Maple syrup urine disease

Case contributed by Varun Babu
Diagnosis almost certain

Presentation

Posturing of all four limbs and extension of neck on day 4. Metabolic acidosis detected on arterial blood gas, a provisional diagnosis of metabolic encephalopathy was considered. No significant ante - or post natal clinical history.

Patient Data

Age: Neonate
Gender: Male
mri

Delay in myelination with diffusion restriction seen involving bilateral corona radiata, posterior limbs of internal capsule, thalami, mid brain, cerebellar peduncles and pons/medulla. 

A possibility of dysmyelination was suggested. 

Case Discussion

Metabolic work up confirmed a diagnosis of maple syrup urine disease.

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