Cerebral palsy in siblings caused by compound heterozygous mutations in the gene encoding protein C
Article first published online: 19 FEB 2010
© The Authors. Journal compilation © Mac Keith Press 2010
Developmental Medicine & Child Neurology
Volume 52, Issue 5, pages 489–493, May 2010
How to Cite
FONG, C. Y., MUMFORD, A. D., LIKEMAN, M. J. and JARDINE, P. E. (2010), Cerebral palsy in siblings caused by compound heterozygous mutations in the gene encoding protein C. Developmental Medicine & Child Neurology, 52: 489–493. doi: 10.1111/j.1469-8749.2010.03618.x
- Issue published online: 13 APR 2010
- Article first published online: 19 FEB 2010
- Accepted for publication 7th December 2009. Published online 19th February 2010.
We report two sisters with extensive bilateral periventricular haemorrhagic infarction (PVHI) causing cerebral palsy (CP). The older sister presented at 20 months with cortical visual blindness, spastic diplegia, and purpura fulminans. The younger sister presented aged 3 days old with apnoeas and multifocal seizures. She subsequently had global developmental delay, cortical visual blindness, spastic quadriplegia, epilepsy, and purpura fulminans at age 2 years. Neuroimaging of both siblings showed bilateral PVHI consistent with bilateral cerebral intramedullary venous thrombosis occurring at under 28 weeks’ gestation for the older sister and around time of birth for the younger sister. At latest follow-up, the older sister (13y) has spastic diplegia at Gross Motor Function Classification System (GMFCS) level II, and the younger sister (10y) has spastic quadriplegia at GMFCS level IV. Both sisters showed partial quantitative reduction in plasma protein C antigen and severe qualitative reduction in plasma protein C anticoagulant activity. They were heterozygous for two independent mutations in the protein C gene (PROC). There was no other risk factor for CP. To our knowledge, this is the first family reported with compound heterozygous PROC mutations as the likely genetic cause of familial CP. This report adds to the list of known monogenic causes of CP.