Cortical pencil lining in neuroferritinopathy: A diagnostic clue

Abstract

Neurodegeneration with brain iron accumulation (NBIA) includes pantothenate kinase-associated neurodegeneration (PKAN, NBIA1), PLA2G6-associated neurodegeneration (PLAN, NBIA2), neuroferritinopathy, aceruloplasminemia, and MIN-associated neurodegeneration (MPAN).1 Clinically, they can have similar presentation, with a combination of progressive extrapyramidal, cognitive, and bulbar features.1 Since genetic testing is costly and not easily accessible, MRI clues, such as the eye of the tiger sign for PKAN,2,3 are useful to guide the confirmatory genetic analyses. Herein, we describe a distinct imaging pattern of cortical iron deposition on susceptibility-weighted MRI (SWI) in genetically proven cases of neuroferritinopathy, which is not seen in genetically proven cases of PKAN or PLAN, the 2 most common forms of NBIA.