Central nervous system manganese induced lesions and clinical consequences in patients with hereditary hemorrhagic telangiectasia
Abstract Background Around 47–74% of patients with hereditary hemorrhagic telangiectasia (HHT) have hepatic vascular malformations (HVMs); magnetic resonance images (MRI) of the central nervous system (CNS) might show in T1 sequences a hyper-intensity signal in different areas, mainly in the basal g...
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| Format: | Article |
| Language: | English |
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BMC
2017-05-01
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| Series: | Orphanet Journal of Rare Diseases |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13023-017-0632-2 |
| _version_ | 1818911229157048320 |
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| author | M. M. Serra C. H. Besada A. Cabana Cal A. Saenz C. V. Stefani D. Bauso A. B. Golimstok J. C. Bandi D. H. Giunta C. M. Elizondo |
| author_facet | M. M. Serra C. H. Besada A. Cabana Cal A. Saenz C. V. Stefani D. Bauso A. B. Golimstok J. C. Bandi D. H. Giunta C. M. Elizondo |
| author_sort | M. M. Serra |
| collection | DOAJ |
| description | Abstract Background Around 47–74% of patients with hereditary hemorrhagic telangiectasia (HHT) have hepatic vascular malformations (HVMs); magnetic resonance images (MRI) of the central nervous system (CNS) might show in T1 sequences a hyper-intensity signal in different areas, mainly in the basal ganglia (BG) as consequence of manganese (Mn) deposits as observed in cirrhotic patients. These patients might suffer from different neuropsychiatric disorders (hepatic encephalopathy). In HHT patients, even in the presence of hepatic shunts, hepatocellular function is usually preserved. Additionally, Mn shares iron absorption mechanisms, transferrin and CNS transferrin receptors. In iron deficiency conditions, the Mn may harbor transferrin and access BG. The objectives were to describe frequency of BG Mn deposit-induced lesions (BGMnIL) in HHT patients, its relationship with iron deficiency anemia (IDA) and HVMs. Finally, explore the association between neuropsychological and motor consequences. We performed a cross-sectional study. We determined HHT patients with or without BG-MnIL by the MRI screening of the CNS. We included all patients with lesions and a random sample of those without lesions. All patients underwent standardized and validated neuropsychological assessment to evaluate BG actions. Results were analyzed with multiple logistic regression, adjusting for potential confounders. Results Among 307 participants from a cohort included in the Institutional HHT Registry, 179 patients had MRI performed and Curaçao Criteria ≥3. The prevalence of BG-MnIL was 34.6% (95%CI 27.69-42.09). While neuropsychological symptoms were present in all patients, BG-MnIL patients performed poorly in three of the neuropsychological tests (serial dotting, line tracing time, number connection test A). HVMs frequency in BG-MnIL was 95.1%, versus 71.4% in those without lesions (p < 0.001). IDA frequency was 90.3% versus 54% (p < 0.001). When IDA is present, estimated risk for BG-MnIL is remarkably high (OR 7.73, 95%CI 2.23–26.73). After adjustment for possible confounders (gender, age, presence of HVMs), IDA was still associated with increased risk of BG-MnIL (adjusted OR 6.32, 95% CI 2.32–17.20; p < 0.001). Conclusions Physicians should assess BG-MnIL in HHT patients in CNS-MRI. IDA and HVMs present increased risk of lesions. Patients with BG-MnIL have neuropsychological impairment, and they might benefit from sparing IDA, or undergoing future therapeutic options. Trial registration NCT01761981 . Registered January 3rd 2013. |
| first_indexed | 2024-12-19T22:55:23Z |
| format | Article |
| id | doaj.art-3557844225764ed98f344413acd6f8fd |
| institution | Directory Open Access Journal |
| issn | 1750-1172 |
| language | English |
| last_indexed | 2024-12-19T22:55:23Z |
| publishDate | 2017-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Orphanet Journal of Rare Diseases |
| spelling | doaj.art-3557844225764ed98f344413acd6f8fd2022-12-21T20:02:39ZengBMCOrphanet Journal of Rare Diseases1750-11722017-05-0112111010.1186/s13023-017-0632-2Central nervous system manganese induced lesions and clinical consequences in patients with hereditary hemorrhagic telangiectasiaM. M. Serra0C. H. Besada1A. Cabana Cal2A. Saenz3C. V. Stefani4D. Bauso5A. B. Golimstok6J. C. Bandi7D. H. Giunta8C. M. Elizondo9Internal Medicine Department. Hospital Italiano de Buenos Aires. Argentina (HIBA)Radiology Department, HIBANeurology Department, HIBAARG (Argentine Rendu Study Group)Neurology Department, HIBANeurology Department, HIBANeurology Department, HIBAInternal Medicine Department. Hospital Italiano de Buenos Aires. Argentina (HIBA)Internal Medicine Department. Hospital Italiano de Buenos Aires. Argentina (HIBA)Internal Medicine Department. Hospital Italiano de Buenos Aires. Argentina (HIBA)Abstract Background Around 47–74% of patients with hereditary hemorrhagic telangiectasia (HHT) have hepatic vascular malformations (HVMs); magnetic resonance images (MRI) of the central nervous system (CNS) might show in T1 sequences a hyper-intensity signal in different areas, mainly in the basal ganglia (BG) as consequence of manganese (Mn) deposits as observed in cirrhotic patients. These patients might suffer from different neuropsychiatric disorders (hepatic encephalopathy). In HHT patients, even in the presence of hepatic shunts, hepatocellular function is usually preserved. Additionally, Mn shares iron absorption mechanisms, transferrin and CNS transferrin receptors. In iron deficiency conditions, the Mn may harbor transferrin and access BG. The objectives were to describe frequency of BG Mn deposit-induced lesions (BGMnIL) in HHT patients, its relationship with iron deficiency anemia (IDA) and HVMs. Finally, explore the association between neuropsychological and motor consequences. We performed a cross-sectional study. We determined HHT patients with or without BG-MnIL by the MRI screening of the CNS. We included all patients with lesions and a random sample of those without lesions. All patients underwent standardized and validated neuropsychological assessment to evaluate BG actions. Results were analyzed with multiple logistic regression, adjusting for potential confounders. Results Among 307 participants from a cohort included in the Institutional HHT Registry, 179 patients had MRI performed and Curaçao Criteria ≥3. The prevalence of BG-MnIL was 34.6% (95%CI 27.69-42.09). While neuropsychological symptoms were present in all patients, BG-MnIL patients performed poorly in three of the neuropsychological tests (serial dotting, line tracing time, number connection test A). HVMs frequency in BG-MnIL was 95.1%, versus 71.4% in those without lesions (p < 0.001). IDA frequency was 90.3% versus 54% (p < 0.001). When IDA is present, estimated risk for BG-MnIL is remarkably high (OR 7.73, 95%CI 2.23–26.73). After adjustment for possible confounders (gender, age, presence of HVMs), IDA was still associated with increased risk of BG-MnIL (adjusted OR 6.32, 95% CI 2.32–17.20; p < 0.001). Conclusions Physicians should assess BG-MnIL in HHT patients in CNS-MRI. IDA and HVMs present increased risk of lesions. Patients with BG-MnIL have neuropsychological impairment, and they might benefit from sparing IDA, or undergoing future therapeutic options. Trial registration NCT01761981 . Registered January 3rd 2013.http://link.springer.com/article/10.1186/s13023-017-0632-2Hepatic vascular malformationsHereditary hemorrhagic telangiectasiaBasal ganglia manganese depositsIron deficiency anemia |
| spellingShingle | M. M. Serra C. H. Besada A. Cabana Cal A. Saenz C. V. Stefani D. Bauso A. B. Golimstok J. C. Bandi D. H. Giunta C. M. Elizondo Central nervous system manganese induced lesions and clinical consequences in patients with hereditary hemorrhagic telangiectasia Orphanet Journal of Rare Diseases Hepatic vascular malformations Hereditary hemorrhagic telangiectasia Basal ganglia manganese deposits Iron deficiency anemia |
| title | Central nervous system manganese induced lesions and clinical consequences in patients with hereditary hemorrhagic telangiectasia |
| title_full | Central nervous system manganese induced lesions and clinical consequences in patients with hereditary hemorrhagic telangiectasia |
| title_fullStr | Central nervous system manganese induced lesions and clinical consequences in patients with hereditary hemorrhagic telangiectasia |
| title_full_unstemmed | Central nervous system manganese induced lesions and clinical consequences in patients with hereditary hemorrhagic telangiectasia |
| title_short | Central nervous system manganese induced lesions and clinical consequences in patients with hereditary hemorrhagic telangiectasia |
| title_sort | central nervous system manganese induced lesions and clinical consequences in patients with hereditary hemorrhagic telangiectasia |
| topic | Hepatic vascular malformations Hereditary hemorrhagic telangiectasia Basal ganglia manganese deposits Iron deficiency anemia |
| url | http://link.springer.com/article/10.1186/s13023-017-0632-2 |
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