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In older children or adults it may be considered if there are clinical symptoms suggestive of carnitine deficiency (hypotonia, lethargy), a significant decrease in the serum free carnitine levels, an impairment in hepatic function tests, or hyperammonaemia, even in the absence of VHE

NOTE ADDED IN PROOF After this article was submitted for publication on January 2, 2013, the following article was published prior to publication which strongly supports the hypothesis in the current article

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The smaller cells test positive for neurogenic markers such as synaptophysin, chromogranin A, neuron-specific enolase (NSE), and glial fibrillary acidic protein (GFAP) (Mota et al., 2021)

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