Neurodegeneration with brain iron accumulation: A cautionary tale

Hallervorden and Spatz first described, in a sibship of 12, five sisters with clinically increasing dysarthria and progressive dementia, whose brains showed a brown discoloration of the globus pallidus and substantia nigra. Subsequently the basis has been shown to be a neurodegeneration with brain iron accumulation or pantothenate kinase-associated neurodegeneration due to mutations in the pantothenate kinase 2 (PANK2) gene. Progressive dystonia, Parkinsonism and dementia characterise the syndrome in children. The pathology comprises neuronal loss, axonal swelling, gliosis and iron deposits in the basal nuclei, disclosed by 'the eye of the tiger' sign on MR imaging. Since the criminal, unethical National Socialist activities of Hallervorden and Spatz came to light 'neurodegeneration with brain iron accumulation' has become the preferred nomenclature.