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The Role of Folate Deficiency as a Potential Risk Factor for Nontraumatic Anterior Spinal Artery Syndrome in an Adolescent Girl

Nontraumatic anterior spinal artery syndrome (ASAS) is an extremely rare clinical condition in pediatric populations with a mostly unknown underlying etiology. Here we discuss the case of a previously healthy 14-year-old girl presenting with sudden onset acute flaccid paralysis to the emergency depa...

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Autores principales: Hu, Chun-Chieh, Yang, Yung-Yu, Luxton, G. W. Gant, Lin, Yu-Pang, Hung, Kuo-Sheng, Hu, Chih-Fen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9688490/
https://www.ncbi.nlm.nih.gov/pubmed/36358396
http://dx.doi.org/10.3390/brainsci12111470
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author Hu, Chun-Chieh
Yang, Yung-Yu
Luxton, G. W. Gant
Lin, Yu-Pang
Hung, Kuo-Sheng
Hu, Chih-Fen
author_facet Hu, Chun-Chieh
Yang, Yung-Yu
Luxton, G. W. Gant
Lin, Yu-Pang
Hung, Kuo-Sheng
Hu, Chih-Fen
author_sort Hu, Chun-Chieh
collection PubMed
description Nontraumatic anterior spinal artery syndrome (ASAS) is an extremely rare clinical condition in pediatric populations with a mostly unknown underlying etiology. Here we discuss the case of a previously healthy 14-year-old girl presenting with sudden onset acute flaccid paralysis to the emergency department. A spinal STIR/DWI MRI revealed hyperintensities extending from cervical vertebrae C3-6, consistent with the diagnosis of ASAS. In order to determine any precipitating causes of ASAS, we also extensively investigated established potential risk factors for ASAS in our patient and noticed that she had a marked folate deficiency requiring folic acid supplementation to prevent future episodes of ASAS as well as to repair the patient’s injured spinal cord. Interestingly, the patient did not display elevated levels of homocysteine nor did she possess the three pathogenic MTHFR mutations characteristic of ASAS. Although her folate deficiency did not cause responsive hyperhomocysteinemia, and she did not have pathogenic MTHFR mutations that impair the function of methylenetetrahydrofolate reductase in folate cycle, we suggest that isolated folate deficiency may play a role in adolescent cases of ASAS that, once identified, would require prompt identification and early intervention to improve the prognosis of these patients.
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spelling pubmed-96884902022-11-25 The Role of Folate Deficiency as a Potential Risk Factor for Nontraumatic Anterior Spinal Artery Syndrome in an Adolescent Girl Hu, Chun-Chieh Yang, Yung-Yu Luxton, G. W. Gant Lin, Yu-Pang Hung, Kuo-Sheng Hu, Chih-Fen Brain Sci Case Report Nontraumatic anterior spinal artery syndrome (ASAS) is an extremely rare clinical condition in pediatric populations with a mostly unknown underlying etiology. Here we discuss the case of a previously healthy 14-year-old girl presenting with sudden onset acute flaccid paralysis to the emergency department. A spinal STIR/DWI MRI revealed hyperintensities extending from cervical vertebrae C3-6, consistent with the diagnosis of ASAS. In order to determine any precipitating causes of ASAS, we also extensively investigated established potential risk factors for ASAS in our patient and noticed that she had a marked folate deficiency requiring folic acid supplementation to prevent future episodes of ASAS as well as to repair the patient’s injured spinal cord. Interestingly, the patient did not display elevated levels of homocysteine nor did she possess the three pathogenic MTHFR mutations characteristic of ASAS. Although her folate deficiency did not cause responsive hyperhomocysteinemia, and she did not have pathogenic MTHFR mutations that impair the function of methylenetetrahydrofolate reductase in folate cycle, we suggest that isolated folate deficiency may play a role in adolescent cases of ASAS that, once identified, would require prompt identification and early intervention to improve the prognosis of these patients. MDPI 2022-10-29 /pmc/articles/PMC9688490/ /pubmed/36358396 http://dx.doi.org/10.3390/brainsci12111470 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Hu, Chun-Chieh
Yang, Yung-Yu
Luxton, G. W. Gant
Lin, Yu-Pang
Hung, Kuo-Sheng
Hu, Chih-Fen
The Role of Folate Deficiency as a Potential Risk Factor for Nontraumatic Anterior Spinal Artery Syndrome in an Adolescent Girl
title The Role of Folate Deficiency as a Potential Risk Factor for Nontraumatic Anterior Spinal Artery Syndrome in an Adolescent Girl
title_full The Role of Folate Deficiency as a Potential Risk Factor for Nontraumatic Anterior Spinal Artery Syndrome in an Adolescent Girl
title_fullStr The Role of Folate Deficiency as a Potential Risk Factor for Nontraumatic Anterior Spinal Artery Syndrome in an Adolescent Girl
title_full_unstemmed The Role of Folate Deficiency as a Potential Risk Factor for Nontraumatic Anterior Spinal Artery Syndrome in an Adolescent Girl
title_short The Role of Folate Deficiency as a Potential Risk Factor for Nontraumatic Anterior Spinal Artery Syndrome in an Adolescent Girl
title_sort role of folate deficiency as a potential risk factor for nontraumatic anterior spinal artery syndrome in an adolescent girl
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9688490/
https://www.ncbi.nlm.nih.gov/pubmed/36358396
http://dx.doi.org/10.3390/brainsci12111470
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