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ARTICLES
Year : 1973  |  Volume : 21  |  Issue : 1  |  Page : 40-42

Juvenile amaurotic family idiocy with cherry-red spot and cataract


1 Department of Ophthalmology, Mahatma Gandhi Medical College, Indore, India
2 Department of Medicine, Mahatma Gandhi Medical College, Indore, India

Correspondence Address:
M C Nahata
Department of Ophthalmology, Mahatma Gandhi Medical College, Indore
India
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Source of Support: None, Conflict of Interest: None


PMID: 4793008

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How to cite this article:
Nahata M C, Sethi P K, Chhabra M L, Khandekar J D, Dixit V P, Mukerji D P. Juvenile amaurotic family idiocy with cherry-red spot and cataract. Indian J Ophthalmol 1973;21:40-2

How to cite this URL:
Nahata M C, Sethi P K, Chhabra M L, Khandekar J D, Dixit V P, Mukerji D P. Juvenile amaurotic family idiocy with cherry-red spot and cataract. Indian J Ophthalmol [serial online] 1973 [cited 2020 Nov 27];21:40-2. Available from: https://www.ijo.in/text.asp?1973/21/1/40/31418

Ever since the description of pigmentary macular degeneration in cases of juvenile amaurotic family idiocy by BATTEN, [3] numerous reports of this disease have appeared in lite­rature. The occurrence of cherry-red spot in adults, however, has been ex­ceptional. WYBURN-MASON [13] report­ed one, PESME AND VERGER [7] -two, SMITH [9] -one, ANDERSON, MARGOLIS AND LYNN-two, COBB-VILLANI-­three, and TITTARELLI, GIAGHEDDU AND SPADETTA [10] one case of amauro­tic family idiocy in adults exhibiting cherry-red spots. To our knowledge, cataract has not yet been reported in amaurotic family idiocy.


  Case Reports Top


Case No. 1:-B.J. 19 years, male farmer was admitted in the M. Y. Hospital on 30-4-69 with the com­plaints of vertigo, gradually progres­sive weakness in all four extremities and change in speech since last three years. Since one year he was having difficulty in writing suggestive of cere­bellar dysfunction. He also had gene­ralised epileptiform convulsions twice within the last year. Central nervous system examination revealed bilateral cerebellar ataxia as evidenced by ver­tigo, scanning speech, dysmetria, dys­diadochokinesis, trunkal ataxia and ataxic gait. There was no nystagmus. He had marked hyper-reflexia, ankle clonus and absent cremastric reflexes on both sides, indicative of bilateral pyramidal tract affection. Higher functions and other systems did not reveal any abnormality.

The visual acuity was 6/9 for dis­tance, and N 6 for near each eye. The ocular movements, central and peri­pheral fields of vision and intra-ocular tension were normal. Slit-Lamp exa­mination revealed a bilaterally similar cataract. In the lens, the region of the infantile and adult nucleus was studded with numerous punctate scin­tilating opacities. A few opacities were present in the region of the em­bryonic, and the foetal nuclei and so also in the subcapsular regions. The disc and blood vessels were found normal on fundus examination. In the central area there was a greyish­white areola extending approximately two disc diameters horizontally and a little less vertically, surrounding a wine-red spot, the so called cherry­red spot.


  Investigations Top


Urine, V.D.R.L. & C.S.F.-were normal.

Blood:-Vacuoles in the cytoplasm were observed in 14 per cent of lym­phocytes.

E.E.G.:-Showed diffuse slow waves in all leads.

Case No. 2:-S.N. 16 years, male farmer, the brother of case 1, was admitted to the M.Y. Hospital with -the complaint of dimness of vision-, for distance since the last four years. Central nervous system examination revealed first degree nystagmus, inten­tion tremors and incoordination, sug­gestive of cerebellar affection. The ocular movements were normal. The deep reflexes were exaggerated. Other systems did not reveal any abnormal­ity. The visual acuity was 6/60 for .distance, which improved to 6/9.with correction of his compound myopic astigmatism. He could read N 6 print for near. The peripheral fields of vision were constricted, the :central fields being normal. The--lens changes and the fundus picture were similar to those of Case 1. The ocu­lar tension was. normal.


  Investigations Top


Urine, V.D.R.L. and C.S.F.-were normal.

Brood: Vacuoles in the cytoplasm were observed in 9 per cent of lym­phocytes.

-E.E.G.:--There were spikes and short waves present in the tracings suggestive of a borderline epileptiform disorder.

The other members of the family were called but did not turn up for examination. However both the pati­ents were reasonably sure that similar symptoms did not occur in the family in the last two generations.


  Discussion Top


In both the cases the diagnosis of juvenile amaurotic idiocy was based on the clinical features of age of onset of symptoms, typical wine-red spots at the maculae, diffuse neurological signs suggestive of cerebro-cerebellar affection and the presence of vacuo­lated, lymphocytes in the peripheral blood smears. However the feature of mental deficiency was conspicuously absent.

In general the age of onset and the natural history of this disease tends to follow, a set pattern in a particular family (ANDERSON et , al,[1] COBB,[4] VILLANI[11]) . In our cases the ages at which the symptoms first appeared were 16 years and 12 years respectively. However in the younger, brother the optic nerve involvement was more marked and the cerebellar signs were 'less, perhaps due to lipidosis affecting different sites of the neuroectoderm. This can be considered to be the cause of the different field defects in case No. 2 (S.N.) from those observed by TITTARELLI et al.[10]

Lipidosis affecting the ganglion cells of the retina is responsible for the oedematous changes -appearing in them and thus permitting. the .choroi­dal reflex to become prominent through the thin fovea centralis, which manifests as the cherry red spot. This spot, is commonly seen in cases of Tay-Sachs' disease. Presence of similar spots in metabolic disorders in adults is extremely rare. However we could note citations of eleven cases with cherry red spots in adults with amaurotic family idiocy.

The occurrence of vacuoles in the cytoplasm of lymphocytes in juvenile family idiocy has been noted by BAGH AND HORTLING,[2] RAYNER[8] and others. FUKUDA AND MIURA[6] studied these vacuolated lymphocytes with the elec­tron microscope and suggested that these vacuoles may contain lipids. In our cases vacuoles in the cytoplasm occurred in 14 per cent in case No. 1 and in 9 per cent of lymphocytes in case No. 2.

The most unusual feature was the presence of cataracts in both the brothers. These cataracts can be considered to be typical. We could find no mention of morphologi­cally similar cataracts in any of the commonly known congenital types. Punctate scintilating opacities were present in all the nuclei of the lens including few very small opacities in the zone of the embryonic nucleus. Presence of bilaterally similar cata­racts in two brothers indicates a com­mon genetic origin.

Whether the cataracts and the lipoid disorder are the result of two different genetic disorders occurring together coincidentally or have the same gene­tic origin is difficult to say.

It is suggested that more cases of juvenile amaurotic family idiocy should be examined by the slit lamp as these finer lenticular changes are likely to be missed during routine exa­mination.


  Summary Top


Two brothers suffering from juve­nile amaurotic family idiocy are re­ported.

The unusual features in these cases were the presence of cherry-red spots at the maculae, absence of idiocy, vacuolated lymphocytes in blood and cataracts.

 
  References Top

1.
Anderson B. Margolis, G. and Lynn. W. S.: Ocular lesions related to disturbances in fat metabolism. Amer. J. Ophthal. 45: No. 4, Pt. II, p. 23, 1958.  Back to cited text no. 1
    
2.
Bagh von and Hortling: Nord. Med. 38: 1072, 1948. Cited in 5.  Back to cited text no. 2
    
3.
Batten, F. E.: Cerebral degenera­tion with symmetrical changes in the maculae in two members of a family. Trans. Ophthal. Soc. U.K. 23: 386. 1903.  Back to cited text no. 3
    
4.
Cobb, W.: Personal Commun. Cited in 10.  Back to cited text no. 4
    
5.
Duke-Elder, S. and Dobree, J. H.: System of Ophthalmology, Vol. 10, p. 480. Henry Kimpton, London, 1967.  Back to cited text no. 5
    
6.
Fukuda, K. and Miura, A. B.: The ultrastructure of vacuolated lympho­cytes in the peripheral blood of Juvenile Amaurotic Familial Idiocy. Tohoku J. Med. 89: 113, 1966, taken from: Ophthal. Lit. 20, of 1966, No. 2892.  Back to cited text no. 6
    
7.
Pesme. P. and Verger, P.: Bull. Soc. franc. Ophthal. 59: 56, 1946. Cited in 10.  Back to cited text no. 7
    
8.
Rayner: Acta genet. (Basel), 3: 1, 1952. Cited in 5.  Back to cited text no. 8
    
9.
Smith, J. L.: Cited in 12, p. 668.  Back to cited text no. 9
    
10.
Tittarelli, R., Giagheddu, M. and Spadetta, V.: Typical Ophthalmo­scopic picture of "Cherry-red spot" in an adult with the myoclonic syn­drome. Brit. J. Ophthal. 50: 414, 1966.  Back to cited text no. 10
    
11.
Villant, G.: Personal Commun. 1964, Cited in 10.  Back to cited text no. 11
    
12.
Walsh, F. B.: Clinical Neuro-Oph­thalmology. Ed. 2, p. 668. Williams and Wilkins, Baltimore, - 1957.  Back to cited text no. 12
    
13.
Wyburn-Mason, R.: On some ano­malous. forms of amaurotic idiocy and their bearing on the relation­ship of the various types. Brit. J. Ophthal. 27: 145, 193, 1943.  Back to cited text no. 13
    




 

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