一例晚期婴儿型神经元蜡样质脂褐素沉积病的临床、遗传和脑超微结构特点

Clinical, genetic and cerebral nitrastructural features of late infantile neuronal ceroid lipofuscinosis： a case report

目的通过分析1例晚期婴儿型神经元蜡样质脂褐素沉积病（LINCL）病例，探讨LINCL的临床、遗传和病理特点。方法收集1例LINCL患者的l临床表现、家族史资料，并对其脑电图（EEG）、影像学和脑组织病理活检结果进行分析。结果EEG显示弥漫背景脑电慢化，间歇期阵发全面性棘慢波及尖慢波节律。头颅MRI检查发现患儿及其胞兄脑萎缩尤以小脑萎缩明显。脑组织活检光镜下见大脑皮层弥漫性损害，可见变性、萎缩和未成熟神经元。变性及萎缩的神经元内可见嗜银颗粒沉积，电镜下神经元胞浆中可见大量脂褐素样结构。结论此例患者的临床和病理改变符合LINCL的诊断．但其特殊的家族遗传史及病理特征提示其可能为新的LINCL变异型。

Objective To study the clinical, histopathological and inheritance features of late infantile neuronal ceroid lipofuscinosis （LINCL）. Methods The clinical manifestations and family history of a 4-year-old girl with an established diagnosis of LINCL were investigated and the findings in EEG, magnetic resonance imaging （MRI） and histological examination were analyzed. Results EEG of the patient showed diffuse background slowing with bursts of generalized spike-and-wave discharges or polyspike-and-wave activity. Brain MRI for her and her brother revealed brain atrophy, especially diffuse cerebellar atrophy. Histopathological examination also showed diffuse damages in the gray matter where numerous degenerated and atrophic neurons were found. Some immature neurons occurred in the disrupted cortical lamination. Electron microscopy revealed numerous osmiophilic granular lipofuscin inclusions in the cytoplasm of the neurons. Conclusion This patient presented with typical clinical and cerebellar ultrastructural features of L1NCL, but the inheritance characteristics of the patient and the prominent lipofuscin pigments in the neurons suggest a case of new LINCL variant.