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Open Access Case report

Severe and rapidly progressing cognitive phenotype in a SCA17-family with only marginally expanded CAG/CAA repeats in the TATA-box binding protein gene: A case report

Troels Tolstrup Nielsen12*, Skirmante Mardosiene3, Annemette Løkkegaard3, Jette Stokholm1, Susanne Ehrenfels3, Sara Bech2, Lars Friberg4, Jens Kellberg Nielsen5 and Jørgen E Nielsen12

Author Affiliations

1 Memory Disorders Research Group, Neurogenetics Clinic, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark

2 Department of Cellular and Molecular Medicine, Section of Neurogenetics, The Panum Institute, University of Copenhagen, Copenhagen, Denmark

3 Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark

4 Department of Clinical Physiology and Nuclear Medicine, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark

5 Department of Radiology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark

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BMC Neurology 2012, 12:73  doi:10.1186/1471-2377-12-73

Published: 13 August 2012

Abstract

Background

The autosomal dominant spinocerebellar ataxias (SCAs) confine a group of rare and heterogeneous disorders, which present with progressive ataxia and numerous other features e.g. peripheral neuropathy, macular degeneration and cognitive impairment, and a subset of these disorders is caused by CAG-repeat expansions in their respective genes. The diagnosing of the SCAs is often difficult due to the phenotypic overlap among several of the subtypes and with other neurodegenerative disorders e.g. Huntington’s disease.

Case presentation

We report a family in which the proband had rapidly progressing cognitive decline and only subtle cerebellar symptoms from age 42. Sequencing of the TATA-box binding protein gene revealed a modest elongation of the CAG/CAA-repeat of only two repeats above the non-pathogenic threshold of 41, confirming a diagnosis of SCA17. Normally, repeats within this range show reduced penetrance and result in a milder disease course with slower progression and later age of onset. Thus, this case presented with an unusual phenotype.

Conclusions

The current case highlights the diagnostic challenge of neurodegenerative disorders and the need for a thorough clinical and paraclinical examination of patients presenting with rapid cognitive decline to make a precise diagnosis on which further genetic counseling and initiation of treatment modalities can be based.

Keywords:
Spinocerebellar ataxia type 17; Dementia; Short CAG repeat expansion