The Perirolandic Sign: A Unique Imaging Finding Observed in Association with Polymerase γ-Related Disorders

AJNR Am J Neuroradiol. 2020 May;41(5):917-922. doi: 10.3174/ajnr.A6514. Epub 2020 May 7.

Abstract

Pathogenic variants in the polymerase γ gene (POLG) cause a diverse group of pathologies known as POLG-related disorders. In this report, we describe brain MR imaging findings and electroencephalogram correlates of 13 children with POLG-related disorders at diagnosis and follow-up. At diagnosis, all patients had seizures and 12 had abnormal MR imaging findings. The most common imaging findings were unilateral or bilateral perirolandic (54%) and unilateral or bilateral thalamic signal changes (77%). Association of epilepsia partialis continua with perirolandic and thalamic signal changes was present in 86% and 70% of the patients, respectively. The occipital lobe was affected in 2 patients. On follow-up, 92% of the patients had disease progression or fatal outcome. Rapid volume loss was seen in 77% of the patients. The occipital lobe (61%) and thalamus (61%) were the most affected brain regions. Perirolandic signal changes and seizures may represent a brain imaging biomarker of early-onset pediatric POLG-related disorders.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Brain / diagnostic imaging*
  • Brain / pathology
  • Child
  • Child, Preschool
  • DNA Polymerase gamma / genetics
  • Electroencephalography
  • Female
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Mitochondrial Diseases / diagnostic imaging*
  • Mitochondrial Diseases / genetics
  • Mitochondrial Diseases / pathology
  • Neuroimaging / methods*
  • Retrospective Studies
  • Seizures / diagnostic imaging*
  • Seizures / genetics*
  • Seizures / pathology

Substances

  • DNA Polymerase gamma
  • POLG protein, human