A 7-month-old male presented in the ED with head injury and seizure concerns. Bilateral subdural hemorrhages of different ages and multilayered intraretinal hemorrhages in both eyes were found, without bone fractures or cervical spine ligamentous injury. In addition, the patient had a rapid progression of macrocephaly. Analysis of urine organic acids revealed 2-hydroxyglutaric acid (2HGA) and 2-hydroxyglutaric lactone (2HGL) markedly elevated (Figure 1). The presence of either the D-form or the L-form of 2HGA was analyzed (Figure 2).
|Ester Perales Clemente, Ph.D.
Fellow, Clinical Biochemical Genetics
|Piero Rinaldo, M.D., Ph.D.
Consultant, Lab Genetics and Genomics
Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine