[Clinical aspects and course of Sturge-Weber syndrome in childhood]

We report on symptoms, clinical course and prognostic factors of eight children (6 girls and 2 boys) with Sturge-Weber syndrome. The period of observation was 1 to 17 years (mean 8.8 years). All patients had the classical symptoms with facial port-wine stain nevus and intracranial calcifications. In two cases a bilateral distribution of the nevus was found. All patients but one had epileptic seizures which were followed by Todd's palsies in five. Four children additionally suffered from hydrophthalmia. Another patient had an angiomatosis of the retina and cataract. Neurological findings were normal in three patients, minimal signs were found in three, one patient had a spastic hemiplegia and another one hypotone tetraplegia. The mental development was normal in three patients, however severe dyscalculia occurred in one of them. Five patients were mentally retarded, three of them severely. The prognosis was the worse the earlier the cerebral seizures appeared.

[Retinal angiomatoses]

The three classical angiomatoses of the retina are described on the basis of the clinical picture. If early diagnosis is possible, the otherwise inevitable progression to exudative retinal detachment and secondary glaucoma may be avoided through extensive coagulation by laser, xenon or cryopexy. - The prognosis is best in Leber's retinitis; it in much poorer in cases of von Hippel-Lindau angiomatosis and primary Coats' disease.

Rhegmatogenous retinal detachment in angiomatosis retinae

Three patients with von Hippel tumors of the retina developed rhegmatogenous retinal detachments caused by surface traction on the angioma. The break in each case was located at the posterior base of the angioma, between the afferent and efferent vessels. Conventional scleral buckling surgery with cryotherapy and a silicone episcleral sponge successfully reattached the retina in all three cases.

CT and MR of angiomatous malformations of the choroid plexus in patients with Sturge-Weber disease

Eight patients with Sturge-Weber disease were evaluated by CT (six patients), MR (one patient), or both (one patient). CT scans of five of seven patients showed enlargement and increased enhancement of the choroid plexus on the same side as the facial and intracranial lesions. MRI showed similar findings in both patients examined. This enlargement, seen in six of eight cases of Sturge-Weber disease, is compatible with the presence of angiomatous malformations of the choroid plexus. It appears to be a common finding in this disease.

[Bone angiomatoses in children. Apropos of 3 personal cases]

Three observations of skeletal angiomatosis are reported: one diffuse and two focal forms (Gorham's disease). The analysis of these cases and a review of the literature enhance the clinical and radiological presentation of this uncommon disease. The authors point out the interest of indirect lymphoscintigraphy and dwell on the gravity of its course, in spite of therapeutic attempts.

[Retinal angiomatoses]

The three classic angiomatoses of the retina are described according to the clinical picture. If early diagnosis is possible, then the inevitable progression to exudative retinal detachment and secondary glaucoma may be avoided by extensive coagulation with laser, xenon or cryopexy. Prognosis is best with Leber's retinitis, much less so in cases of von Hippel-Lindau angiomatosis and primary Coats' disease.

[Angiomatosis of bone--report of two cases]

Primary angiomatosis of bone is a rare bone tumor. Only 26 cases have been reported previously in literature. The authors add two cases in this paper. In one of them the right calcaneus bone and distal phalanges of the first and second toes were involved, an occurrence not yet been described. From the clinical point of view, the authors made an attempt to put forward a criterion for distinguishing the two types of primary bone angiomatosis--angiomatosis and massive osteolysis. The first type was usually operable with good results. As for the second type, no proper therapy has been found but irradiation might relieve the symptoms and control the development of the tumor. The authors emphasize that the roentgenogram is too equivocal to diagnose and the definite diagnosis almost always depends upon histopathologic examination characterized by the formation of abundant capillaries or cavernous vessels or both.

Invasive pulmonary haemangiomatosis

Invasive pulmonary haemangiomatosis is a recently described disease in which exceedingly thin-walled vessels of capillary or venous dimensions infiltrate the lung parenchyma and pulmonary blood vessels. The angiomatous vessels, of obscure origin, infiltrate the media and intima of muscular pulmonary arteries, pulmonary veins and venules. The occlusion of the veins and venules by the thin-walled vessels, and the reactive intimal fibrosis they provoke, leads to pulmonary capillary dilatation, collections of intra-alveolar siderophages, fibrosis of alveolar walls and osseous nodules. This secondary pulmonary veno-occlusive disease in turn leads to hypertensive pulmonary vascular disease. Hence invasive pulmonary haemangiomatosis represents a fourth cause of 'unexplained pulmonary hypertension', the other three being unexplained plexogenic pulmonary arteriopathy, recurrent pulmonary thromboembolism, and pulmonary veno-occlusive disease. Two previously reported cases of invasive pulmonary haemangiomatosis presented with recurrent haemoptysis and the gradual development of chronic respiratory insufficiency associated with diffuse infiltrates in the chest radiograph. In one of these cases a haemothorax had developed. Such clinical features may be of importance in coming to the correct diagnosis.

Placental chorioangiomatosis--a high risk pregnancy

A case of diffuse chorioangiomatosis leading to fetal hydrops, disseminated intravascular coagulopathy with massive umbilical vein thrombosis and fetal death is described. Although rare, this benign mesenchymatous malformation of the placenta should be kept in mind as a possible cause of neonatal morbidity. Prenatal diagnosis could prevent fetal death.

Regional cerebral blood flow characteristics of the Sturge-Weber syndrome

Four patients with the Sturge-Weber syndrome were studied using the non-invasive Xenon-133 inhalation technique. All four patients had decreased regional cerebral blood flow in the area of their lesion, and in two patients who were subsequently tested with 5% carbon dioxide inhalation, impaired vasomotor reactivity was documented. Diminished regional cerebral blood flow is consistent with previously described nuclide flow studies which demonstrated a delay in the initial perfusion blush in the region of the abnormal vasculature. The focal decrease in blood flow was greatest in the most severely affected patient, but was also prominent in the two younger patients, both of whom have excellent neurologic function. These studies suggest that localized decrease in blood flow and vasomotor dysfunction in Sturge-Weber syndrome can precede the occurrence of severe neurologic impairment and extensive cerebral atrophy and possibly be a major contributing factor in progressive dysfunction. A secondary observation was that the blood flow in the unaffected hemisphere was significantly greater in two children compared to the two adults and was similar to the age-related differences reported for normal children and adults.

Renal carcinoma in Lindau's disease

A case of Lindau's disease is presented where renal carcinoma was detected 2.5 years after surgical removal of a cerebellar haemangioblastoma. This patient had no retinal lesions. The importance of screening for renal carcinoma in patients showing one or more manifestations of the disease and screening relatives is emphasized.

Early prenatal ultrasonic findings in Klippel-Trenaunay-Weber syndrome

Routine sonography prior to genetic amniocentesis revealed the presence of a large complex mass with pulsating channels over the anterior fetal chest wall. This led to early termination of pregnancy in a fetus affected with the rare Klippel-Trenaunay-Weber Syndrome.

von Hippel-Lindau disease: a familial, often lethal, multi-system phakomatosis

A review of 36 cases of von Hippel-Lindau disease underscores the important role of the ophthalmologist in evaluating this phakomatosis. Retinal angiomatosis occurred in almost two-thirds of those affected, was usually diagnosed before other target organs, and frequently led to decreased visual acuity. Common non-ophthalmic manifestations included cerebellar (69%), medullary (11%) and spinal (8%) hemangioblastoma, renal cell carcinoma (22%), and polycythemia (17%). Pheochromocytoma was a les common association. The most common causes of death were cerebellar hemangioblastoma and renal cell carcinoma. For the surveillance of suspected von Hippel-Lindau victims, a detailed family history and retinal examination is recommended. Essential laboratory tests include a complete blood count and computed tomography of the head, upper cervical region, and abdomen. Periodic pre-symptomatic screening is imperative for follow-up investigation of affected individuals to determine possible additional occult manifestations and of non-affected family members at risk to von Hippel-Lindau disease.