EPRS1 related hypomyelinating leukodystrophy (HLD15)

Hypomyelinating leukodystrophy
Pediatric diseases

General description

EPRS1-associated hypomyelinating leukodystrophy, also known as hypomyelinating leukodystrophy 15 (HLD15), is an autosomal recessive genetic disorder caused by mutations in the EPRS1 gene, which encodes a bifunctional aminoacyl-tRNA synthetase responsible for catalyzing the aminoacylation of glutamic acid and proline tRNA species. These mutations lead to reduced translation capacity in the central nervous system, resulting in insufficient myelination and hypomyelinating leukodystrophy.

The disease typically manifests in infancy with microcephaly and developmental delays, including motor and intellectual impairments. Affected individuals may experience ataxia, dystonia, pyramidal tract signs, and sensorineural hearing loss. Severe cases lead to difficulties in swallowing, requiring gastrostomy feeding, and most patients do not achieve independent walking. Life expectancy is significantly reduced, with death occurring by early childhood.

Non-Space occupying lesion

White matter lesion

Anatomical regions
  • Cerebrum
    Cerebral white matter
  • Cerebellum
    Cerebellar white matter
  • Middle cerebellar peduncle
Symmetric
Bilateral
Diffuse
T1WI
Isointensity
Hypointensity
T2WI
Hyperintensity

MRI shows diffuse hyperintensity on T2WI in cerebral and cerebellar white matter, as well as middle cerebellar peduncles.

Non-Space occupying lesion

Corticospinal tract lesion

Anatomical regions
  • Corticospinal tract
Symmetric
Bilateral
T2WI
Hyperintensity
Non-Space occupying lesion

Spinal lesion

Anatomical regions
  • Spinal cord
    Spinal white matter
    Posterior column
Bilateral
T2WI
Hyperintensity
Non-Space occupying lesion

Corpus callosum atrophy

Anatomical regions
  • Corpus callosum
Symmetric
Bilateral
Morphology
Atrophy
Thinning

Corpus callosum atrophy is present in all cases, and cerebral atrophy becomes more pronounced with aging.

Non-Space occupying lesion

Cerebral atrophy

Anatomical regions
  • Cerebrum
Symmetric
Bilateral
Morphology
Atrophy