Glutaric acidemia type 1 (GA1) is an inborn error of lysine, hydroxylysine and tryptophan metabolism caused by the deficiency of glutaryl-CoA dehydrogenase (GCDH). GA1 is a neurodegenerative disorder with loss of neurons in the basal ganglia. Clinical features vary, but often include macrocephaly, gait abnormalities, hypotonia, spasms, rigidity and seizures. Retinal or subdural hemorrhages can also occur. Other than possible macrocephaly, patients appear normal at birth. Clinical features are typically preceded by an acute encephalopathic illness with fever before five years of age.