• Fabrícia Lima Fontes-Dantas, Gustavo da Fontoura Galvão, Elielson Veloso da Silva, Soniza Alves-Leon, Cecília da Silva Rêgo Cláudia C Translational Neuroscience Laboratory (LabNet), Post-Graduation Program in Neurology, Universidade Federal do Estado do Rio de Janeiro, UN, Diogo Gomes Garcia, Suelen Adriani Marques, Blanco Martinez Ana Maria AM Neurodegeneration and Repair Lab oratory, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil., Marcello Reis da Silva, and Marcondes de Souza Jorge J Department of Neurosurgery, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil. Electronic address: jormarcondes@gm.
• Translational Neuroscience Laboratory (LabNet), Post-Graduation Program in Neurology, Universidade Federal do Estado do Rio de Janeiro, UNIRIO, Rio de Janeiro, Rio de Janeiro, Brazil.
• World Neurosurg. 2020 Jun 1; 138: 535-540.e8.

BackgroundCerebral cavernous malformations (CCMs) are vascular capillary anomalies with a dysfunctional endothelial adherent junction profile, depicting hemorrhage and epilepsy as the main clinical features. With the advent of an increasingly personalized medicine, better comprehension of genetic mechanisms behind CCM represents an important key in the management of the patients and risk rating in relatives. In this context, genetic factors that might influence clinical expressiveness of CCM need to be identified.Case DescriptionA 33-year-old woman harboring multiple CCM lesions with a CCM1 mutational profile already being treated conservatively for a right mesial temporal lobe CCM presented with refractory seizures. Magnetic resonance imaging showed no bleeding in the lesion, and the patient was submitted to complete resection of the CCM. Histopathology of the CCM samples depicted an extensive inflammatory reaction and colocalization of CD20+ and CD68+ cells. Genetic analyses of the patient and her mother demonstrated a novel CCM1 (KRIT1) frameshift mutation (c.1661_1662insT; p.Leu554PhefsTer14). Furthermore, variants in CD14 (rs778588), TLR-4 (rs10759930), SOD2 (rs4880), APEX1 (rs1130409), and OGG1 (rs1052133), known as polymorphisms related to disease aggressiveness, were detected in the patient and not in her oligosymptomatic mother harboring the same CCM1 mutation.ConclusionsHeterogeneity of clinical manifestations among individuals with familial CCM with the same genotype adds mechanistic involvement of modifier factors as phenotypic markers. We describe a novel CCM1/KRIT1 familial mutation in which the coexistence of genetic variants in inflammation and oxidative stress may be related to variable expressiveness of the disease.Copyright © 2020 Elsevier Inc. All rights reserved.

42 keywords...

hide…