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Diffuse hypomyelination is not obligate for POLR3-related disorders
Roberta La Piana1, Ferdy K Cayami1, Luan T Tran1
1From the Laboratory of Neurogenetics of Motion (R.L.P.) and Department of Neuroradiology (R.L.P.), Montreal Neurological Institute and Hospital, and the Departments of Neurology and Neurosurgery (R.L.P., L.T.T., K.G., G.B.) and Pediatrics (R.L.P., L.T.T., K.G., G.B.), McGill University, Montreal, Canada; Departments of Child Neurology (F.K.C., M.S.v.d.K., N.I.W.) and Clinical Genetics (F.K.C., R.v.S.), VU University Medical Center, Amsterdam, the Netherlands; Department of Genetics (K.Õ.) United Laboratories, Tartu University Hospital, Tartu; Department of Pediatrics (K.Õ.), University of Tartu, Estonia; Institute of Human Genetics (T.H.), Technische Universität München; Institute of Human Genetics (T.H.), Helmholtz Zentrum München, Munich, Germany; Department of Neurology (E.W.), Birmingham Children's Hospital, UK; Department of Neurology (D.T.), University Clinic Essen, University of Duisburg-Essen, Germany; Department of Child and Adolescent Neurology (H.M.), Institute of Mother and Child, Warsaw, Poland; Department of Child Neurology (B.T.P.), AMC Academic Medical Center, Amsterdam, the Netherlands; West Midlands Regional Clinical Genetics Unit (C.P., H.C.), Birmingham Women's Hospital, UK; Departments of Pediatrics (T.A.) and Medical Genetics (H.O.), Faculty of Medicine (F.O.), Ege University, Izmir, Turkey; Department of Neurology (A.V.), Children's National Health System, Washington, DC; Neuroscience Campus Amsterdam (M.S.v.d.K., N.I.W.), the Netherlands; and Department of Medical Genetics (G.B.), Montreal Children's Hospital, McGill University Health Center, Montreal, Canada.
POLR3 gene mutations can present with atypical MRI findings, including selective corticospinal tract involvement and cerebellar atrophy, not just diffuse hypomyelination.
Area of Science:
- Neuroimaging
- Genetics
- Neurology
Background:
- Mutations in POLR3A and POLR3B genes are associated with specific neurological disorders.
- The classic MRI phenotype includes diffuse hypomyelination and specific brain region abnormalities.
- Atypical presentations may broaden the diagnostic spectrum.
Purpose of the Study:
- To describe novel MRI patterns in patients with POLR3A/POLR3B mutations.
- To identify presentations that deviate from the typical hypomyelination pattern.
Main Methods:
- Multicenter retrospective study.
- Collected neuroradiologic, clinical, and molecular data.
- Focused on patients without the classic MRI phenotype.
Main Results:
- Eight patients identified (6 POLR3A, 2 POLR3B).
- Two novel MRI patterns observed: selective corticospinal tract involvement (4 patients) and cerebellar atrophy (4 patients).
- Incomplete hypomyelination seen in 5 participants.
Conclusions:
- Diffuse hypomyelination is not a mandatory feature of POLR3-related disorders.
- Selective corticospinal tract involvement and cerebellar atrophy are significant atypical MRI findings.
- These patterns expand the understanding of POLR3-related disorder imaging.

