2023 Volume 93 Issue 2 Pages 67-72
Tay-Sachs disease involves accumulation of GM2 gangliosides in lysosomes due to a metabolic disorder of brain-abundant gangliosides. In the infantile type, death typically occurs by 3 years of age. We report brain magnetic resonance imaging (MRI) abnormalities in a case of infantile Tay-Sachs disease. The 8-month-old patient had development delay and began regression at 1 year of age. A cherry-red fundus spot and low β-hexosaminidase A (Hex A) levels in leukocytes indicated GM2 gangliosidosis. Gene analysis identified homozygous pathogenic variants in the HEXA gene, leading to Tay-Sachs disease diagnosis.
At 10 months of age, brain MRI showed age-appropriate myelination. At 1 year 9 months, T2-weighted imaging showed high intensity in the subcortical white matter, with delayed myelination. At 2 years 4 months, the cerebral white matter, putamen, caudate nucleus, thalami (except ventral), middle cerebellar peduncle, and dentate nucleus showed high intensity on T2-weighted imaging. At 5 years 8 months, cerebral and basal ganglia atrophy was observed. The caudate nucleus and putamen showed high intensity on T1-weighted images and low intensity on T2-weighted images. Unlike typical infantile Tay-Sachs characteristics, higher Hex A activity in this case probably contributed to a milder phenotype and myelination acquisition during infancy.
