Maple syrup urine disease: Magnetic resonance imaging findings in three patients

Aliya Allahwala, Sibtain Ahmed, Bushra Afroze

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Maple syrup urine disease (MSUD) is an autosomal recessive inherited metabolic disorder, caused by branched-chain alpha-ketoacid dehydrogenase (BCKD) deficiency, leading to toxic accumulation of branched-chain amino acids (BCAAs) including leucine, isoleucine and valine and their corresponding α-ketoacids. The diagnosis of MSUD is based on elevated BCAAs and alloisoleucine in plasma, and branched-chain hydroxyacids and ketoacids in urine. The identification of alloisoleucine >5 μmol/L is considered pathognomonic. Moreover, brain magnetic resonance imaging (MRI) showing atypical signal intensity and oedema is characteristic of MSUD. Recognition of the classical neuro-radiological findings of MSUD is particularly useful in local settings as many healthcare facilities lack the resources to measure Plasma Amino Acids (PAA). We report three cases of MSUD, in whom the disorder was strongly suspected at presentation, based on classical brain MRI findings, which was urgently confirmed by PAA analysis.

Original languageEnglish
Pages (from-to)1309-1313
Number of pages5
JournalJournal of the Pakistan Medical Association
Issue number4
Publication statusPublished - Apr 2021


  • Amino acids
  • Brain
  • Diagnosis
  • Inherited metabolic disorders
  • Magnetic resonance imaging
  • Maple syrup urine disease


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