Maple syrup urine disease: magnetic resonance imaging findings in three patients

Authors

  • Aliya Allahwala 2nd Year MBBS Student, Aga Khan University, Karachi, Pakistan
  • Sibtain Ahmed Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
  • Bushra Afroze Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan

DOI:

https://doi.org/10.47391/JPMA.1341

Abstract

Abstract

Maple syrup urine disease (MSUD) is an autosomal recessive inherited metabolic disorder, caused by branched-chain alpha-ketoacid dehydrogenase (BCKD) deficiency, leading to toxic accumulation of branched-chain amino acids (BCAAs) including leucine, isoleucine and valine and their corresponding ?-ketoacids. The diagnosis of MSUD is based on elevated BCAAs and allo-isoleucine in plasma, and branched-chain hydroxyacids and ketoacids in urine. The identification of alloisoleucine >5 ┬Ámol/L is considered pathognomonic. Moreover, brain magnetic resonance imaging (MRI) showing atypical signal intensity and oedema is characteristic of MSUD. Recognition of the classical neuro-radiological findings of MSUD is particularly useful in local settings as many healthcare facilities lack the resources to measure Plasma Amino Acids (PAA). We report three cases of MSUD, in whom the disorder was strongly suspected at presentation, based on classical brain MRI findings, which was urgently confirmed by PAA analysis

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Published

2021-01-21

Issue

Section

Case Series