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Autosomal dominant chorea-acanthocytosis with polyglutamine-containing neuronal inclusions
R H Walker1, S Morgello, B Davidoff-Feldman
1Department of Neurology, Veterans Affairs Medical Center, Bronx, NY, USA. ruth.walker@mountsinai.org
Background:
The term chorea-acanthocytosis describes a heterogeneous group of neurodegenerative disorders with variable clinical features and modes of inheritance. The characteristic acanthocytic appearance of red blood cells is attributed to abnormalities of a membrane protein, band 3, although the relationship between this and the neurodegenerative process has yet to be determined.
Objective:
To describe features of phenotype, inheritance, and neuropathological findings in a family with this disorder.
Methods:
Clinical and hematologic evaluations were performed on all available family members and neuropathological examination was performed on one case.
Results:
Autosomal dominant inheritance was evident, with variable clinical features of chorea or parkinsonism, marked cognitive changes, but no seizures or peripheral neurologic abnormalities. Abnormalities of band 3 were demonstrated on gel electrophoresis of red blood cell membranes. Neuropathological examination revealed severe neuronal loss of the caudate-putamen and intranuclear inclusion bodies in many areas of the cerebral cortex. These inclusion bodies were immunoreactive for ubiquitin, expanded polyglutamine repeats, and torsinA.
Conclusions:
This family extends the genetic spectrum of chorea-acanthocytosis to include autosomal dominant inheritance, possibly due to expanded trinucleotide repeats. Intraneuronal inclusion bodies have recently been associated with a wide range of inherited neurodegenerative disorders and may provide a clue to etiopathogenesis, in addition to potentially indicating a function of torsinA.