Expanding Role of Proton Magnetic Resonance Spectroscopy: Timely Diagnosis and Treatment Initiation in Partial Ornithine Transcarbamylase Deficiency

Kuntal Sen, Carlos Castillo Pinto, Andrea L Gropman, Kuntal Sen, Carlos Castillo Pinto, Andrea L Gropman

Abstract

We report the case of a 3-year-old male patient who presented with a 3-day history of altered mental status, emesis, and abdominal pain in the setting of a viral illness. A rapid screening revealed a high ammonia level and after reviewing his proton magnetic resonance spectroscopy (1H MRS) which showed the classic triad of high glutamate, low choline, and myoinositol, a diagnosis of ornithine transcarbamylase deficiency (OTCD) was made within 6 hours of presentation. Therapy with sodium phenylbutyrate and sodium benzoate was initiated and patient was discharged after 3 days with no neurologic disability. Biochemical and molecular testing eventually confirmed the diagnosis. 1H MRS is a practical and fast neuroimaging modality that can aid in diagnosis of OTCD and enables faster initiation of treatment in acute settings.

Keywords: multimodal neuroimaging; partial OTC deficiency; proton MR spectroscopy.

Conflict of interest statement

Conflict of Interest None declared.

Thieme. All rights reserved.

Figures

Fig. 1
Fig. 1
Single voxel magnetic resonance spectroscopy (left basal ganglia) shows an elevated glutamine and glutamate peak complex and reduction of myoinositol, and choline was mildly depressed (purple: control, black: ornithine transcarbamylase deficiency patient).

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Source: PubMed

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