and images in the follow up of an adult patient who presented an uncommon peroxisomal disease (1/20,000 males) that occurred by ABCD1 gene mutation in the Xq28 chromosome; to bring forward the imaging features (which nowadays is the most useful and accessible diagnostic tool) and clinical presentation of adrenoleukodystrophy in adulthood; to propose a differential diagnosis in aid of a prompt recognition of the disease hereafter from a neurologist approach. In relation of a clinical case we reviewed the literature to correlate the principal findings and evolution of the disease. This thrilling but at the same time unfortunate disease is not only a diagnostic problem is also a therapeutic quest besides all the related familial, labor, and social related problems. The very-long chain fatty acids (VLCFA) accumulation leads to a not completely understood mechanisms that precipitate the specific malfunction of the nervous system and adrenal gland. The initial corticospinal bilateral involvement provokes a spastic paraparesis but with the affection of others pathways multiple manifestations appears, with dementia and finally loss of the most of cortical functions secondary to the white matter affection. Since the hematopoietic stem cell transplantation can be treated with variable results, other treatments, as the Lorenzo%27s oil, have not been consistent with a substantial improvement of the affected individual. The genetic advice and support to the patient and the family are essentials as well as the screening in individuals at risk before the onset of the disease. © 2019
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Our objective is to review the initial presentation, evolution, progression, final stage, and images in the follow up of an adult patient who presented an uncommon peroxisomal disease (1/20,000 males) that occurred by ABCD1 gene mutation in the Xq28 chromosome; to bring forward the imaging features (which nowadays is the most useful and accessible diagnostic tool) and clinical presentation of adrenoleukodystrophy in adulthood; to propose a differential diagnosis in aid of a prompt recognition of the disease hereafter from a neurologist approach. In relation of a clinical case we reviewed the literature to correlate the principal findings and evolution of the disease. This thrilling but at the same time unfortunate disease is not only a diagnostic problem is also a therapeutic quest besides all the related familial, labor, and social related problems. The very-long chain fatty acids (VLCFA) accumulation leads to a not completely understood mechanisms that precipitate the specific malfunction of the nervous system and adrenal gland. The initial corticospinal bilateral involvement provokes a spastic paraparesis but with the affection of others pathways multiple manifestations appears, with dementia and finally loss of the most of cortical functions secondary to the white matter affection. Since the hematopoietic stem cell transplantation can be treated with variable results, other treatments, as the Lorenzo's oil, have not been consistent with a substantial improvement of the affected individual. The genetic advice and support to the patient and the family are essentials as well as the screening in individuals at risk before the onset of the disease. © 2019
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Adrenoleukodystrophy; Adrenomyeloneuropathy; Cerebral adrenoleukodystrophy; Demyelination; Myelopathy ABC transporter D1; very long chain fatty acid; adrenoleukodystrophy; adult; amnesia; anxiety; apathy; Babinski reflex; brain cortex atrophy; case report; chromosome Xq; clinical article; corpus callosum; dementia; demyelination; depression; differential diagnosis; distal paresthesia; dysmetria; falling; family history; fasciculation; fatty acid blood level; follow up; gait disorder; gene mutation; genetic risk; headache; hematopoietic stem cell transplantation; hereditary motor sensory neuropathy; hospital admission; human; hyperreflexia; impotence; insomnia; late onset disorder; longitudinal study; male; mental health; motor neuron disease; muscle cramp; muscle rigidity; nuclear magnetic resonance imaging; pain; physical examination; primary lateral sclerosis; priority journal; recurrent infection; Review; speech disorder; spinal cord atrophy; thoracic spinal cord; urinary tract infection; urinary urgency; white matter; X chromosome; X chromosome linked disorder
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