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New Neuroimaging Findings in Patients with Molybdenum Cofactor Deficiency Type A: A Case Report and Literature Review
Hui Liu1, Xiaohe Yu2, Singting He2
1Department of Radiology, Central South University, Xiangya Hospital, Changsha, China.
Introduction:
Molybdenum cofactor deficiency (MoCD-A) is an extremely rare autosomal recessive disease that presents with intractable seizures. The diagnosis poses challenges due to the limited number of cases reported worldwide. Magnetic resonance imaging (MRI) is a useful diagnostic tool that can detect brain injury associated with the disorder. The prognosis of MoCD-A is poor partly because most cases are initially misdiagnosed as HIE (hypoxic ischemic encephalopathy), emphasizing the need for an early and accurate diagnosis to improve quality of life and provide adequate genetic counseling to avoid new cases in the future.
Case Report:
This report presents a case of molybdenum cofactor deficiency type A (MoCD-A) caused by MOCS1 gene mutations. A male newborn was admitted on the 10th day of birth due to uncontrolled seizures and feeding difficulties. Brain MRI showed severe cerebral damage with multiple foci that did not enhance upon contrast administration. The diagnosis was confirmed by genetic analysis and the patient received rehabilitation. His parents also received genetic counseling. To the best of our knowledge, this is the first reported MoCD-A case that had enhanced MR imaging with Gd-DTPA (0.1 mmol/kg). In addition, we reviewed the clinical and neuroimaging features of 25 newborns diagnosed with MoCD-A, as documented in the existing literature.
Conclusion:
MRI is crucial in the diagnosis of MoCD-A. A correct diagnosis can provide the family with timely genetic counseling to prevent future cases.
Insights
Molybdenum cofactor deficiency type A (MoCD-A) is a rare genetic disorder. Early diagnosis using MRI and genetic analysis is vital for treatment and preventing future cases.
Area of Science:
- Genetics
- Neurology
- Pediatrics
Background:
- Molybdenum cofactor deficiency type A (MoCD-A) is an extremely rare autosomal recessive disorder.
- It presents with severe neurological symptoms like intractable seizures in newborns.
- Diagnostic challenges exist due to its rarity and potential misdiagnosis as hypoxic ischemic encephalopathy (HIE).
Approach:
- Presents a case of MoCD-A in a male newborn with MOCS1 gene mutations, characterized by seizures and feeding difficulties.
- Utilized brain MRI, including contrast-enhanced imaging (Gd-DTPA), to identify severe cerebral damage.
- Reviewed clinical and neuroimaging findings of 25 MoCD-A cases from existing literature.
Key Points:
- Magnetic resonance imaging (MRI) is a critical diagnostic tool for detecting brain injury in MoCD-A.
- This case is the first reported MoCD-A with enhanced MR imaging using Gd-DTPA.
- Genetic analysis confirmed the diagnosis, enabling appropriate genetic counseling for the family.
Conclusions:
- MRI, particularly enhanced imaging, is crucial for diagnosing MoCD-A.
- Early and accurate diagnosis facilitates timely genetic counseling.
- Preventing misdiagnosis improves patient outcomes and allows for family planning.
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