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Istoric
Boala Menkes
Patologie
Cuprul
citocrom C oxidaza
superoxid dismutaza
lizil oxidaza
tirozinaza
acid ascorbic oxidaza
ceruloplasmina si beta dopamin hidroxilaza.
Patologie cont.
Frecventa
Incidenta:
1:50.000 la 1:250.000.
Sex
Varsta
Debut
nu reusesc sa evolueze
Clinica
Examen
fizic
Clinica
Examen
Facies
fizic
Clinica
Examen fizic
Afectiunivasculare:
rupturi arteriale
anevrisme ale arterelor brahiale, lombare si iliace.
anevrisme ale venei jugulare interne
hipoplazia arterei pulmonare
Modificarischelet:
figura 3
oase sinuase
largirea metafizei la coaste si femur cu formare
osteofite lateral de aici fracturi (fig. 4)
fracturi congenitale si deformari ( fig.3) .
osteoporoza
reactie periostale diafizara
distantarea partiala posterioara a corpurilor
vertebrale
oase vormiene
pectus excavatus
figura 4
Clinica
Examen fizic
Diatezehemoragice
Calculirenali
Pacienticusindromulcornuluioccipital sunt
afectati predominant prin modificari ale tesutului
conjunctiv si osos:
incluzand piele hiperelastica sau/si hipersensibila
(fig. 5)
articulatiile sunt hiperextensibile
avem hernii, diverticuloza vezicala
anormalitati osoase incluzand exostoza occipitala
(coarne) care sunt calcificate, aceste calcificari au
margini ascutite in cadrul insertiei tendinoase
occipitale a muschiului trapez si SCM (fig. 6)
coarnele pot fi absente in copilarie. Acesti pacienti
pot avea retard mental moderat si disfunctie
autonoma
figura 5
figura 6
Cauze
Diagnostic diferential
Boala Leigh
O boala genetica rara neuro-metabolica ce afecteaza SNC
Apare la copii cu varsta intre 3 luni si 2 ani
Cauzata de mutatii in ADN-ul mitocondrial sau prin deficiente ale enzimei piruvatdehidrogenaza
Simptomele evolueaza rapid: ingreunarea procesului de supt, pierderea controlului motric,
slabiciune, lipsa tonusului muscular, insuficienta respiratorie si renala
Fenilcetonuria
O boala genetica ce duce la cresterea concentratiei aminoacidului fenilalanina
Netratata duce la retard mental
Semnele sunt reprezentate de depigmentarea pielii si a parului, crestere deficitara (intarzaiata)
Examen paraclinic
Teste de diagnostic
Examen paraclinic
Teste de diagnostic
Catecolaminele plasmatice:
nivel scazut de noradrenalina
Raport crescut hidroxilfenilalanina (DOPA) si dihidrofenilglicol (DHPG)
datorita scaderii activitatii betadopaminhidroxilazei. Valori mai ridicate arata
severitatea bolii.
> 5 in ser (N = 1.7 3.3)
> 1 in LCR (N = 0.3-0.7)
Valori in urina ale raportului dintre acidul homovanilic si cel vanilmandelic >
4 a fost observat in 2005 la 0.18% dintre pacienti in studiul Matsuo
Examen paraclinic
Teste de diagnostic
Examen paraclinic
Studii imagistice
CT
IRM
Examen paraclinic
Alte teste
Stadiul incipient:
in criza la EEG apar spike-uri ale unor unde lente in regiunile posterioare
intre crize unde lente polimorfice si multifocale sau mixtura undelor lente cu
spike-uri
Stadiul tardiv
Sfaturi
genetice
in familiile cu un copil afectat, se face testare genetica
prenatala aplicat pentru viitoarele sarcini
reabilitare, fizioterapie
pacientii au deformari osoase si un risc crescut permanent
de a face fracturi
Tratament
oral:
Tratament cont.
Cupru-histidina
Prognostic
Majoritatea pacientilor netratati, cu forma clasica, mor pana in 3 ani.
Alexandru
nascut in 2003, august, este primul caz Menkes diagnosticat din tara
primul copil dorit al unui cuplu tanar ( mama -28 ani, tata 29 ani),
aparent sanatosi.
greutatea la nastere =3000g, lungime = 49 cm, acestea fiind normale
prezenta unui cefalhematom occipito-temporal drept si a sternului
infundat cu torace excavat au ingrijorat familia.
Evolutia a fost marcata de:
hipotonie
intarziere psihomotorie in primele luni
la varsta de 5 luni au aparut crize de epilepsie.
Treptat, faciesul si parul au luat un aspect caracteristic, iar la varsta de 7 luni
i s-a diagnosticat boala: sindromul Menkes.
Danut
frecvent convulsii
la 5 luni nu facea nimic din ce trebuia sa faca un sugar de varsta aceea.
Bibliografie
Adaletli I, Omeroglu A, Kurugoglu S, et al. Lumbar and iliac artery aneurysms in Menkes'
disease: endovascular cover stent treatment of the lumbar artery aneurysm. Pediatr
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ATP7A gene for Menkes disease/occipital horn syndrome in three affected males in a single
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Bibliografie cont.
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Hardman B, Michalczyk A, Greenough M, et al. Hormonal regulation of the Menkes and Wilson coppertransporting ATPases in human placental Jeg-3 cells. Biochem J. Mar 1 2007;402(2):241-50. [Medline].
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Bibliografie cont.
Kodama H, Gu YH, Mizunuma M. Drug targets in Menkes disease - prospective developments. Expert Opin Ther
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Lane C, Petris MJ, Benmerah A, et al. Studies on endocytic mechanisms of the Menkes copper-translocating P-type
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deficiency and apoptosis in primary neurons, PC12 and SHSY-5Y cells. Neurobiol Dis. Sep 2006;23(3):725-30.
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Bibliografie cont.
Pedespan JM, Jouaville LS, Cances C, et al. Menkes disease: study of the mitochondrial respiratory chain in three
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Petris MJ, Mercer JF. The Menkes protein (ATP7A; MNK) cycles via the plasma membrane both in basal and
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Tumer Z, Birk Moller L, Horn N. Screening of 383 unrelated patients affected with Menkes disease and finding of
57 gross deletions in ATP7A. Hum Mutat. Dec 2003;22(6):457-64. [Medline].
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