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Late-onset ornithine transcarbamylase deficiency mimicking a focal opercular syndrome
  1. Eoghan Donlon1,
  2. Jamie McGettigan1,
  3. Christine Gaffney1,
  4. Marzuki Wan Ahmad1,
  5. Peter Boers1,
  6. Eileen Treacy2,
  7. Elijah Chaila1
  1. 1 Department of Neurology, University Hospital Limerick, Dooradoyle, Ireland
  2. 2 Department of Metabolic Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
  1. Correspondence to Dr Eoghan Donlon, Department of Neurology, University Hospital Limerick, Dooradoyle, Ireland; eoghandonlon{at}


A previously healthy 27-year-old man was brought to hospital after been found late at night confused, agitated and talking incoherently. He represented 12 days later with focal seizures, progressing to anarthria and encephalopathy. MR scan of brain showed diffuse cerebral oedema and his plasma ammonia was >2000 µmol/L (12–55 µmol/L). He developed refractory status epilepticus and subsequently died. Genetic analysis identified an ornithine transcarbamylase (OTC) gene mutation on the X chromosome. We discuss this atypical presentation of OTC deficiency as a rare but treatable cause of hyperammonaemic encephalopathy.

  • metabolic disease
  • clinical neurology

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  • Contributors ED conceived of and drafted the manuscript. JMG, CG, MWA, PB, ET and EC reviewed, revised and edited the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned. Externally peer reviewed by Elaine Murphy, London, UK.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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