{"0": "Ragged red muscle fibers", "1": "Abnormal circulating metabolite concentration", "2": "Muscle fiber atrophy", "3": "Intellectual disability progressive", "4": "Deviation of the thumb", "5": "Abnormal conjugate eye movement", "6": "Polyneuropathy", "7": "Abnormality of coordination", "8": "Infectious encephalitis", "9": "Decreased plasma carnitine", "10": "Abnormal csf protein level", "11": "Abnormal epiphyseal ossification", "12": "Abnormal atrioventricular conduction", "13": "Abnormality of the curvature of the vertebral column", "14": "Subcutaneous nodule", "15": "Focal t2 hyperintense basal ganglia lesion", "16": "Excessive daytime somnolence", "17": "Mutism", "18": "Toe walking", "19": "Decreased activity of mitochondrial complex iv", "20": "Abnormal mitochondria in muscle tissue", "21": "Feeding difficulties", "22": "Congenital diaphragmatic hernia", "23": "Abnormal circulating fatty acid concentration", "24": "Abnormal head movements", "25": "Ambiguous genitalia", "26": "Abnormal brainstem mri signal intensity", "27": "Platyspondyly", "28": "Skin rash", "29": "Lower limb hypertonia", "30": "Ketosis", "31": "Focal t2 hyperintense brainstem lesion", "32": "Retinal dysplasia", "33": "Periventricular heterotopia", "34": "Skin nodule", "35": "Abnormal erythrocyte enzyme level", "36": "Impaired pain sensation", "37": "Heart block", "38": "Bradycardia", "39": "Abnormal anterior eye segment morphology", "40": "Abnormal circulating fatty acid anion concentration", "41": "Ketoacidosis", "42": "Poikilocytosis", "43": "Decreased activity of the pyruvate dehydrogenase complex", "44": "Fibrous tissue neoplasm", "45": "Cardiac conduction abnormality", "46": "Abnormal caudate nucleus morphology", "47": "Basal ganglia gliosis", "48": "Paroxysmal involuntary eye movements", "49": "Brisk reflexes"}