Subdural hemorrhage as an initial sign of glutaric aciduria type 1: a diagnostic pitfall

Pediatr Radiol. 1996 Nov;26(11):779-81. doi: 10.1007/BF01396200.

Abstract

The case of a 9-month-old girl with glutaric aciduria type 1 (GA 1) is reported. On initial presentation at 6 months of age, the patient demonstrated bilateral subdural hemorrhages and widening of the basal cisterns. After neurosurgical intervention the subdural effusions regressed; their etiology remained unclear. At the age of 9 months the patient presented again because of progressive loss of psychomotor abilities and a dystonic movement disorder. Cerebral MRI revealed regressive subdural hematoma, but marked frontotemporal atrophy as well. Because of a suspected metabolic disorder, urinary analysis of organic acids was performed. This repeatedly showed marked excretion of glutaric acid, 3-hydroxyglutaric acid and glutaconic acid, indicating a diagnosis of GA 1. Considering our patient's history, we recommend the inclusion of GA 1 in the differential diagnosis of patients with unexplained subdural hematoma and neurological deficits.

Publication types

  • Case Reports

MeSH terms

  • Amino Acid Metabolism, Inborn Errors / diagnosis
  • Amino Acid Metabolism, Inborn Errors / urine
  • Atrophy
  • Cisterna Magna / diagnostic imaging
  • Cisterna Magna / pathology
  • Developmental Disabilities / diagnosis
  • Diagnosis, Differential
  • Female
  • Frontal Lobe / diagnostic imaging
  • Frontal Lobe / pathology
  • Glutarates / urine*
  • Glutaryl-CoA Dehydrogenase
  • Hematoma, Subdural / diagnosis*
  • Hematoma, Subdural / diagnostic imaging
  • Humans
  • Infant
  • Lysine / metabolism
  • Magnetic Resonance Imaging
  • Movement Disorders / diagnosis
  • Oxidoreductases / deficiency*
  • Oxidoreductases Acting on CH-CH Group Donors*
  • Psychomotor Performance
  • Temporal Lobe / diagnostic imaging
  • Temporal Lobe / pathology
  • Tomography, X-Ray Computed
  • Tryptophan / metabolism

Substances

  • Glutarates
  • Tryptophan
  • Oxidoreductases
  • Oxidoreductases Acting on CH-CH Group Donors
  • Glutaryl-CoA Dehydrogenase
  • glutaric acid
  • Lysine