Clinical and Cognitive Features of Four Patients with Hereditary Cerebral Small Vessel Disease Caused by Notch3 Gene Mutation

doi:10.3969/j.issn.1673-5765.2018.09.006

Abstract

Abstract:

Objective To analyze and compare the clinical and cognitive features of four patients with hereditary cerebral small vessel disease (CSVD) caused by Notch3 gene mutation. Methods The clinical data of four hereditary CSVD patients with Notch3 gene mutation were collected. Initial symptom, clinical manifestation, imaging feature, auxiliary examinations, gene detection and neuropsychological assessment were analyzed and compared. Results For reasons of seeing a doctor, two patients were acute stroke, one was cognitive impairment and the other one was dizziness and headache. One acute stroke patient also had familial alopecia and lumbago. Two patients had risk factors of cerebrovascular disease. Magnetic resonance imaging of four patients all showed white matter lesions in different degree and not in the same location. NOTCH3 gene mutation of four patients located at exon 3, 4, 20 and 11, respectively. Neuropsychological assessment suggested they all had cognitive impairment, and the evaluation results showed an obvious decline in executive function, language, abstract thinking and delayed memory, but not obvious change in orientation, calculation, naming, attention and etc. Conclusion Hereditary CSVD patients caused by Notch3 gene mutation have different clinical features, which have heterogeneity among these individuals.

Key words: NOTCH3 gene; Hereditary cerebral small vessel disease; Neuropsychological assessment

摘要：

目的对4例NOTCH3基因突变的遗传性脑小血管病患者的临床及认知特点进行分析比较。

方法回顾性收集2015年5月-2017年9月天津市环湖医院神经内科收治的4例NOTCH3基因突变的遗传性脑小血管病患者的临床资料，分析其首发症状、临床表现、影像学检查、辅助检查、基因检测及相关神经心理学评估等方面的特点。

结果 4例NOTCH3基因突变的患者中2例以急性缺血性卒中，1例以认知功能障碍，1例以头晕头痛就诊，其中1例患者除了有急性卒中症状外还伴有家族性秃头和腰痛。4例患者中2例伴有脑血管病危险因素。4例患者头颅MRI 均可见不同程度皮质下脑白质损害，但部位不完全相同。4例患者基因检测分别在19号染色体NOTCH3基因3号，4号，20号，11号外显子发生杂合突变。4例患者神经心理学评估均提示存在认知功能障碍，主要在执行功能、语言、抽象能力及延迟回忆方面分值降低，而在定向力、计算力、命名、注意力等方面降低不明显。

结论 NOTCH3基因突变的遗传性脑小血管病患者在临床特征方面有各自不同的特点，个体间存在异质性。

关键词: NOCTH3基因; 遗传性脑小血管病; 神经心理学评估

CHEN Yuan, ZHOU Yu-Ying, WANG Yan, ZHANG Hui-Hong. Clinical and Cognitive Features of Four Patients with Hereditary Cerebral Small Vessel Disease Caused by Notch3 Gene Mutation[J]. Chinese Journal of Stroke, 2018, 13(09): 915-921.

陈嫄, 周玉颖, 王艳, 张惠红. 4例NOTCH3 基因突变的遗传性脑小血管病患者临床及认知特点[J]. 中国卒中杂志, 2018, 13(09): 915-921.

References

[1] SMITH E E，SCHNEIDER J A，WARDLAW J

M，et al. Cerebral Microinfarcts：The Invisible

Lesions[J]. Lancet Neurology，2012，11（3）：272.

[2] OPHERK C，GONIK M，DUERING M，et

al. Genome-wide genotyping demonstrates a

polygenic risk score associated with white matter

hyperintensity volume in CADASIL[J]. Stroke，2014，

45（4）：968-972.

[3] NOZAKI H，NISHIZAWA M，ONODERA O.

Hereditary cerebral small-vessel disease[J]. Nihon

Rinsho，2013，71（3）：545-554.

[4] 孙一志，吴志英. CADASIL患者的临床、影像和

Notch3基因突变特点及我国研究现状[J]. 中国卒中

杂志，2012，7（2）：136-140.

[5] PANTONI L. Cerebral small vessel disease：from

pathogenesis and clinical characteristics to

therapeutic challenges[J]. Lancet Neurology，2010，9

（7）：689-701.

[6] CHOI J C. Genetics of Cerebral Small Vessel

Disease[J]. J Stroke，2015，17（1）：7-16.

[7] 任志霞，时英英，陈祖芝，等. 来自19个家系37例伴有

皮质下梗死和白质脑病的常染色体显性遗传性脑动

脉病的临床影像及NOTCH3基因突变特征分析[J].

中华神经科杂志，2017，50（8）：613-618.

[8] TAN Q C，ZHANG J T，CUI R T，et al.

Characteristics of CADASIL in Chinese mainland

patients[J]. Neurology India，2014，62（3）：257.

[9] GE W，KUANG H，WEI B，et al. A Novel Cysteine-

Sparing，NOTCH3，Mutation in a Chinese

Family with CADASIL[J/OL]. PloS one，2014，9

（8）：e104533. https：//journals.plos.org/plosone/

article?id=10.1371/journal.pone.0104533.

[10] YAMAMOTO Y，IHARA M，THAM C，et al.

Neuropathological Correlates of Temporal Pole

White Matter Hyperintensities in CADASIL[J].

Stroke，2009，40（6）：2004-2011.

[11] WANG Z，YUAN Y，ZHANG W，et al. NOTCH3

mutations and clinical features in 33 mainland

Chinese families with CADASIL[J]. J Neurol

Neurosurg Psychiatry，2011，82（5）：534-539.

[12] LEE Y，LIU C M，LIN K，et al. Population-specific

spectrum of NOTCH3 mutations，MRI features

and founder effect of CADASIL in Chinese[J]. J Neurology，2009，256（2）：249-255.

[13] 袁云. CADASIL的诊断与鉴别诊断[J]. 中国神经精

神疾病杂志，2007，33（11）：641-643.

[14] YAMADA H，YASUDA T，KOTORII S，et al.

Report of a patient with CADASIL having a novel

missense mutation of the Notch 3 gene--association

with alopecia and lumbar herniated disk[J]. Rinshō

shinkeigaku，2001，41（2-3）：144-146.

[15] CHARIDIMOU A，PANTONI L，LOVE S. The

concept of sporadic cerebral small vessel disease：A

road map on key definitions and current concepts[J].

Int J Stroke，2016，11（1）：6-18.

[16] CRAGGS L J，YAMAMOTO Y，DERAMECOURT

V，et al. Microvascular pathology and morphometrics

of sporadic and hereditary small vessel diseases of

the brain[J]. Brain Pathology，2014，24（5）：495-

509.

[17] LIEM M K，LESNIK OBERSTEIN S A，Haan J，et

al. MRI correlates of cognitive decline in CADASIL：

a 7-year follow-up study[J]. Neurology，2009，72（2）：

143-148.

[18] CHARLTON R A，MORRIS R G，NITKUNAN

A，et al. The cognitive profiles of CADASIL and

sporadic small vessel disease[J]. Neurology，2006，

66（10）：1523-1526.

[19] BARNAY J L，WAUQUIEZ G，BONNIN-KOANG

H Y，et al. Feasibility of the Cognitive Assessment

scale for Stroke Patients（CASP）vs . MMSE and

MoCA in aphasic left hemispheric stroke patients[J].

Annals of Physical & Rehabilitation Medicine，2014，

57（6-7）：422-435.

[20] 郭艳，蒋超. MoCA和MMSE量表在脑小血管病性认

知障碍中的应用比较[J]. 中国老年学，2014，34（4）：

897-898.