TABLE 1.

Clinical presentation of MMA patients of different ages.

Ages	System	Clinical presentation
Neonates (0–28 days)	Nervous system	Lethargy, apnoea Muscular hypotonia Seizures, neurocognitive impairment Visual inattention or nystagmus Hydrocephalus
	Digestive system	Poor feeding, vomiting
	Blood circulation system	Anemia/thrombocytopenia or pancytopenia Megaloblastosis Cardiomyopathy Pulmonary hypertension
	Urinary system	Hemolytic uremic syndrome
Infants (1–12 months)	Nervous system	Developmental delay (learning disabilities, intellectual disability) Acute encephalopathy Visual and cognitive impairment Microcephaly Muscular hypotonia Seizures Visual inattention or nystagmus
	Digestive system	Anorexia Failure to thrive
	Blood circulation system	Anemia/thrombocytopenia or pancytopenia Megaloblastosis Pulmonary hypertension
	Urinary system	Hemolytic uremic syndrome
Children (1–12 years)	Nervous system	Acute or chronic behavioral or psychiatric abnormalities Acute encephalopathy Movement disorders, dystonia, ataxia, limb weakness Seizures, lethargy Neuropsychiatric disturbance, personality changes Visual impairment (maculopathy, optic atrophy, Peripheral retinopathy) Sensory disturbance
	Blood circulation System	Pulmonary hypertension Venous thrombosis, pulmonary thromboembolism Hypertensive encephalopathy
	Urinary system	Hemolytic uremic syndrome Kidney failure
Adolescence and adulthood (>12years)	Nervous system	Cognitive decline Neuropsychiatric disturbance, personality changes, social withdrawal, depression Decreased ability to study or work Sensory disturbance, ataxia, limb weakness Visual impairment or blindness
	Blood circulation system	Pulmonary hypertension Venous thrombosis, pulmonary thromboembolism Hypertensive encephalopathy
	Urinary system	Hemolytic uremic syndrome Thrombotic microangiopathy Kidney failure