Adult phenylketonuria presenting with subacute severe neurologic symptoms

Morinobu Seki, Tsubasa Takizawa, Shigeaki Suzuki, Toshihiko Shimizu, H. Shibata, T. Ishii, T. Hasegawa, N. Suzuki

Research output: Contribution to journalArticle

Abstract

We report a 48-year-old Japanese woman with phenylketonuria (PKU) who presented with severe neurological symptoms more than 30. years after discontinuation of dietary treatment. She was diagnosed with PKU at 6-years-old and was treated with a phenylalanine restricted diet until she was 15. years old. When she was 48-years-old she started having difficulty walking. After several months, she presented with severe disturbance of consciousness and was admitted. She was diagnosed as having neurological complications associated with PKU. We observed temporal changes in her laboratory data, brain MRI and single-photon emission computed tomography (SPECT) scan findings. Brain MRI on T2-weighted, fluid-attenuated inversion recovery and diffusion-weighted images revealed high intensity lesions in her bilateral frontal lobes and 123I-IMP SPECT showed marked and diffuse hypoperfusion in the bilateral cerebrum and cerebellum. After the resumption of dietary treatment, serum phenylalanine concentrations immediately decreased to the normal range. However, her neurological symptoms took longer to improve. We also found no clear temporal association between MRI findings and clinical severity. SPECT abnormalities showed marked improvement after treatment. It is well known that PKU patients who discontinue the dietary restriction from their childhood develop minor neurological impairments. However, PKU patients with late-onset severe neurological symptoms are very rare. To our knowledge, this is the first report regarding SPECT findings of PKU patients with late-onset severe neurological deterioration.

Original languageEnglish
JournalJournal of Clinical Neuroscience
DOIs
Publication statusAccepted/In press - 2015

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Phenylketonurias
Neurologic Manifestations
Single-Photon Emission-Computed Tomography
Phenylalanine
Mobility Limitation
Inosine Monophosphate
Brain
Cerebrum
Frontal Lobe
Consciousness
Cerebellum
Reference Values
Therapeutics
Diet
Serum

Keywords

  • Adult
  • MRI
  • Neurological deterioration
  • Phenylketonuria
  • SPECT

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology
  • Physiology (medical)

Cite this

Adult phenylketonuria presenting with subacute severe neurologic symptoms. / Seki, Morinobu; Takizawa, Tsubasa; Suzuki, Shigeaki; Shimizu, Toshihiko; Shibata, H.; Ishii, T.; Hasegawa, T.; Suzuki, N.

In: Journal of Clinical Neuroscience, 2015.

Research output: Contribution to journalArticle

Seki, Morinobu ; Takizawa, Tsubasa ; Suzuki, Shigeaki ; Shimizu, Toshihiko ; Shibata, H. ; Ishii, T. ; Hasegawa, T. ; Suzuki, N. / Adult phenylketonuria presenting with subacute severe neurologic symptoms. In: Journal of Clinical Neuroscience. 2015.
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AU - Ishii, T.

AU - Hasegawa, T.

AU - Suzuki, N.

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