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Moya Moya Syndrome in a Child With Pyruvate Kinase Deficiency and Combined Prothrombotic Factors

Second Department of Pediatrics, University of Athens, "P & A Kyriakou" Children's Hospital

Konstantinos A. Voudris, MD

Department of Neurology, "P & A Kyriakou" Children's Hospital, kvoudris{at}otenet.gr

Sotiria Mastroyianni, MD

Department of Neurology, "P & A Kyriakou" Children's Hospital

Eleni Vagiakou, MD

Department of Microbiology, "G. Genimatas" General Hospital

George Magoufis, MD

Henry Dynan Hospital, Athens, Greece

Peter Koukoutsakis, MD

Second Department of Pediatrics, University of Athens, "P & A Kyriakou" Children's Hospital

A 13-year-old Greek girl with pyruvate kinase deficiency and moya moya angiographic pattern is reported. She also had raised serum lipoprotein (a) concentration and was homozygous for the C677T mutation of the methylenetetrahydrofolate reductase gene. She presented with neonatal onset of anemia, hemolytic and aplastic crises, especially during infections, stroke, and also progressive motor and mental deterioration. A digital cranial angiography at 13 years revealed the typical angiographic findings of moya moya angiopathy. This is likely the first patient with pyruvate kinase deficiency and moya moya syndrome and also the combination of elevated serum lipoprotein (a) concentration and the C677T mutation of the methylenetetrahydrofolate reductase gene to be reported. In patients with pyruvate kinase deficiency and moya moya syndrome, a search for raised serum lipoprotein (a) concentrations and the C677T mutation of the methylenetetrahydrofolate reductase gene should be considered.

Key Words: pyruvate kinase deficiency • moya moya syndrome • lipoprotein (a) • C677T mutation of the methylenetetrahydrofolate reductase gene

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