Brain MRI findings in patients with Fabry disease

BackgroundTo evaluate the presence of ischemic and hemorraghic lesions in brain MRI of patients with Fabry disease (FD).MethodsBrain MRI studies in 46 consecutive patients were evaluated using classic sequences as well as GRE-weighted images, for ischemic lesions and chronic microbleed detection.Of the 36 adult patients (15 males, mean age 31.2 years; 21 females, mean age 41.6 years). All had signs or symptoms of FD but lacked history of stroke or TIA.ResultsTen patients under 20 years of age initially presented a normal MRI. One child developed a hyperintense occipital lesion on T2-weighted imaging during control MRI.Sixteen adult patients (44.4%) had brain MRI evidence of small vessel disease in the basal ganglia, corona radiata, thalamus or brainstem, as well as in the periventricular white matter. Patients with MRI abnormalities were older (45.6 vs 30.9 years, p = 0.005), with more vascular risk factors (1.2 vs 0.6 p = 0.043).Three women (mean age 59.5 years) presented deep chronic microbleeds identified by GRE. Moreover, Flair and T2-weighted images revealed white matter disease and deep gray matter involvement.Conclusion44.4% of adult patients with FD without clinical history of CVA or prior dialysis had evidence of small vessel disease on MRI and 11% showed cerebral microbleeds.FD is a treatable disorder that should be routinely included in the differential diagnosis of ischemic and microhemorraghic lesions in young adults.