# Cerebral edema in maple syrup urine disease: spectrum of clinical presentation and treatment outcomes

## TL;DR

This study examines how cerebral edema presents and is treated in adults with maple syrup urine disease, highlighting the challenges in diagnosis and outcomes.

## Contribution

The study provides insights into the variable clinical presentation and treatment outcomes of cerebral edema in adult MSUD patients.

## Key findings

- Seven patients had ten episodes of encephalopathy, with cerebral edema in nine.
- Five patients fully recovered, while two died despite treatment.
- Early recognition of encephalopathy is challenging in adult MSUD patients.

## Abstract

Maple syrup urine disease (MSUD) is an inherited neurometabolic disorder caused by a deficiency of branched-chain α-keto acid dehydrogenase complex activity. There is an accumulation of neurotoxic branched-chain amino acids and their corresponding alpha-ketoacids. During acute metabolic decompensation, there is a high risk of mortality due to encephalopathy and cerebral edema, leading to cerebellar herniation.

This study reviewed the clinical presentation, management, and outcome of adult patients with MSUD who were admitted to our hospital with encephalopathy and cerebral edema during the 8-year study period.

Seven patients were admitted with ten episodes of encephalopathy, and cerebral edema was present during nine episodes. One asymptomatic patient had an elective admission with cerebral edema. Five patients had a full recovery to baseline, while two patients died.

This study describes the variable clinical presentation of cerebral edema in adult patients with MSUD. Early recognition and prompt treatment of encephalopathy is challenging, particularly in adult patients, as the multidisciplinary teams may not be familiar with this rare disease.