Journal of Pediatric Neurosciences
CASE REPORT
Year
: 2020  |  Volume : 15  |  Issue : 3  |  Page : 325--327

Early-onset parkinsonism and halo sign: Beta-propeller protein-associated neurodegeneration


Debopam Samanta1, Raghu Ramakrishnaiah2 
1 Child Neurology Division, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
2 Division of Neuroradiology and Pediatric Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA

Correspondence Address:
Dr. Debopam Samanta
1 Children’s Way, Little Rock, Arkansas, AR.
USA

A 13-year-old girl with infantile-onset self-resolving epilepsy and developmental delay had an unremarkable workup, including normal brain magnetic resonance imaging (MRI) and chromosomal microarray. During adolescence, she presented with features of early-onset parkinsonism: gait dyspraxia, freezing during walking, cogwheel rigidity in both upper extremities, and left arm dystonia. Repeat brain MRI showed iron deposition on the substantia nigra (SN) and basal ganglia, with hyperintense halo sign around a central linear hypointensity within the SN on the T1 imaging sequence. Whole-exome sequencing with trio revealed de novo heterozygote mutation in WDR45 to confirm the diagnosis of beta-propeller protein-associated neurodegeneration (BPAN). BPAN is a rare neurodegenerative with brain iron accumulation disorder with the pathognomonic halo sign. Preferential iron deposition over the SN compared to globus pallidus can distinguish this condition from other iron storage disorders. BPAN does not cause the radiologic eye of the tiger sign seen in other forms of iron storage disorders. Other types of childhood-onset parkinsonian disorders, such as PINK1-related Parkinson disease and Parkin-type Parkinson disease, do not have iron storage in the brain. This report describes a case of early-onset parkinsonism secondary to a mutation in WDR45. It underscores the importance of brain MRI to differentiate this condition from other childhood-onset parkinsonism and also other brain iron accumulation disorders. This report also shows iron deposition over the pituitary as a novel site of iron deposition in BPAN and emphasizes the presence of peri-dentate white matter volume loss and hyperintensity, which is another key radiologic abnormality associated with BPAN.


How to cite this article:
Samanta D, Ramakrishnaiah R. Early-onset parkinsonism and halo sign: Beta-propeller protein-associated neurodegeneration.J Pediatr Neurosci 2020;15:325-327


How to cite this URL:
Samanta D, Ramakrishnaiah R. Early-onset parkinsonism and halo sign: Beta-propeller protein-associated neurodegeneration. J Pediatr Neurosci [serial online] 2020 [cited 2021 Oct 23 ];15:325-327
Available from: https://www.pediatricneurosciences.com/article.asp?issn=1817-1745;year=2020;volume=15;issue=3;spage=325;epage=327;aulast=Samanta;type=0