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Progression of a globus pallidus infarct in a patient with methylmalonic acidemia

Progression of a globus pallidus infarct in a patient with methylmalonic acidemia
This 16-month-old patient was known to have MMA due to the CblB defect that had been diagnosed 6 months previously. Within 24 hours after onset of symptoms from gastroenteritis, she became lethargic and was taken to the emergency department.
(A) CT at the time of admission to the hospital appears to have normal findings.
(B) CT scan 35 hours later shows distinct hypoattenuating abnormalities involving the entirety of each GP. DWI performed 1 week later showed restricted diffusion in each GP.
(C) High-resolution MPRAGE image and (D) T2-weighted image (b = 0 image from DTI) acquired 7.5 years later demonstrate bilateral complete GP infarcts.
MMA: methylmalonic acidemia; CblB: cobalamin B; CT: computed tomography; GP: globus pallidus; DWI: diffusion-weighted imaging; MPRAGE: magnetization-prepared rapid acquisition with gradient echo; DTI: diffusion tensor imaging.
Republished with permission of the American Society of Neuroradiology, from: Baker EH, Sloan JL, Hauser NS, et al. MRI characteristics of globus pallidus infarcts in isolated methylmalonic acidemia. AJNR Am J Neuroradiol 2015; 36:194; permission conveyed through Copyright Clearance Center, Inc. Copyright © 2015.
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