1
|
Xie M, Tang J, Zhang Y, Deng Y, Ma K, Xiang X, Tang L. Assessment of the Corneal Biomechanical Features of Sturge-Weber Syndrome Using Dynamic Ultrahigh-speed Scheimpflug Imaging. Cornea 2024:00003226-990000000-00650. [PMID: 39104013 DOI: 10.1097/ico.0000000000003617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 05/29/2024] [Indexed: 08/07/2024]
Abstract
PURPOSE To evaluate the corneal biomechanical characteristics of eyes with Sturge-Weber syndrome (SWS) secondary glaucoma (SSG) by analyzing corneal biomechanical parameters obtained using the Corneal Visualization Scheimpflug Technology instrument (Corvis ST). METHODS In patients with SWS, eyes affected by SSG were designated as the SSG group while the contralateral eyes were designated as the SWS contralateral group (SC group). Patients from the myopia clinic served as the control group. Dynamic corneal response parameters (DCRs) including the stress-strain index (SSI)-a critical material stiffness parameter that excludes interference from IOP and central corneal thickness (CCT)-were analyzed. RESULTS For CCT, no significant difference was observed between the SSG and SC groups. However, significant differences were found between the SSG and control groups and between the SC and control groups. Parameters such as HC Time, A1 Deformation Amp., A2 Deformation Amp., length of Whole Eye Movement (WEM), DA Ratio Max (2 mm), PachySlope, DA Ratio Max (1 mm), and ARTh showed significant differences between the SSG group and control group. In the SSG group, 4 of night eyes had an SSI of less than 0.85. CONCLUSIONS Some DCRs indicated a stiffer cornea in the SSG group, possibly due to a thicker cornea in this group. On analyzing SSI, it was found that corneal material properties change, becoming less stiff in some of the patients with SSG. In conclusion, our study provides a preliminary exploration of the biomechanical properties of SWS secondary glaucoma.
Collapse
Affiliation(s)
- Mengzhen Xie
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Jing Tang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Yao Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Yingping Deng
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Ke Ma
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Xingye Xiang
- School of Life Science and Engineering, Southwest Jiaotong University, Chengdu, Sichuan, China; and
- Georgia State University, Atlanta, GA
| | - Li Tang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
2
|
Wang Y, Geng G, Hu W, Zhang H, Liu Y, Gao Z, Zhang H, Shi J. Epileptic seizures as an initial symptom for Sturge‑Weber syndrome type III: A report of two cases. Exp Ther Med 2024; 28:299. [PMID: 38868613 PMCID: PMC11168029 DOI: 10.3892/etm.2024.12588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 02/23/2024] [Indexed: 06/14/2024] Open
Abstract
Sturge-Weber syndrome (SWS) type III, a rare neurocutaneous disorder, presents diagnostic challenges due to its variable clinical manifestations. The present study focuses on enhancing the understanding of this syndrome by conducting a detailed analysis of two pediatric cases and providing a comprehensive review of the existing literature. The cases, managed at the Children's Hospital Affiliated to Shandong University (Jinan, China), highlight the diverse clinical presentations and successful management strategies for SWS type III. In the first case, a 4-year-old male patient exhibited paroxysmal hemiplegia, epileptic seizures and cerebral angiographic findings indicative of left pia mater and venous malformation. The second case involved a 2.5-year-old male patient presenting with recurrent seizures and angiographic findings on the right side. Both cases underscore the importance of considering epileptic seizures, acquired and transient hemiplegia and cognitive impairments in the diagnosis of SWS type III. The present study provides insights into the effective use of both pharmacological and surgical interventions, drawing from the positive outcomes observed in these cases. The findings emphasize the need for heightened awareness and a meticulous approach in diagnosing and treating SWS type III, contributing to the better management and prognosis of this condition.
Collapse
Affiliation(s)
- Yaping Wang
- Epilepsy Center, Jinan Children's Hospital (Children's Hospital Affiliated to Shandong University), Jinan, Shandong 250000, P.R. China
| | - Guifu Geng
- Epilepsy Center, Jinan Children's Hospital (Children's Hospital Affiliated to Shandong University), Jinan, Shandong 250000, P.R. China
| | - Wandong Hu
- Epilepsy Center, Jinan Children's Hospital (Children's Hospital Affiliated to Shandong University), Jinan, Shandong 250000, P.R. China
| | - Huan Zhang
- Epilepsy Center, Jinan Children's Hospital (Children's Hospital Affiliated to Shandong University), Jinan, Shandong 250000, P.R. China
| | - Yong Liu
- Epilepsy Center, Jinan Children's Hospital (Children's Hospital Affiliated to Shandong University), Jinan, Shandong 250000, P.R. China
| | - Zaifen Gao
- Epilepsy Center, Jinan Children's Hospital (Children's Hospital Affiliated to Shandong University), Jinan, Shandong 250000, P.R. China
| | - Hongwei Zhang
- Epilepsy Center, Jinan Children's Hospital (Children's Hospital Affiliated to Shandong University), Jinan, Shandong 250000, P.R. China
| | - Jianguo Shi
- Epilepsy Center, Jinan Children's Hospital (Children's Hospital Affiliated to Shandong University), Jinan, Shandong 250000, P.R. China
| |
Collapse
|
3
|
Dingenen E, Segers D, De Maeseneer H, Van Gysel D. Sturge-Weber syndrome: an update for the pediatrician. World J Pediatr 2024; 20:435-443. [PMID: 38658498 DOI: 10.1007/s12519-024-00809-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 03/27/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Sturge-Weber syndrome (SWS) is a rare congenital neurocutaneous disorder characterized by the simultaneous presence of both cutaneous and extracutaneous capillary malformations. SWS usually presents as a facial port-wine birthmark, with a varying presence of leptomeningeal capillary malformations and ocular vascular abnormalities. The latter may lead to significant neurological and ocular morbidity such as epilepsy and glaucoma. SWS is most often caused by a somatic mutation involving the G protein subunit alpha Q or G protein subunit alpha 11 gene causing various alterations in downstream signaling pathways. We specifically conducted a comprehensive review focusing on the current knowledge of clinical practices, the latest pathophysiological insights, and the potential novel therapeutic avenues they provide. DATA SOURCES A narrative, non-systematic review of the literature was conducted, combining expert opinion with a balanced review of the available literature. A search of PubMed, Google Scholar and Embase was conducted, using keywords "Sturge-Weber Syndrome" OR "SWS", "Capillary malformations", "G protein subunit alpha 11" OR "G protein subunit alpha Q". RESULTS One of the hallmark features of SWS is the presence of a port-wine birthmark at birth, and forehead involvement is most indicative for SWS. The most common ocular manifestations of SWS are glaucoma and choroidal hemangioma. Glaucoma presents in either in infancy (0-3 years of age) or later in life. Neurological complications are common in SWS, occurring in about 70%-80% of patients, with seizures being the most common one. SWS significantly impacts the quality of life for patients and their families, and requires a multidisciplinary approach for diagnosis and treatment. Currently, no disease-modifying therapies exist, and treatment is mostly focused on symptoms or complications as they arise. CONCLUSIONS: SWS remains a complex and heterogeneous disorder. Further research is needed to optimize diagnostic and therapeutic strategies, and to translate insights from molecular pathogenesis to clinical practice.
Collapse
Affiliation(s)
- Emilie Dingenen
- Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
| | - Damien Segers
- Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
| | - Hannelore De Maeseneer
- Department of Pediatrics, O.L.Vrouw Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium
| | - Dirk Van Gysel
- Department of Pediatrics, O.L.Vrouw Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium.
- Interdisciplinary Unit of Pediatric Dermatology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.
| |
Collapse
|
4
|
Naithani R, Joseph S, Sathiamoorthi S, Freedman SF. Unilateral Glaucoma Without Facial Angioma in a Pediatric Patient: A Suspected Sturge-Weber Syndrome Variant. J Pediatr Ophthalmol Strabismus 2024; 61:e19-e22. [PMID: 38788140 DOI: 10.3928/01913913-20240301-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
The authors report a case of a 5-month-old full-term infant with chronic conjunctival redness and elevated intraocular pressure in the right eye. Magnetic resonance imaging ruled out leptomeningeal angiomatosis. Despite lacking a typical port-wine mark, the diagnosis of Sturge-Weber syndrome was established based on specific observations in the right eye that involved unilateral vascular glaucoma. These findings included Haab striae, a larger axial length measurement, an increased number of episcleral vessels with blood in Schlemm canal, and a thicker choroid in the macular region. This is the first reported pediatric case with these specific ocular manifestations in the absence of facial angioma, highlighting the need for awareness among clinicians to avoid misdiagnosis and facilitate proper management. [J Pediatr Ophthalmol Strabismus. 2024;61(3):e19-e22.].
Collapse
|
5
|
Kado I, Ogashira S, Ono S, Koizumi K, Nakagawa T, Yoshimi Y, Kunimatsu R, Ito S, Koizumi Y, Ogasawara T, Aikawa T, Tanimoto K. Surgical Orthodontic Treatment for Skeletal Maxillary Protrusion in Sturge-Weber Syndrome: A Case Report and Review of the Literature. Cureus 2024; 16:e59964. [PMID: 38854229 PMCID: PMC11162147 DOI: 10.7759/cureus.59964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 06/11/2024] Open
Abstract
Sturge-Weber syndrome (SWS) is characterized by hemangiomas, glaucoma, and central nervous system disorders. Here, we report the case of a 15-year-old boy with SWS and upper-lip hypertrophy who underwent surgical orthodontic treatment for correction of a large overjet and deep overbite. In addition to the a large overjet and deep overbite, interdental spacing was observed in both the arches. The mandible was retrognathic and deviated to the right side. No maxillary occlusal canting or temporomandibular joint symptoms were observed. The patient was diagnosed with skeletal maxillary protrusion with spaced dentition and mandibular deviation to the right due to SWS. After presurgical orthodontic treatment using a multibracket appliance, we performed a sagittal split ramus osteotomy (SSRO) alone due to the presence of a hemangioma around the maxilla. No abnormal bleeding or cerebral hemorrhage due to increased blood pressure was observed during the SSRO. Postoperatively, the maxillary and mandibular arches were well-aligned, the deep overbite and excessive overjet improved, and bilateral angle class I molar and canine relationships were established. Furthermore, mandibular deviation improved, and the midlines of both arches approximately coincided with the facial midline. In conclusion, orthognathic surgery is feasible in patients with SWS after carefully evaluating the sites and sizes of the hemangiomas.
Collapse
Affiliation(s)
- Isamu Kado
- Department of Orthodontics and Craniofacial Developmental Biology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Shintaro Ogashira
- Department of Orthodontics and Craniofacial Developmental Biology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Shigehiro Ono
- Department of Oral and Maxillofacial Surgery, Hiromashi University Hospital, Hiroshima, JPN
| | - Koichi Koizumi
- Department of Oral Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Takayuki Nakagawa
- Department of Oral and Maxillofacial Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Yuki Yoshimi
- Department of Orthodontics and Craniofacial Developmental Biology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Ryo Kunimatsu
- Department of Orthodontics and Craniofacial Developmental Biology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Shota Ito
- Department of Orthodontics and Craniofacial Developmental Biology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Yuma Koizumi
- Department of Orthodontics and Craniofacial Developmental Biology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Tomohiro Ogasawara
- Department of Orthodontics and Craniofacial Developmental Biology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Tomonao Aikawa
- Department of Oral and Maxillofacial Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Kotaro Tanimoto
- Department of Orthodontics and Craniofacial Developmental Biology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| |
Collapse
|
6
|
Sato A, Furusho H, Matsumura T, Nakano M, Sawaki K, Yoshioka Y, Akashi S, Miyauchi M, Mizukawa N, Iida S. Sturge-Weber syndrome with cemento-ossifying fibroma in the maxilla and giant odontoma in the mandible: A case report. Heliyon 2024; 10:e29445. [PMID: 38660248 PMCID: PMC11040041 DOI: 10.1016/j.heliyon.2024.e29445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 04/26/2024] Open
Abstract
Sturge-Weber syndrome (SWS) is a neurocutaneous syndrome with vascular lesions of the cerebral meninges, port wine spots on the face, and glaucoma of the eyes; it is a congenital, non-genetic disease whose etiology and mechanisms are unknown. In this report, we describe a rare case of SWS with unilateral large odontogenic tumors in the maxilla and mandible. The histopathological diagnosis of the maxillary bone lesion on biopsy was juvenile psammomatoid ossifying fibroma, which is considered a type of ossifying fibroma of craniofacial bone origin. However, the final pathological diagnosis of the excision was cemento-ossifying fibroma derived from periodontal ligament cells, and we discuss the histopathology in detail. In addition, the mandibular lesion was one of the largest odontomas reported to date. Furthermore, in this case, we suggest the possibility that the maxillary and mandibular bone lesions are not separate lesions, but a series of lesions related to SWS.
Collapse
Affiliation(s)
- Aki Sato
- Department of Dentistry and Oral Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Hisako Furusho
- Department of Pathology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
- Department of Oral and Maxillofacial Pathobiology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Tatsushi Matsumura
- Department of Oral and Maxillofacial Surgery, Wakayama Medical University, Wakayama, Japan
| | - Makoto Nakano
- Department of Dentistry and Oral Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Koichi Sawaki
- Department of Dentistry and Oral Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Yohsuke Yoshioka
- Department of Dentistry and Oral Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Sho Akashi
- Department of Dentistry and Oral Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Mutsumi Miyauchi
- Department of Oral and Maxillofacial Pathobiology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | | | - Seiji Iida
- Department of Dentistry and Oral Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
- Department of Oral and Maxillofacial Reconstructive Surgery, Okayama University Hospital, Okayama, Japan
- Department of Oral and Maxillofacial Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| |
Collapse
|
7
|
Gaonker T, Dutta P. The Incomplete Sturge-Weber. Eye (Lond) 2024:10.1038/s41433-024-03082-5. [PMID: 38671148 DOI: 10.1038/s41433-024-03082-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 03/29/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Affiliation(s)
- Tanvi Gaonker
- Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, 110002, India.
| | - Paromita Dutta
- Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, 110002, India
| |
Collapse
|
8
|
Sherwani OA, Patra PC, Ahmad SA, Hasan S. Sturge-Weber Syndrome: A Report of a Rare Case. Cureus 2023; 15:e51110. [PMID: 38274914 PMCID: PMC10809882 DOI: 10.7759/cureus.51110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2023] [Indexed: 01/27/2024] Open
Abstract
Sturge-Weber Syndrome (SWS) is a rare congenital developmental disorder that arises from the abnormal persistence of the embryonic vascular plexus. The syndrome encompasses hamartomatous malformations that can impact the skin, eyes, and nervous system. The broad array of clinical manifestations and potentially life-threatening complications underscores the crucial and imperative need for an accurate diagnosis. An effective treatment strategy for SWS patients involves a multidisciplinary approach. Dental procedures in these individuals pose challenges due to the potential risk for substantial bleeding during both intra- and postoperative phases. This article aims to document a rare case of Sturge Weber Syndrome in a 21-year-old female patient who presented with seizures, unilateral facial port wine stains, gingival hyperplasia, and intracranial calcifications.
Collapse
Affiliation(s)
- Osama A Sherwani
- Dental Surgery, Uttar Pradesh Provincial Medical Services, Bulandshahr, IND
- Dentistry, Faculty of Dental Sciences, Manav Rachna International Institute of Research and Studies, Faridabad, IND
| | | | - Syed A Ahmad
- Oral and Maxillofacial Surgery, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, IND
| | - Shamimul Hasan
- Oral Medicine and Radiology, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, IND
| |
Collapse
|
9
|
Ciancimino C, Di Pippo M, Rullo D, Ruggeri F, Grassi F, Scuderi G, Abdolrahimzadeh S. An Update on Multimodal Ophthalmological Imaging of Diffuse Choroidal Hemangioma in Sturge-Weber Syndrome. Vision (Basel) 2023; 7:64. [PMID: 37873892 PMCID: PMC10594527 DOI: 10.3390/vision7040064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/28/2023] [Accepted: 10/03/2023] [Indexed: 10/25/2023] Open
Abstract
Sturge-Weber syndrome (SWS) is characterized by facial port-wine stains, leptomeningeal hemangiomas, and prominent ocular manifestations such as glaucoma and diffuse choroidal hemangiomas (DCHs). Imaging modalities are critical for diagnosing and longitudinally monitoring DCHs in SWS. Fundus photography is fundamental in assessing both eyes simultaneously, fluorescein angiography and indocyanine green angiography effectively map the retinal and choroidal circulation, and ultrasonography offers essential structural insights into the choroid and retina. NIR imaging reveals subtle retinal pigment changes, often overlooked in standard fundus examination. Enhanced depth imaging spectral domain optical coherence tomography (EDI-SDOCT) and swept-source OCT (SSOCT) improve the visualization of the choroidal-scleral boundary, essential for DCH characterization. The potential of OCT angiography (OCTA) is under exploration, particularly its role in predicting signs of disease progression or worsening, as well as potential new biomarkers such as the choroidal vascularity index (CVI). The present review aims to provide an update on multimodal imaging of DCHs in SWS.
Collapse
Affiliation(s)
| | | | | | | | | | - Gianluca Scuderi
- Ophthalmology Unit, Neurosciences, Mental Health, and Sense Organs (@NESMOS) Department, Faculty of Medicine and Psychology, University of Rome Sapienza, St. Andrea Hospital, 00189 Rome, Italy; (C.C.); (M.D.P.); (D.R.); (F.R.); (F.G.); (S.A.)
| | | |
Collapse
|
10
|
Huang L, Sun H, Liu Y, Xu L, Hu M, Yang Y, Wang N, Wu Y, Guo W. GNAQ R183Q somatic mutation contributes to aberrant arteriovenous specification in Sturge-Weber syndrome through Notch signaling. FASEB J 2023; 37:e23148. [PMID: 37606556 DOI: 10.1096/fj.202300608r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/08/2023] [Accepted: 08/04/2023] [Indexed: 08/23/2023]
Abstract
Episcleral vasculature malformation is a significant feature of Sturge-Weber syndrome (SWS) secondary glaucoma, the density and diameter of which are correlated with increased intraocular pressure. We previously reported that the GNAQ R183Q somatic mutation was located in the SWS episclera. However, the mechanism by which GNAQ R183Q leads to episcleral vascular malformation remains poorly understood. In this study, we investigated the correlation between GNAQ R183Q and episcleral vascular malformation via surgical specimens, human umbilical vein endothelial cells (HUVECs), and the HUVEC cell line EA.hy926. Our findings demonstrated a positive correlation between episcleral vessel diameter and the frequency of the GNAQ R183Q variant. Furthermore, the upregulation of genes from the Notch signaling pathway and abnormal coexpression of the arterial marker EphrinB2 and venous marker EphB4 were demonstrated in the scleral vasculature of SWS. Analysis of HUVECs overexpressing GNAQ R183Q in vitro confirmed the upregulation of Notch signaling and arterial markers. In addition, knocking down of Notch1 diminished the upregulation of arterial markers induced by GNAQ R183Q. Our findings strongly suggest that GNAQ R183Q leads to malformed episcleral vasculatures through Notch-induced aberrant arteriovenous specification. These insights into the molecular basis of episcleral vascular malformation will provide new pathways for the development of effective treatments for SWS secondary glaucoma.
Collapse
Affiliation(s)
- Lulu Huang
- Department of Ophthalmology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Hao Sun
- Department of Ophthalmology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yixin Liu
- Department of Ophthalmology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Li Xu
- Department of Ophthalmology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Menghan Hu
- Shanghai Key Laboratory of Multidimensional Information Processing, East China Normal University, Shanghai, China
| | - Yijie Yang
- Department of Ophthalmology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Ning Wang
- Department of Ophthalmology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yue Wu
- Department of Ophthalmology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Wenyi Guo
- Department of Ophthalmology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| |
Collapse
|
11
|
Zhang X, Hu Y, Li D, Qian X, Xu Y, Guo M, Li Q. Isolated diffuse choroidal hemangioma without systemic symptoms: a case report. BMC Ophthalmol 2023; 23:300. [PMID: 37407944 DOI: 10.1186/s12886-023-03057-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 06/21/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Sturge-Weber syndrome is a nonhereditary congenital neurocutaneous syndrome characterized by a distinctive facial capillary malformation,neurological abnormalities, and ocular abnormalities such as glaucoma and choroidal hemangioma.It can be divided into different subtypes according to different clinical manifestations. It is rare for a patient to present with isolated difuse choroidal hemangioma and ipsilateral abnormal conjunctival and episcleral vessels without other systemic symptoms. CASE PRESENTATION We report a 30-year-old man with isolated diffuse choroidal hemangioma in his right eye without systemic symptoms, such as vascular malformations in the skin or leptomeningeal angiomatosis. The only additional ophthalmic finding was ipsilateral abnormal conjunctival and episcleral vessels without glaucoma. However, there was no evidence of leptomeningeal angiomatosis or port-wine stain on the right side of the face, or glaucoma, which are common clinical manifestations of the Sturge-Weber syndrome (SWS).The absence of these characteristic symptoms did not preclude the diagnosis, and the patient could be diagnosed with a particular subtype of SWS. CONCLUSIONS This is a rare case of documented isolated difuse choroidal hemangioma with ipsilateral abnormal conjunctival and episcleral vessels without glaucoma which we think it is belonging to a particular subtype of SWS.In addition to the traditional clinical manifestations, more and more atypical clinical manifestations are also accompanied by SWS, which requires our clinicians to continuously discover and report, so as to help more clinicians understand this disease.
Collapse
Affiliation(s)
- Xiaohua Zhang
- Department of Ophthalmology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
| | - Yongping Hu
- Department of Ophthalmology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Di Li
- Department of Ophthalmology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoxiao Qian
- Department of Ophthalmology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yongning Xu
- Department of Ophthalmology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Man Guo
- Department of Ophthalmology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qihang Li
- Department of Ophthalmology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
12
|
Senthilkumar VA, Kohli P, Mishra C, Mamchisetti K. Ocular features in a patient presenting with a rare combination of multiple phakomatoses. BMJ Case Rep 2022; 15:e252746. [PMID: 36384883 PMCID: PMC9670835 DOI: 10.1136/bcr-2022-252746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Phakomatoses are a group of congenital disorders characterised by hamartomatous lesions of the skin as well as the central and peripheral nervous systems. The presence of naevus flammeus or port-wine stain is a characteristic feature of many such disorders including Sturge-Weber syndrome (SWS), Klippel-Trenaunay syndrome (KTS) and Phakomatosis pigmentovascularis (PPV).We describe the ocular findings in a patient with coexisting PPV, SWS and KTS.
Collapse
Affiliation(s)
| | - Piyush Kohli
- Department of Vitreoretinal services, C.L. Gupta Eye Institute, Moradabad, Uttar Pradesh, India
| | - Chitaranjan Mishra
- Department of Glaucoma, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | | |
Collapse
|
13
|
Coronado-Lopez JP, Coronado JF, Gomez-Urrego JF, Londono-Chavez R. Type III Sturge Weber Syndrome, An Uncommon Cause of Status Epilepticus. JOURNAL OF PEDIATRIC EPILEPSY 2022. [DOI: 10.1055/s-0042-1757917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Introduction Sturge Weber syndrome (SWS) is a rare neurocutaneous condition due to the mutation of the GNAQ gen. This condition is characterized by skin, eye, and brain compromise, but the type III only affects the brain, making it a challenging condition to diagnose.
Clinical Case A Hispanic 4 year-old female, with a history of complex febrile seizure in her medical records, presented to the emergency room in status epilepticus after 24 hours of upper respiratory symptoms. After a neurological and radiologic evaluation, SWS III was diagnosed, which led to a pharmacological adjustment for achieving control of the seizures, with a great clinical evolution.
Discussion The pathophysiology, diagnostics, and proper management of this disease are discussed.
Conclusion SWS is a rare neurocutaneous disease, usually diagnosed in patients with pathognomonic features, however it is important to know that type III SWS exists and represents a challenging diagnosis, leading to a time-race for starting proper management, considering that the outcome includes a better life-quality, a higher cognitive result, and reduced morbimortality.
Collapse
|
14
|
Raval DM, Rathod VM, Patel AB, Sharma B, Lukhi PD. Sturge-Weber Syndrome: A Rare Case Report. Cureus 2022; 14:e28786. [PMID: 36225423 PMCID: PMC9533190 DOI: 10.7759/cureus.28786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
Sturge-Weber syndrome (SWS) is a rare sporadic neurocutaneous syndrome characterized by angiomas involving the face, eyes, and brain (leptomeninges). Classical port-wine stains are seen in the ophthalmic and maxillary division of the trigeminal nerve. The most common presenting feature is seizures, the onset of which ranges from birth to late adulthood. Diagnosis is mainly done by brain radio imaging (CT scan and MRI with gadolinium contrast) where characteristic features of calcification and leptomeningeal enhancement are seen. We report a newly diagnosed case of SWS in a 31-year-old female patient who presented to our hospital with a complaint of generalized tonic-clonic (GTCS) type of convulsion two days prior to the admission with purple discoloration of the skin on the right side of the face, trunk, and right upper limb since birth. During the evaluation of past medical history, the patient was found to have a known case of epilepsy since the age of three months and on was on irregular treatment. To find out the cause of the seizure and skin lesions, further investigations were done which were suggestive of SWS in MRI and CT scanning of the brain. The patient was counseled about the syndrome and discharged on anti-convulsion treatment with advice for dye laser photocoagulation for port-wine stain. SWS is a rare sporadic genetic disease and diagnosis is primarily done by evaluating history, the presence of port-wine stain, and characteristic features on brain radio imaging. As no definitive treatment is available yet, patients are being treated by medical and surgical interventions for symptoms as well as for associated complications.
Collapse
Affiliation(s)
- Darshankumar M Raval
- Department of General Medicine, Sir Sayaji General (SSG) Hospital, Medical College Baroda, Vadodara, IND
| | - Vaishnavi M Rathod
- Department of General Medicine, Sir Sayaji General (SSG) Hospital, Medical College Baroda, Vadodara, IND
| | - Anjali B Patel
- Department of General Medicine, Sir Sayaji General (SSG) Hospital, Medical College Baroda, Vadodara, IND
| | - Bhavya Sharma
- Department of General Medicine, Sir Sayaji General (SSG) Hospital, Medical College Baroda, Vadodara, IND
| | - Princy D Lukhi
- Department of General Medicine, Sir Sayaji General (SSG) Hospital, Medical College Baroda, Vadodara, IND
| |
Collapse
|
15
|
Diagnostic and Therapeutic Challenges. Retina 2022; 42:1411-1415. [PMID: 34155167 DOI: 10.1097/iae.0000000000003237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
16
|
Durai V, Sagili H, Durairaj J, Ananthakrishnan R, Nair PP, Keepanasseril A, Keepanasseril A. Managing pregnancy in women with Sturge-Weber syndrome: case report and review of the literature. J OBSTET GYNAECOL 2022; 42:751-756. [PMID: 35164628 DOI: 10.1080/01443615.2022.2027895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Sturge-Weber syndrome (SWS) is a sporadic congenital neuro-cutaneous anomaly with capillary-venous malformation involving the brain, eye, and the ophthalmic division of the trigeminal nerve. In these cases, physiological changes in pregnancy, including hormonal and hemodynamic changes, may predispose to increased seizure frequency and even a life-threatening intracranial haemorrhage. There are only few case reports available about the management of women with pregnancy and SWS. We report two patients with SWS diagnosed in childhood and managed during pregnancy and reviewed the outcomes and complications during pregnancy in women with this disorder.
Collapse
Affiliation(s)
- Vignesh Durai
- Department of Obstetrics & Gynecology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Haritha Sagili
- Department of Obstetrics & Gynecology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Jayalakshmi Durairaj
- Department of Obstetrics & Gynecology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Ramesh Ananthakrishnan
- Department of Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Pradeep P Nair
- Department of Neurology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Arun Keepanasseril
- Amrita Institute of Medical Sciences, Kochi, India.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Anish Keepanasseril
- Department of Obstetrics & Gynecology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| |
Collapse
|
17
|
Sah J, Balucani C, Abrams A, Hisamoto Y, Chari G, Velayudhan V, Pavlakis SG. Pearls & Oy-sters: Sturge-Weber Syndrome Unmasked by Traumatic Brain Injury. Neurology 2021; 96:e1262-e1265. [PMID: 33067405 DOI: 10.1212/wnl.0000000000011075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Jeetendra Sah
- From the Departments of Pediatric Neurology (J.S., A.A., Y.H., G.C., S.G.P.) and Radiology (V.V.), SUNY Downstate Health Sciences University, Kings County Hospital Center, Brooklyn, NY; and Johns Hopkins Medicine (C.B.), Department of Neurology, Baltimore, MD.
| | - Clotilde Balucani
- From the Departments of Pediatric Neurology (J.S., A.A., Y.H., G.C., S.G.P.) and Radiology (V.V.), SUNY Downstate Health Sciences University, Kings County Hospital Center, Brooklyn, NY; and Johns Hopkins Medicine (C.B.), Department of Neurology, Baltimore, MD
| | - Aaron Abrams
- From the Departments of Pediatric Neurology (J.S., A.A., Y.H., G.C., S.G.P.) and Radiology (V.V.), SUNY Downstate Health Sciences University, Kings County Hospital Center, Brooklyn, NY; and Johns Hopkins Medicine (C.B.), Department of Neurology, Baltimore, MD
| | - Yoshimi Hisamoto
- From the Departments of Pediatric Neurology (J.S., A.A., Y.H., G.C., S.G.P.) and Radiology (V.V.), SUNY Downstate Health Sciences University, Kings County Hospital Center, Brooklyn, NY; and Johns Hopkins Medicine (C.B.), Department of Neurology, Baltimore, MD
| | - Geetha Chari
- From the Departments of Pediatric Neurology (J.S., A.A., Y.H., G.C., S.G.P.) and Radiology (V.V.), SUNY Downstate Health Sciences University, Kings County Hospital Center, Brooklyn, NY; and Johns Hopkins Medicine (C.B.), Department of Neurology, Baltimore, MD
| | - Vinodkumar Velayudhan
- From the Departments of Pediatric Neurology (J.S., A.A., Y.H., G.C., S.G.P.) and Radiology (V.V.), SUNY Downstate Health Sciences University, Kings County Hospital Center, Brooklyn, NY; and Johns Hopkins Medicine (C.B.), Department of Neurology, Baltimore, MD
| | - Steven G Pavlakis
- From the Departments of Pediatric Neurology (J.S., A.A., Y.H., G.C., S.G.P.) and Radiology (V.V.), SUNY Downstate Health Sciences University, Kings County Hospital Center, Brooklyn, NY; and Johns Hopkins Medicine (C.B.), Department of Neurology, Baltimore, MD
| |
Collapse
|
18
|
Karagir A, Adaki S, Magdum D. Encephalotrigeminal Angiomatosis with Facial Lobular Capillary Hemangioma: An Unusual Case Report. Int J Appl Basic Med Res 2021; 11:44-46. [PMID: 33842296 PMCID: PMC8025953 DOI: 10.4103/ijabmr.ijabmr_301_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 06/15/2020] [Accepted: 09/18/2020] [Indexed: 11/08/2022] Open
Abstract
Encephalotrigeminal angiomatosis, also called Sturge–Weber syndrome (SWS), is a syndrome of etiology which is not yet clear. It is a nonhereditary condition. The clinical features include pigmentation over the facial skin known as port-wine stain, abnormalities of ocular region, and central nervous system involvement as leptomeningeal angioma. In this manuscript, we present a rare case report with an unusual combination of SWS with facial lobular capillary hemangioma.
Collapse
Affiliation(s)
- Amol Karagir
- Department of Oral Medicine and Radiology, BVDU Dental College, Sangli, Maharashtra, India
| | - Shridevi Adaki
- Department of Oral Medicine and Radiology, BVDU Dental College, Sangli, Maharashtra, India
| | - Dilip Magdum
- Department of Oral and Maxillofacial Pathology, BVDU Dental College, Sangli, Maharashtra, India
| |
Collapse
|
19
|
Niang I, Ndiaye KM, Diop AM, Faye I, Thiam M, Ndao CL, Ba S. Sturge Weber syndrome, when brain CT is enough for diagnosis: about a case. Pan Afr Med J 2020; 36:308. [PMID: 33282091 PMCID: PMC7687481 DOI: 10.11604/pamj.2020.36.308.24989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 07/29/2020] [Indexed: 11/11/2022] Open
Abstract
One of the main manifestations of Sturge Weber syndrome is seizures. We report the case of a child received in the context of generalized seizures and in whom a cerebral contrast CT was sufficient to make the diagnosis of Sturge Weber syndrome.
Collapse
Affiliation(s)
- Ibrahima Niang
- Radiology Department, National University Hospital Center Fann, Dakar, Senegal
| | | | | | - Ibrahima Faye
- Radiology Department, National University Hospital Center Fann, Dakar, Senegal
| | - Mbaye Thiam
- Radiology Department, National University Hospital Center Fann, Dakar, Senegal
| | - Coumba Laobé Ndao
- Radiology Department, National University Hospital Center Fann, Dakar, Senegal
| | - Sokhna Ba
- Radiology Department, National University Hospital Center Fann, Dakar, Senegal
| |
Collapse
|
20
|
Muralidharan V, Failla G, Travali M, Cavallaro TL, Politi MA. Isolated leptomeningeal angiomatosis in the sixth decade of life, an adulthood variant of Sturge Weber Syndrome (Type III): role of advanced Magnetic Resonance Imaging and Digital Subtraction Angiography in diagnosis. BMC Neurol 2020; 20:366. [PMID: 33023482 PMCID: PMC7541244 DOI: 10.1186/s12883-020-01944-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/29/2020] [Indexed: 11/13/2022] Open
Abstract
Background Sturge-Weber syndrome (SWS) is primarily diagnosed in pediatric population, but clinical presentation in late adulthood is rarely reported. Evolution of radiological findings in the adulthood variant of SWS with isolated leptomeningeal angiomatosis has never been reported to our knowledge. Case presentation We report here a case of an isolated temporo-parieto-occipital leptomeningeal angiomatosis on the right cerebral hemisphere in a sixty-two-year-old male who presented with generalized seizure, GCS score 14/15 (E4 V4 M6) with equal and reacting pupils, psychomotor slowing, left hemineglect and grade 4 power in the left upper and lower limbs. Over a period of 48 h his neurological status deteriorated, but recovered spontaneously over a week on titration with anticonvulsants. He had a prior history of treatment for focal leptomeningitis, three years ago. Cerebrospinal fluid (CSF) analysis showed glucose of 75 mg/dL, proteins of 65 mg/dL and culture grew no organisms. On follow-up, he had intermittent episodes of focal seizure for two years. Initial, computed tomography of brain showed hyperdense lesion in the parieto-occipital convexity subarachnoid space on the right cerebral hemisphere mimicking subarachnoid hemorrhage and computed tomography angiography showed no significant abnormality. Magnetic resonance imaging (MRI) of brain showed intense pial enhancement in the right temporo-parieto-occipital region with a subtle T2W hyperintense signal in the underlying subcortical white matter without edema or infarct or mass effect. Digital subtraction cerebral angiography (DSA) showed hypertrophy of the cerebral arteries, arteriolo-capillary bed and venules in the right temporo-parieto-occipital territory associated with early arterio-capillary and venous opacification. Serial MRI done after six months, one and two years showed increase in the T2W hyperintense signal in the subcortical white matter and cortical atrophy with no changes in the pial enhancement. MR perfusion imaging showed reduced cerebral blood flow (CBF) and cerebral blood volume (CBV) in the right parieto-temporo-occipital cortical and subcortical regions and increased perfusion in the leptomeninges with reduction of the NAA / Cr ratios in spectroscopy. Conclusion Conglomeration of various radiological findings in MRI, Perfusion, MRS and DSA with the clinical presentation can aid in establishing the diagnosis of this rare presentation of SWS-type 3 variant in late adulthood.
Collapse
Affiliation(s)
- Vetrivel Muralidharan
- Fellow in Advanced Training in Neuroendovascular Interventions, Department of Medical Surgical Science and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
| | - Gaetano Failla
- Department of Neurology, Cannizzaro Hospital, Catania, Italy
| | - Mario Travali
- Resident in Radiology, Department of Medical Surgical Science and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
| | - Tiziana Liliana Cavallaro
- Diagnostic & Interventional Neuroradiology, Department of Neuroradiology, Cannizzaro Hospital, Via Messina, 95126, Catania, Sicily, Italy
| | - Marco Angelo Politi
- Diagnostic & Interventional Neuroradiology, Department of Neuroradiology, Cannizzaro Hospital, Via Messina, 95126, Catania, Sicily, Italy.
| |
Collapse
|
21
|
Sturge-Weber syndrome: an update on the relevant issues for neurosurgeons. Childs Nerv Syst 2020; 36:2553-2570. [PMID: 32564157 DOI: 10.1007/s00381-020-04695-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/21/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Sturge-Weber syndrome (SWS) is a neurocutaneous facomatosis characterized by facial and leptomeningeal angioma, glaucoma, seizures, and neurological disability. Therefore, a challenging multidisciplinary interaction is required for its management. The goal of this paper is to review the main aspects of SWS and to present an illustrative pediatric series. METHODS The pertinent literature has been analyzed, focused mainly on etiopathogenesis, pathology, clinical features, diagnostic tools, management, and outcome of the disease. Moreover, a series of 11 children operated on for refractory epilepsy between 2005 and 2015 (minimum follow-up 5 years, mean follow-up 9.6 years) is reported. The series consists of six boys and five girls with 6.5-month and 16.2-month mean age at seizure onset and at surgery, respectively. Seizures affected all children, followed by hemiparesis and psychomotor delay (81%), glaucoma (54%), and other neurological deficits (45%). RESULTS All children underwent hemispherectomy (anatomical in three cases, functional in two cases, hemispherotomy in six cases); one patient needed a redo hemispherotomy. Mortality was nil; disseminated intravascular coagulation and interstitial pneumonia occurred in one patient each; three children had subdural fluid collection. Eight patients (72%) are in the ILAE Class 1 (completely seizure and aura free), two in Class 2 (only auras, no seizure), and one in Class 3 (1-3 seizure days per year). AEDs discontinuation was possible in 73% of cases. The most important news from the literature concerned the pathogenesis (role of the mutation of the GNAQ gene in the abnormal SWS vasculogenesis), the clinical findings (the features and pathogenesis of the stroke-like episodes are being understood), the diagnostic tools (quantitative MRI and EEG), and both the medical (migraine, seizures) and surgical management (epilepsy). The epileptic outcome of SWS patients is very good (80% are seizure-free), if compared with other hemispheric syndromes. The quality of life is affected by the neurological and cognitive deficits. CONCLUSIONS SWS still is an etiological and clinical challenge. However, the improvements over the time are consistent. In particular, the neurosurgical treatment of refractory epilepsy provides very good results as long as the indication to treatment is correct.
Collapse
|
22
|
Introduction to phacomatoses (neurocutaneous disorders) in childhood. Childs Nerv Syst 2020; 36:2229-2268. [PMID: 32940773 DOI: 10.1007/s00381-020-04758-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/18/2020] [Indexed: 12/12/2022]
Abstract
The Dutch ophthalmologist, Jan van der Hoeve, first introduced the terms phakoma/phakomata (from the old Greek word "ϕαχοσ" = lentil, spot, lens-shaped) to define similar retinal lesions recorded in tuberous sclerosis (1920) and in neurofibromatosis (1923). He later applied this concept: (a) to similar lesions in other organs (e.g. brain, heart and kidneys) (1932) and (b) to other disorders (i.e. von Hippel-Lindau disease and Sturge-Weber syndrome) (1933), and coined the term phakomatoses. At the same time, the American neurologist Paul Ivan Yakovlev and psychiatrist Riley H. Guthrie (1931) established the key role of nervous systems and skin manifestations in these conditions and proposed to name them neurocutaneous syndromes (or ectodermoses, to explain the pathogenesis). The Belgian pathologist, Ludo van Bogaert, came to similar conclusions (1935), but used the term neuro-ectodermal dysplasias. In the 1980s, the American paediatric neurologist Manuel R. Gomez introduced the concept of "hamartia/hamartoma" instead of phakoma/phakomata. "Genodermatoses" and "neurocristopathies" were alternative terms still used to define these conditions. Nowadays, however, the most acclaimed terms are "phacomatoses" and "neurocutaneous disorders", which are used interchangeably. Phacomatoses are a heterogeneous group of conditions (mainly) affecting the skin (with congenital pigmentary/vascular abnormalities and/or tumours), the central and peripheral nervous system (with congenital abnormalities and/or tumours) and the eye (with variable abnormalities). Manifestations may involve many other organs or systems including the heart, vessels, lungs, kidneys and bones. Pathogenically, they are explained by interplays between intra- and extra-neuronal signalling pathways encompassing receptor-to-protein and protein-to-protein cascades involving RAS, MAPK/MEK, ERK, mTOR, RHOA, PI3K/AKT, PTEN, GNAQ and GNA11 pathways, which shed light also to phenotypic variability and overlapping. We hereby review the history, classification, genomics, clinical manifestations, diagnostic criteria, surveillance protocols and therapies, in phacomatoses: (1) predisposing to development of tumours (i.e. the neurofibromatoses and allelic/similar disorders and schwannomatosis; tuberous sclerosis complex; Gorlin-Goltz and Lhermitte-Duclos-Cowden syndromes); (2) with vascular malformations (i.e. Sturge-Weber and Klippel-Trenaunay syndromes; megalencephaly/microcephaly-capillary malformation syndromes; CLOVES, Wyburn-Mason and mixed vascular nevus syndromes; blue rubber bleb nevus syndrome; hereditary haemorrhagic telangiectasia); (3) with vascular tumours (von Hippel-Lindau disease; PHACE(S)); (4) with pigmentary/connective tissue mosaicism (incontinentia pigmenti; pigmentary/Ito mosaicism; mTOR-related megalencephaly/focal cortical dysplasia/pigmentary mosaicism; RHOA-related ectodermal dysplasia; neurocutaneous melanocytosis; epidermal/papular spilus/Becker nevi syndromes; PENS and LEOPARD syndromes; encephalocraniocutaneous lipomatosis; lipoid proteinosis); (5) with dermal dysplasia (cerebellotrigeminal dermal dysplasia); and (6) with twin spotting or similar phenomena (phacomatosis pigmentovascularis and pigmentokeratotica; and cutis tricolor).
Collapse
|
23
|
Oral Surgery in Patients With Sturge-Weber Syndrome. J Craniofac Surg 2020; 32:e85-e88. [PMID: 32941214 DOI: 10.1097/scs.0000000000007048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT The Sturge-Weber syndrome (SSW) is a congenital neurocutaneous malformation, with angiomas involving the leptomeningea and facial skin. This syndrome is characterized by corticocerebral angiomatosis, cerebral calcifications, ocular affections, mental retardation, increased risk of stroke, counterlateral hemiplegia, and seizures. Another important feature of SSW is the flameus nevus on the face. In the oral cavity, SSW appears as hemangiomatous lesions affecting the mucous membranes and occasionally the dental pulp. Gingival hyperplasia may be present due to the use of anticonvulsant drugs. The present article reports the management of 2 female patients with Sturge-Weber syndrome who required oral surgery in regions affected by hemangiomatous lesions. In the first case, no hemostatic agents were necessary. On the other hand, the second case required the use of several hemostatic agents to control hemorrhage during surgery. Both patients recovered uneventfully without episodes of bleeding or infection.
Collapse
|
24
|
|
25
|
Soto H, Bowen RC, Cebulla C, McHugh KM, Singh AD. Isolated Diffuse Choroidal Hemangioma: A Variant of Sturge-Weber Syndrome? J Pediatr Ophthalmol Strabismus 2020; 57:e43-e47. [PMID: 32579687 DOI: 10.3928/01913913-20200512-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 03/13/2020] [Indexed: 11/20/2022]
Abstract
The authors report a case of a diffuse choroidal hemangioma in the left eye of a 17-year-old girl. No evidence of leptomeningeal angiomatosis was found on magnetic resonance imaging and neither the medical history nor the clinical examination revealed a port wine birthmark on the left side of the face. Fine telangiectatic vessels were found on the bulbar conjunctiva of the ipsilateral eye. Because of the shared destination of the vessel-trigeminal-ectoderm complex that migrates toward the optic placode, forming choriocapillaris, upper facial skin (upper eyelid), and conjunctival vessels, an embryological basis can be offered for ophthalmic angiomatosis of Sturge-Weber syndrome. The authors propose that vascular angiomatosis of upper eyelid skin and conjunctiva are phenotypically equivalent and may be present or absent, independent of each other. Their proposed expansion of Sturge-Weber syndrome diagnostic criteria needs to be validated by a comprehensive review of ophthalmic features of Sturge-Weber syndrome. [J Pediatr Ophthalmol Strabismus. 2020;57:e43-e47.].
Collapse
|
26
|
Boos MD, Bozarth XL, Sidbury R, Cooper AB, Perez F, Chon C, Paras G, Amlie-Lefond C. Forehead location and large segmental pattern of facial port-wine stains predict risk of Sturge-Weber syndrome. J Am Acad Dermatol 2020; 83:1110-1117. [PMID: 32413446 DOI: 10.1016/j.jaad.2020.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/23/2020] [Accepted: 05/05/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Children with forehead port-wine stains (PWSs) are at risk of Sturge-Weber syndrome (SWS). However, most will not develop neurologic manifestations. OBJECTIVE To identify children at greatest risk of SWS. METHOD In this retrospective cohort study of children with a forehead PWS, PWSs were classified as "large segmental" (half or more of a contiguous area of the hemiforehead or median pattern) or "trace/small segmental" (less than half of the hemiforehead). The outcome measure was a diagnosis of SWS. RESULTS Ninety-six children had a forehead PWS. Fifty-one had a large segmental PWS, and 45 had a trace/small segmental PWS. All 21 children with SWS had large segmental forehead PWSs. Large segmental forehead PWSs had a higher specificity (0.71 vs 0.27, P < .0001) and a higher positive predictive value (0.41 vs 0.22, P < .0001) for SWS than any forehead involvement by a PWS. LIMITATIONS Retrospective study at a referral center. CONCLUSION Children with large segmental forehead PWSs are at highest risk of SWS.
Collapse
Affiliation(s)
- Markus D Boos
- Division of Dermatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington.
| | - Xiuhua L Bozarth
- Division of Neurology, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington
| | - Robert Sidbury
- Division of Dermatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington
| | - Andrew B Cooper
- Enterprise Analytics, Seattle Children's Hospital, Seattle, Washington
| | - Francisco Perez
- Division of Radiology, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington
| | - Connie Chon
- Departmentof Pedatrics, Seattle Children's Hospital, Seattle, Washington
| | - Gabrielle Paras
- University of Washington School of Medicine, Seattle, Washington
| | - Catherine Amlie-Lefond
- Division of Neurology, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington
| |
Collapse
|
27
|
Rihani HT, Dalvin LA, Hodge DO, Pulido JS. Incidence of Sturge-Weber syndrome and associated ocular involvement in Olmsted County, Minnesota, United States. Ophthalmic Genet 2020; 41:108-124. [PMID: 32233696 PMCID: PMC8851558 DOI: 10.1080/13816810.2020.1731834] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 02/05/2020] [Accepted: 02/09/2020] [Indexed: 01/15/2023]
Abstract
Background: Sturge-Weber syndrome (SWS) is a rare sporadic syndrome characterized by nevus flammeus (port-wine stain, PWS) in the trigeminal nerve distribution, diffuse choroidal hemangioma, and brain leptomeningeal hemangioma. We are unaware of previous reports of SWS incidence in the United States. This study investigated SWS incidence and associated ocular involvement in Olmsted County, Minnesota.Materials and methods: The Rochester Epidemiology Project database was used to identify SWS cases from January 1, 2000-December 31, 2017. Incidence of SWS was calculated using the Olmsted County census population. A literature review of studies investigating SWS-associated ocular involvement was also performed.Results: There were 13 patients with SWS in Olmsted County classified as type 1 (31%) or type 2 (69%). Age and sex-adjusted incidence of SWS was 0.19/100,000/year. Race was predominantly Caucasian (85%), with sex female (69%) or male (31%). All patients had PWS, mostly with unilateral distribution in the V1 and/or V2 region (85%). Two cases (15%) had associated Klippel-Trenaunay syndrome. The most common ocular features included: dilated episcleral vessels (46%), glaucoma (46%), retinal detachment (23%), DCH (7.7%), strabismus (31%), and refractive error (38%). PWS in the V1 distribution was associated with all cases of glaucoma, DCH, and neurological involvement. Severe visual impairment (>0.6 LogMAR, Snellen equivalent ≤20/100) was found in (23%) at final follow-up, and one patient (8%) required enucleation for uncontrolled glaucoma.Conclusions: SWS affects approximately 0.19/100,000/year in Olmsted County. Early diagnosis, intervention, lifelong follow-up, and multidisciplinary approach should be used to optimize systemic and ocular outcomes.
Collapse
Affiliation(s)
- Heba T Rihani
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - Lauren A Dalvin
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - David O Hodge
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida, USA
| | - Jose S Pulido
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Molecular Medicine, Mayo Clinic, Minnesota, USA
| |
Collapse
|
28
|
Affiliation(s)
- D Dhingra
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh. India
| | - P Kataria
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh. India
| | - S Singh Pandav
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh. India
| | - S Kaushik
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh. India
| |
Collapse
|
29
|
Andica C, Hagiwara A, Hori M, Haruyama T, Fujita S, Maekawa T, Kamagata K, Yoshida MT, Suzuki M, Sugano H, Arai H, Aoki S. Aberrant myelination in patients with Sturge-Weber syndrome analyzed using synthetic quantitative magnetic resonance imaging. Neuroradiology 2019; 61:1055-1066. [DOI: 10.1007/s00234-019-02250-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 06/19/2019] [Indexed: 12/16/2022]
|
30
|
Stilo S, Ugga L, Russo C, Guadagno E, Del Basso De Caro ML, D'Amico A, Elefante A. B-cell central nervous system lymphoma developing in a patient with cerebral meningioangiomatosis. Radiol Case Rep 2019; 14:538-543. [PMID: 30976365 PMCID: PMC6443910 DOI: 10.1016/j.radcr.2019.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/05/2019] [Accepted: 02/08/2019] [Indexed: 11/16/2022] Open
Abstract
Meningioangiomatosis is a rare congenital hamartomatous malformation of the leptomeninges that can also involve the adjacent cerebral tissue, sometime arising in association with neurofibromatosis. Here we report the case of a 55-year-old man with neuroradiological evidence of meningioangiomatosis, known to be a well-defined malformative-dysplastic lesion, preceding the onset of central nervous system B-cell lymphoma. We describe for the first time this unusual association, highlighting how meningioangiomatosis could accompany different pathologies more frequently than thought.
Collapse
Affiliation(s)
- Salvatore Stilo
- Department of Advanced Biomedical Sciences, Neuroradiology Unit, University "Federico II", Via Pansini, 5, 80131 Naples, Italy
| | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences, Neuroradiology Unit, University "Federico II", Via Pansini, 5, 80131 Naples, Italy
| | - Camilla Russo
- Department of Advanced Biomedical Sciences, Neuroradiology Unit, University "Federico II", Via Pansini, 5, 80131 Naples, Italy
| | - Elia Guadagno
- Department of Advanced Biomedical Sciences, Pathology Unit, University "Federico II", Naples, Italy
| | | | - Alessandra D'Amico
- Department of Advanced Biomedical Sciences, Neuroradiology Unit, University "Federico II", Via Pansini, 5, 80131 Naples, Italy
| | - Andrea Elefante
- Department of Advanced Biomedical Sciences, Neuroradiology Unit, University "Federico II", Via Pansini, 5, 80131 Naples, Italy
| |
Collapse
|
31
|
Kaushik S, Kataria P, Joshi G, Singh R, Handa S, Pandav SS, Ram J, Gupta A. Perioperative Propranolol: A Useful Adjunct for Glaucoma Surgery in Sturge-Weber Syndrome. Ophthalmol Glaucoma 2019; 2:267-274. [PMID: 32672550 DOI: 10.1016/j.ogla.2019.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 03/12/2019] [Accepted: 03/21/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Ocular manifestations of Sturge-Weber syndrome (SWS) include choroidal hemangioma and glaucoma. Intraocular pressure (IOP) reduction in these patients commonly is associated with sight-threatening choroidal effusions. Oral propranolol is the standard of care for infantile cutaneous hemangioma, but its role in choroidal hemangioma largely is unexplored. We studied the role of perioperative oral propranolol during glaucoma surgery in SWS. DESIGN Prospective, nonrandomized case series with historical controls. PARTICIPANTS Fourteen eyes of 12 patients with SWS scheduled for glaucoma surgery were included, and the outcomes were compared with those of historical controls without propranolol use (15 eyes of 14 patients). METHODS Patients in the prospective cohort received oral propranolol 2 mg/kg of body weight daily in 2 divided doses 1 week before surgery and continued for 6 weeks after surgery. There was no modification (e.g., posterior sclerotomy) in the existing surgical technique. The historical control group was identified from records and SWS diagnosis validated by chart review. MAIN OUTCOME MEASURES The incidence and extent of postoperative choroidal effusion, additional procedures required compared with the control group, and adverse effects of the drug in the prospective cohort. RESULTS Average follow-up was 25.7±12.1 months (95% confidence interval, 19.3-32.1 months). The intraocular pressure reduced from 25.2±9.7 mmHg at presentation to 16.25±6.2 mmHg, 14.6±4.5 mmHg, 13.7±6.4 mmHg, and 16.5±8.0 mmHg at 1 week, 1 month, 3 months, and 1 year after surgery, respectively. In the perioperative propranolol group, no patient demonstrated sight-threatening choroidal effusion within the vascular arcades. In the 2 patients with bilateral disease, both eyes of each patient showed peripheral choroidal effusion, which settled with medical treatment. Surgery was a repeat procedure in 3 of the 4 eyes. There were no adverse effects of propranolol in any patient. In the control group, 5 of 12 eyes showed peripheral choroidal effusion after primary glaucoma surgery, whereas 5 of 6 eyes that underwent repeat surgery failed demonstrated sight-threatening choroidal effusion requiring surgical intervention. CONCLUSIONS Oral propranolol seems to be an effective method to minimize the development of sight-threatening choroidal effusion after glaucoma surgery in SWS.
Collapse
Affiliation(s)
- Sushmita Kaushik
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Pankaj Kataria
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Gunjan Joshi
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Singh
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sabia Handa
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Surinder S Pandav
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jagat Ram
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amod Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
32
|
Pasquini L, Tortora D, Manunza F, Rossi Espagnet MC, Figà-Talamanca L, Morana G, Occella C, Rossi A, Severino M. Asymmetric cavernous sinus enlargement: a novel finding in Sturge-Weber syndrome. Neuroradiology 2019; 61:595-602. [PMID: 30747269 DOI: 10.1007/s00234-019-02182-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 01/29/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Enlargement of deep cerebral veins and choroid plexus engorgement are frequently reported in Sturge-Weber syndrome. We aim to describe cavernous sinus involvement in patients with this syndrome and to identify possible clinical-neuroimaging correlations. METHODS Sixty patients with Sturge-Weber syndrome (31 females, mean age 4.5 years) and 120 age/sex-matched controls were included in this retrospective study. We performed a visual analysis to identify patients with asymmetric cavernous sinus enlargement. Then, we measured on axial T2WI the left (A), right (B), and bilateral (LL) transverse diameters of the cavernous sinus. We calculated the module of the difference |A-B| and the cavernous sinus asymmetry index as the ratio |A-B|/LL. Differences among groups were assessed by Mann-Whitney U and Kruskal-Wallis tests. Clinicoradiological associations were evaluated by Fisher exact test. RESULTS We found seven subjects (11.6%) with asymmetric CS enlargement. The |A-B| and cavernous sinus asymmetry index were higher in patients with asymmetric CS enlargement compared with controls and patients without visible CS abnormalities (pB < 0.05). Asymmetric CS enlargement was always ipsilateral to facial port-wine stains (7/7), and, when present, to leptomeningeal vascular malformations (4/7). It was significantly associated with ipsilateral bone marrow changes (p = 0.013) and dilated veins (p = 0.002). Together with brain atrophy and deep venous dilatation, this sign was associated with neurological deficits (p < 0.05). CONCLUSIONS We expanded the spectrum of venous abnormalities in SWS, showing the presence of asymmetric cavernous sinus enlargement in more than one tenth of patients, likely related to increased venous drainage.
Collapse
Affiliation(s)
- Luca Pasquini
- Neuroradiology Unit, NESMOS Department, Sant'Andrea Hospital, La Sapienza University, Rome, Italy
| | - Domenico Tortora
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147, Genoa, Italy
| | | | | | | | - Giovanni Morana
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147, Genoa, Italy
| | - Corrado Occella
- Dermatology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Andrea Rossi
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147, Genoa, Italy.
| | - Mariasavina Severino
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147, Genoa, Italy
| |
Collapse
|
33
|
Shchederkina IO, Livshtz MI, Kuzmina EV, Seliverstova EV, Kessel AE, Petryaykina EE. [Sturge-Weber syndrome in children. Clinical features, diagnosis and approaches to therapy on the example of three clinical cases]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:55-64. [PMID: 32207732 DOI: 10.17116/jnevro201911911255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sturge-Weber syndrome belongs to the group of phacomotoses and is characterized by a combined lesion of the skin, eyes, nervous system and internal organs. The clinical course of Sturge-Weber syndrome is quite diverse. Of particular interest in the practice of pediatric neurology and neurosurgery is the fact that 72-90% of patients present with epilepsy. Of particular difficulty is the differential diagnosis of epileptic seizures and stroke-like episodes. The article presents clinical cases of patients with Sturge-Weber syndrome of various ages with epileptic seizures and transient ischemic attacks.
Collapse
Affiliation(s)
- I O Shchederkina
- Morozov Moscow children clinical hospital, Pediatric stroke center, Moscow, Russia
| | - M I Livshtz
- Morozov Moscow children clinical hospital, Pediatric stroke center, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
| | - E V Kuzmina
- Morozov Moscow children clinical hospital, Pediatric stroke center, Moscow, Russia
| | - E V Seliverstova
- Morozov Moscow children clinical hospital, Pediatric stroke center, Moscow, Russia
| | - A E Kessel
- Morozov Moscow children clinical hospital, Pediatric stroke center, Moscow, Russia
| | - E E Petryaykina
- Morozov Moscow children clinical hospital, Pediatric stroke center, Moscow, Russia; Russian University of Friendship, Moscow, Russia
| |
Collapse
|
34
|
Gürsoy S, Erçal D. Genetic Evaluation of Common Neurocutaneous Syndromes. Pediatr Neurol 2018; 89:3-10. [PMID: 30424961 DOI: 10.1016/j.pediatrneurol.2018.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 08/03/2018] [Accepted: 08/06/2018] [Indexed: 12/12/2022]
Abstract
The neurocutaneous syndromes are a group of multisystem disorders that affect the skin and central nervous system. Neurofibromatosis 1, neurofibromatosis 2, tuberous sclerosis complex, and Sturge-Weber syndrome are the four major neurocutaneous disorders that mainly present in childhood. In this review, we discuss the clinical findings and genetic diagnosis, related genes/pathways and genotype-phenotype correlations of these four neurocutaneous syndromes.
Collapse
Affiliation(s)
- Semra Gürsoy
- Department of Pediatric Genetics, Dr. Behcet Uz Children's Hospital, Izmir, Turkey.
| | - Derya Erçal
- Department of Pediatric Genetics, Dokuz Eylül University Medical School, Izmir, Turkey
| |
Collapse
|
35
|
Warne RR, Carney OM, Wang G, Bhattacharya D, Chong WK, Aylett SE, Mankad K. The Bone Does Not Predict the Brain in Sturge-Weber Syndrome. AJNR Am J Neuroradiol 2018; 39:1543-1549. [PMID: 30026385 DOI: 10.3174/ajnr.a5722] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/18/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE It has been hypothesized that skull marrow signal alteration may represent an early disease manifestation of Sturge-Weber syndrome before development of its intracranial manifestations. We alternatively hypothesized that intraosseous changes are associated with the overlying port-wine stain rather than the intracranial stigmata of Sturge-Weber syndrome and hence are not a predictor of brain involvement. MATERIALS AND METHODS MR imaging of children presenting with port-wine stain and/or Sturge-Weber syndrome between 1998 and 2017 was evaluated by 2 pediatric neuroradiologists for marrow signal abnormality and pial angioma and other Sturge-Weber syndrome features: ocular hemangioma, atrophy, and white matter changes (advanced myelination). Groups were divided into port-wine stain-only (without intracranial Sturge-Weber syndrome features) and Sturge-Weber syndrome (the presence of cerebral pial angioma). The χ2 test was performed to evaluate the association between port-wine stain and bone marrow changes and between osseous change and pial angioma. RESULTS We reviewed 139 cases: 40 with port-wine stain-only and 99 with Sturge-Weber syndrome with pial angioma. Fifteen of 99 cases of Sturge-Weber syndrome had no port-wine stain. In the port-wine stain-only cohort, 78% had ipsilateral bony changes and 17% had no intraosseous changes. In the Sturge-Weber syndrome cohort, 84/99 had associated port-wine stain, 91% (P < .01) had bony changes ipsilateral to the port-wine stain or had no bone changes in the absence of port-wine stain, and 77% (P = .27) had bony changes ipsilateral to a cerebral pial angioma. Eighty percent of patients with Sturge-Weber syndrome who lacked a port-wine stain also lacked marrow changes. Five patients with bilateral port-wine stain and bilateral marrow changes had only a unilateral pial angioma. CONCLUSIONS Intraosseous marrow changes are strongly associated with facial port-wine stain; no significant association was found between pial angioma and bone marrow changes.
Collapse
Affiliation(s)
- R R Warne
- From the Department of Paediatric Neuroradiology (R.R.W., O.M.C., D.B., W.K.C., K.M.), Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - O M Carney
- From the Department of Paediatric Neuroradiology (R.R.W., O.M.C., D.B., W.K.C., K.M.), Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - G Wang
- Department of Biostatistics (G.W.), University of Sydney School of Public Health, Sydney, New South Wales, Australia 2006
| | - D Bhattacharya
- From the Department of Paediatric Neuroradiology (R.R.W., O.M.C., D.B., W.K.C., K.M.), Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - W K Chong
- From the Department of Paediatric Neuroradiology (R.R.W., O.M.C., D.B., W.K.C., K.M.), Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - S E Aylett
- Neurosciences (S.E.A.), Great Ormond Street Hospital for Children and Developmental Neurosciences University College London, NHS Foundation Trust, London UK
| | - K Mankad
- From the Department of Paediatric Neuroradiology (R.R.W., O.M.C., D.B., W.K.C., K.M.), Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| |
Collapse
|
36
|
Pavlenko D, Scovpen T, Vitovska O. Sturge-Weber syndrome-associated glaucoma and intraocular osseous metaplasia: a unique complicated case. BMJ Case Rep 2018; 2018:bcr-2017-223983. [PMID: 29769188 PMCID: PMC5965766 DOI: 10.1136/bcr-2017-223983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2018] [Indexed: 11/04/2022] Open
Abstract
A 30-year-old European man was admitted to our centre complaining about severe pain of the right eye (OD) and right part of the face, redness and no vision of the OD. He had an 18-year history of secondary to Sturge-Weber syndrome glaucoma, 6-month history of red eye and 1-week history of pain in OD. The best-corrected visual acuity was no light perception OD and 20/20 OS. Intraocular pressure was 36 mm Hg OD. Examination revealed endophthalmitis, Sturge-Weber syndrome-associated glaucoma and complicated cataract of OD.Unfortunately, no prescribed treatment helped this patient, so evisceration of OD was performed. During the evisceration, a subretinal 20 mm in width and 22 mm in length osseous tissue, partially vascularised, was removed surgically and was sent to the histological laboratory. Histopathologically, there were data of active inflammatory process, retinal detachment due to huge subretinal osseous metaplasia, gliosis and retinal pigment epithelial hyperplasia, and druses with ossification.
Collapse
Affiliation(s)
- Dmytro Pavlenko
- Department of Ophthalmology, Bogomolets National Medical University, Kyiv, Ukraine
| | - Tetiana Scovpen
- Department of Ophthalmology, Oleksandrivska Clinical Hospital, Kyiv, Ukraine
| | - Oksana Vitovska
- Department of Ophthalmology, Bogomolets National Medical University, Kyiv, Ukraine
| |
Collapse
|
37
|
Sundaram SK, Michelhaugh SK, Klinger NV, Kupsky WJ, Sood S, Chugani HT, Mittal S, Juhász C. GNAQ Mutation in the Venous Vascular Malformation and Underlying Brain Tissue in Sturge-Weber Syndrome. Neuropediatrics 2017; 48:385-389. [PMID: 28571101 PMCID: PMC5587372 DOI: 10.1055/s-0037-1603515] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The recent identification of the somatic GNAQ mutation (c.548G > A) provides insight into the pathogenesis of Sturge–Weber syndrome (SWS). Although the primary SWS brain pathology is the leptomeningeal angiomatosis (LMA), cerebral cortical and white matter abnormalities play a prominent role in the disease manifestations. In some cases, SWS brain involvement is present even without detectable LMA on magnetic resonance imaging (MRI). To expand our understanding of the etiology of SWS brain pathology, surgical SWS brain specimens from nine children (age: 0.8–7.5 years) were carefully separated into LMA and (non-LMA) brain tissue; the latter did not contain any vascular malformation. A custom Competitive Allele-Specific TaqMan PCR (castPCR) assay to detect the mutation in GNAQ was performed in these separated specimens. The mutation was present in all nine LMA and seven of the nine non-LMA brain tissues. LMA tissues were significantly enriched by the mutation, as compared with non-LMA brain (mean: 7.2 ± 2.1% and 1.2 ± 0.4%, respectively; p = 0.008). These results demonstrate that the somatic GNAQ mutation in SWS is not confined to the venous vascular malformation but can directly (although less severely) affect underlying brain parenchyma, not directly affected by LMA, and possibly contribute to SWS brain pathology. Future studies should identify the specific cell type(s) affected by the mutation in the SWS-affected brain parenchyma.
Collapse
Affiliation(s)
- Senthil K. Sundaram
- Department of Pediatrics, Wayne State University, Detroit, Michigan, United States,Children’s Hospital of Michigan, Detroit, Michigan, United States,Department of Neurology, Wayne State University, Detroit, Michigan, United States
| | - Sharon K. Michelhaugh
- Department of Neurosurgery, Wayne State University, Detroit, Michigan, United States
| | - Neil V. Klinger
- Department of Neurosurgery, Wayne State University, Detroit, Michigan, United States
| | - William J. Kupsky
- Department of Pathology, Wayne State University, Detroit, Michigan, United States
| | - Sandeep Sood
- Department of Pediatrics, Wayne State University, Detroit, Michigan, United States,Children’s Hospital of Michigan, Detroit, Michigan, United States,Department of Neurosurgery, Wayne State University, Detroit, Michigan, United States
| | - Harry T. Chugani
- Department of Pediatrics, Wayne State University, Detroit, Michigan, United States,Children’s Hospital of Michigan, Detroit, Michigan, United States,Department of Neurology, Wayne State University, Detroit, Michigan, United States,Division of Pediatric Neurology, Nemours Alfred I. DuPont Hospital for Children, Wilmington, Delaware, United States,Thomas Jefferson University School of Medicine, Philadelphia, Pennsylvania, United States
| | - Sandeep Mittal
- Department of Neurosurgery, Wayne State University, Detroit, Michigan, United States,Department of Oncology, Wayne State University, Detroit, Michigan, United States
| | - Csaba Juhász
- Department of Pediatrics, Wayne State University, Detroit, Michigan, United States,Children’s Hospital of Michigan, Detroit, Michigan, United States,Department of Neurology, Wayne State University, Detroit, Michigan, United States
| |
Collapse
|
38
|
Mohammadipanah F, Salimi F. Potential biological targets for bioassay development in drug discovery of Sturge-Weber syndrome. Chem Biol Drug Des 2017; 91:359-369. [PMID: 28941044 DOI: 10.1111/cbdd.13112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 06/10/2017] [Accepted: 09/18/2017] [Indexed: 01/02/2023]
Abstract
Sturge-Weber Syndrome (SWS) is a neurocutaneous disease with clinical manifestations including ocular (glaucoma), cutaneous (port-wine birthmark), neurologic (seizures), and vascular problems. Molecular mechanisms of SWS pathogenesis are initiated by the somatic mutation in GNAQ. Therefore, no definite treatments exist for SWS and treatment options only mitigate the intensity of its clinical manifestations. Biological assay design for drug discovery against this syndrome demands comprehensive knowledge on mechanisms which are involved in its pathogenesis. By analysis of the interrelated molecular targets of SWS, some in vitro bioassay systems can be allotted for drug screening against its progression. Development of such platforms of bioassay can bring along the implementation of high-throughput screening of natural or synthetic compounds in drug discovery programs. Regarding the fact that study of molecular targets and their integration in biological assay design can facilitate the process of effective drug discovery; some potential biological targets and their respective biological assay for SWS drug discovery are propounded in this review. For this purpose, some biological targets for SWS drug discovery such as acetylcholinesterase, alkaline phosphatase, GABAergic receptors, Hypoxia-Inducible Factor (HIF)-1α and 2α are suggested.
Collapse
Affiliation(s)
- Fatemeh Mohammadipanah
- Department of Microbial Biotechnology, School of Biology and Center of Excellence in Phylogeny of Living Organisms, College of Science, University of Tehran, Tehran, Iran
| | - Fatemeh Salimi
- Department of Microbial Biotechnology, School of Biology and Center of Excellence in Phylogeny of Living Organisms, College of Science, University of Tehran, Tehran, Iran
| |
Collapse
|
39
|
Martins L, Giovani PA, Rebouças PD, Brasil DM, Haiter Neto F, Coletta RD, Machado RA, Puppin-Rontani RM, Nociti FH, Kantovitz KR. Computational analysis for GNAQ mutations: New insights on the molecular etiology of Sturge-Weber syndrome. J Mol Graph Model 2017; 76:429-440. [PMID: 28779688 DOI: 10.1016/j.jmgm.2017.07.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 07/11/2017] [Accepted: 07/12/2017] [Indexed: 12/13/2022]
Abstract
Somatic activating mutations in the GNAQ have been recently associated with several congenital genetic disorders and tumors; however, the molecular mechanism/etiology that leads to GNAQ somatic mosaic mutation are unknown. Here, we reported a case of Sturge-Weber Syndrome (SWS) manifesting cutaneous vascular malformations (hemifacial Port-wine stain), cerebral and ocular vascular abnormalities (including epilepsy and glaucoma) and harboring a c.548G>A (p.R183Q) somatic mosaic mutation in GNAQ. Computational modeling studies were performed to assistant with the comprehension of the functional impact of p.R183Q and p.Q209L mutations in GNAQ, which encodes a G protein subunit alpha q (Gαq). The p.R183Q mutation was predicted to abolish hydrogen bonds between R183 residue and GDP molecule, destabilizing the inactive GDP-bound conformation of the Gαq mutants. Furthermore, replacement of R183 by Q183 residue was predicted to promote conformation changes in protein surface features affecting the switch I region, a key region that undergoes conformational changes triggered by receptor binding during signal transduction. In addition, replacement of Q209 by L209 residue was predicted to affect the molecular interaction between Gαq and Gβ subunit, impairing formation of the inactive heterotrimeric complex. These findings, in association with PPI network analysis, indicate that p.R183Q and p.Q209L mutations result in the over-activation of different downstream effectors, which in turn will determine the distinct cell responses and phenotype. These findings bring new insights on molecular etiology of vascular malformations associated to SWS and on different mechanisms underlying hyperactivation of downstream pathways to Gαq.
Collapse
Affiliation(s)
- Luciane Martins
- Department of Prosthodontics and Periodontics, Division of Periodontics, Piracicaba Dental School, University of Campinas - UNICAMP, Piracicaba, SP, Brazil
| | - Priscila Alves Giovani
- Department of Pediatric Dentistry, Piracicaba Dental School, University of Campinas - UNICAMP, Piracicaba, SP, Brazil
| | - Pedro Diniz Rebouças
- Department of Pediatric Dentistry, Piracicaba Dental School, University of Campinas - UNICAMP, Piracicaba, SP, Brazil
| | - Danieli Moura Brasil
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas - UNICAMP, Piracicaba, SP, Brazil
| | - Francisco Haiter Neto
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas - UNICAMP, Piracicaba, SP, Brazil
| | - Ricardo D Coletta
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas - UNICAMP, Piracicaba, SP, Brazil
| | - Renato Assis Machado
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas - UNICAMP, Piracicaba, SP, Brazil
| | - Regina Maria Puppin-Rontani
- Department of Pediatric Dentistry, Piracicaba Dental School, University of Campinas - UNICAMP, Piracicaba, SP, Brazil
| | - Francisco Humberto Nociti
- Department of Prosthodontics and Periodontics, Division of Periodontics, Piracicaba Dental School, University of Campinas - UNICAMP, Piracicaba, SP, Brazil
| | - Kamila Rosamilia Kantovitz
- Department of Pediatric Dentistry, Piracicaba Dental School, University of Campinas - UNICAMP, Piracicaba, SP, Brazil; Department of Dental Materials, São Leopoldo Mandic School of Dentistry and Research Center, Campinas, SP, Brazil.
| |
Collapse
|
40
|
Tooth extraction with Sturge-Weber syndrome. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2017. [DOI: 10.1016/j.ajoms.2016.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
41
|
Plateroti AM, Plateroti R, Mollo R, Librando A, Contestabile MT, Fenicia V. Sturge-Weber Syndrome Associated with Monolateral Ocular Melanocytosis, Iris Mammillations, and Diffuse Choroidal Haemangioma. Case Rep Ophthalmol 2017; 8:375-384. [PMID: 28868033 PMCID: PMC5567108 DOI: 10.1159/000477612] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 05/15/2017] [Indexed: 11/19/2022] Open
Abstract
We present the case of a 12-year-old boy with Sturge-Weber syndrome and ocular melanocytosis who presented with bilateral naevus flammeus of the face and hyperpigmentation of the right iris associated with ipsilateral iris mammillations. The patient had glaucoma and a diffuse choroidal haemangioma of the right eye. Optical coherence tomography of the anterior segment confirmed iris hyper-pigmentation and did not show abnormalities of the chamber angle structures. B-scan ultrasonography and enhanced depth imaging optical coherence tomography were performed and showed a marked difference in thickness and reflectance between the right and left choroid. Visual field examinations with perimetry showed early defects in the right eye. Peripapillary optical coherence imaging showed borderline values of retinal nerve fibre layer thickness reduction in the right eye. Sturge-Weber syndrome associated with ocular melanocytosis and iris mammillations is an extremely rare condition. This paper highlights the role of multi-imaging methods in the enhanced evaluation of rare diseases towards choosing the most appropriate management strategies and improving the follow-up of patients over time.
Collapse
Affiliation(s)
- Andrea Maria Plateroti
- Ophthalmology Unit, DAI Head and Neck, Azienda Ospedaliera Universitaria Policlinico Umberto I, University of Rome “Sapienza”, Rome, Italy
| | - Rocco Plateroti
- Ophthalmology Unit, DAI Head and Neck, Azienda Ospedaliera Universitaria Policlinico Umberto I, University of Rome “Sapienza”, Rome, Italy
| | - Roberto Mollo
- Ophthalmology Unit, DAI Head and Neck, Azienda Ospedaliera Universitaria Policlinico Umberto I, University of Rome “Sapienza”, Rome, Italy
| | - Aloisa Librando
- Ophthalmology Unit, DAI Head and Neck, Azienda Ospedaliera Universitaria Policlinico Umberto I, University of Rome “Sapienza”, Rome, Italy
| | - Maria Teresa Contestabile
- Ophthalmology Unit, St. Andrea Hospital, NESMOS Department, University of Rome “Sapienza”, Rome, Italy
| | - Vito Fenicia
- Ophthalmology Unit, St. Andrea Hospital, NESMOS Department, University of Rome “Sapienza”, Rome, Italy
| |
Collapse
|
42
|
Ishikawa H, Ii Y, Niwa A, Matsuura K, Maeda M, Tomimoto H. A case of 55-year-old man with first-ever generalized seizure diagnosed with Sturge-Weber syndrome type III by characteristic MRI findings. Rinsho Shinkeigaku 2017; 57:214-219. [PMID: 28450688 DOI: 10.5692/clinicalneurol.cn-001006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 55-year-old man with no mental retardation had presented a history of frequent transient clumsiness of his right upper and lower extremities for about 20 years. He was admitted to a general hospital with weakness of right side of the body, and first-ever generalized seizure attack occurred the next day. Brain CT showed calcification in the left cerebral cortices. So he was referred to our hospital. On neurological examination, he had mild clumsiness of his right upper limb and right pyramidal tract sign. He had neither facial port-wine stain nor glaucoma. The blood test and cerebrospinal fluid analysis were unremarkable. Electroencephalogram showed slowing and reduction of activity at the left frontal and parietal areas with no epileptic activities. Brain CT showed "tram-track calcification" and lobar atrophy in the left fronto-parietal cortices. Susceptibility weighted imaging (SWI) on MRI revealed enlarged transmedullary veins in the left periventricular white matter and low intensity lesions along the cortical gyri. Post gadolinium fluid-attenuated inversion recovery imaging (FLAIR-Gd) showed leptomeningeal enhancement in the left fronto-parietal lobes more extensively than those by post gadolinium T1-weighted image. Brain perfusion single photon emission computed tomography with a technetium-99m-ethyl cysteinate dimer (99mTc-ECD SPECT) revealed hypoperfusion in the fronto-parietal lobes. These clinical and neuroimaging findings were compatible with type III Sturge-Weber syndrome (SWS). His condition was improved after treatment with oral levetiracetam (1,000 mg daily). Although adult-onset type III SWS is very rare, it is important to perform SWI and post-contrast FLAIR for assessing leptomeningeal angioma in patients with seizure with focal cortical calcification even if they have no facial nevus.
Collapse
Affiliation(s)
| | - Yuichiro Ii
- Department of Neurology, Mie University Graduate School of Medicine
| | - Atsushi Niwa
- Department of Neurology, Mie University Graduate School of Medicine
| | - Keita Matsuura
- Department of Neurology, Mie University Graduate School of Medicine
| | - Masayuki Maeda
- Department of Advanced Diagnostic Imaging, Mie University Graduate School of Medicine
| | | |
Collapse
|
43
|
Roach ES. Applying the Lessons of Tuberous Sclerosis: The 2015 Hower Award Lecture. Pediatr Neurol 2016; 63:6-22. [PMID: 27543366 DOI: 10.1016/j.pediatrneurol.2016.07.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 07/07/2016] [Indexed: 12/15/2022]
Abstract
Tuberous sclerosis complex is a dominantly inherited disorder that variably affects the brain, skin, kidneys, heart, and other organs. Its neurological manifestations include epilepsy, autism, cognitive and behavioral dysfunction, and giant cell tumors. A mutation of either TSC1 or TSC2 can cause tuberous sclerosis complex. Their two gene products, hamartin and tuberin, form a physical complex which normally inhibits protein synthesis mediated through the mechanistic target of rapamycin, so a TSC1 or TSC2 mutation results in overactivation of the mechanistic target of rapamycin cascade. In addition to their tumor suppressor roles, TSC1 and TSC2 help to regulate cell size, neuronal migration, axon formation, and synaptic plasticity. Clinical trials of two different the mechanistic target of rapamycin inhibitors have demonstrated substantial improvement of tuberous sclerosis complex-related tumors, and a recent trial also showed a benefit from the mechanistic target of rapamycin inhibitor everolimus in the treatment of refractory epilepsy due to tuberous sclerosis complex. Effective mechanism-based therapy is now available for some manifestations of tuberous sclerosis complex.
Collapse
Affiliation(s)
- E Steve Roach
- Division of Child Neurology, Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, Ohio.
| |
Collapse
|
44
|
Correction of Facial Deformity in Sturge-Weber Syndrome. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e843. [PMID: 27622111 PMCID: PMC5010334 DOI: 10.1097/gox.0000000000000843] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 04/29/2016] [Indexed: 01/06/2023]
Abstract
Background: Although previous studies have reported soft-tissue management in surgical treatment of Sturge–Weber syndrome (SWS), there are few reports describing facial bone surgery in this patient group. The purpose of this study is to examine the validity of our multidisciplinary algorithm for correcting facial deformities associated with SWS. To the best of our knowledge, this is the first study on orthognathic surgery for SWS patients. Methods: A retrospective chart review included 2 SWS patients who completed the surgical treatment algorithm. Radiographic and clinical data were recorded, and a treatment algorithm was derived. Results: According to the Roach classification, the first patient was classified as type I presenting with both facial and leptomeningeal vascular anomalies without glaucoma and the second patient as type II presenting only with a hemifacial capillary malformation. Considering positive findings in seizure history and intracranial vascular anomalies in the first case, the anesthetic management was modified to omit hypotensive anesthesia because of the potential risk of intracranial pressure elevation. Primarily, both patients underwent 2-jaw orthognathic surgery and facial bone contouring including genioplasty, zygomatic reduction, buccal fat pad removal, and masseter reduction without major complications. In the second step, the volume and distribution of facial soft tissues were altered by surgical resection and reposition. Both patients were satisfied with the surgical result. Conclusions: Our multidisciplinary algorithm can systematically detect potential risk factors. Correction of the asymmetric face by successive bone and soft-tissue surgery enables the patients to reduce their psychosocial burden and increase their quality of life.
Collapse
|
45
|
Abstract
Background Sturge-Weber syndrome (SWS) is a rare congenital neurocutaneous disorder. It is characterized by the presence of facial port wine stains, neurological abnormalities like seizures and mental retardation, ocular disorders, oral involvement and leptomeningeal angiomas. Case Report A 13-year-old boy presented with the chief complaint of swollen, bleeding gums and deposits on the teeth. Detailed medical and dental history, clinical examination and investigations confirmed the diagnosis of Sturge-Weber syndrome. The treatment comprised of a thorough plaque control regimen to reduce the gingival enlargement, and it included oral hygiene instructions, thorough scaling, root planing at regular intervals and plaque index scoring which motivated the patient at each visit. Conclusion This case illustrates that early intervention in a patient with Sturge-Weber syndrome is quintessential because of its associated gingival vascular features and their complicating manifestations. Furthermore, the need for periodic oral examinations and maintenance of good oral hygiene to prevent any complications from the oral vascular lesions has been highlighted.
Collapse
Affiliation(s)
- C Nidhi
- Department of Pedodontics & Preventive Dentistry, Maulana Azad Institute of Dental Sciences, Delhi, India
| | - C Anuj
- Department of Dental Surgery, Safdarjang Hospital, Delhi, India
| |
Collapse
|
46
|
Mantelli F, Bruscolini A, La Cava M, Abdolrahimzadeh S, Lambiase A. Ocular manifestations of Sturge-Weber syndrome: pathogenesis, diagnosis, and management. Clin Ophthalmol 2016; 10:871-8. [PMID: 27257371 PMCID: PMC4874637 DOI: 10.2147/opth.s101963] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Sturge–Weber syndrome has been included in the group of phakomatoses that is characterized by hamartomas involving the brain, skin, and eyes. The characteristic facial port-wine stain, involving the first branch of the trigeminal nerve and the embryonic vasculature distribution in this area, leads to several ocular complications of the anterior segment and can involve the eyelids and conjunctiva. The posterior segment of the eyes is also affected with diffuse choroidal hemangiomas. However, the most frequent ocular comorbidity is glaucoma with a prevalence rate ranging from 30%–70%. Glaucoma is related to anterior chamber malformations, high episcleral venous pressure (EVP), and changes in ocular hemodynamics. Glaucoma can be diagnosed at birth, but the disease can also develop during childhood and in adults. The management of glaucoma in Sturge–Weber syndrome patients is particularly challenging because of early onset, frequently associated severe visual field impairment at the time of diagnosis, and unresponsiveness to standard treatment. Several surgical approaches have been proposed, but long-term prognosis for both intraocular pressure control and visual function remains unsatisfactory in these patients. Choroidal hemangiomas may also lead to visual impairment thorough exudative retinal detachment and macular edema. Treatment of exudative hemangioma complications is aimed at destructing the tumor or decreasing tumor leakage.
Collapse
Affiliation(s)
- Flavio Mantelli
- Department of Biology, College of Science and Technology, Temple University, Philadelphia, PA, USA
| | - Alice Bruscolini
- Department of Sense Organs, Section of Ophthalmology, University of Rome "Sapienza", Rome, Italy
| | - Maurizio La Cava
- Department of Sense Organs, Section of Ophthalmology, University of Rome "Sapienza", Rome, Italy
| | - Solmaz Abdolrahimzadeh
- Department of Sense Organs, Section of Ophthalmology, University of Rome "Sapienza", Rome, Italy
| | - Alessandro Lambiase
- Department of Sense Organs, Section of Ophthalmology, University of Rome "Sapienza", Rome, Italy
| |
Collapse
|
47
|
Saroj G, Gangwar A, Dhillon JK. Hypothyroidism and Sturge-Weber Syndrome associated with Bilateral Port-wine Nevus. Int J Clin Pediatr Dent 2016; 9:82-5. [PMID: 27274162 PMCID: PMC4890069 DOI: 10.5005/jp-journals-10005-1339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 03/23/2015] [Indexed: 11/23/2022] Open
Abstract
Sturge-Weber syndrome (SWS) is a rare, nonhereditary developmental condition that is characterized by a hamartomatous vascular proliferation of the brain, resulting in multiple angiomas that occur on the same side due to arteriovenous malformations. It is believed to be caused by persistence of a vascular plexus around the cephalic portion of the neural tube and is present at birth in about 1 in every 50,000 babies. It is one of the phakomatoses which is often associated with port-wine stains (PWSs) of the face, glaucoma, seizures, mental retardation and ipsilateral leptomeningeal angioma. Many people with SWS probably never know they have it. Hypothyroidism is a condition that arises from inadequate release of thyroid-stimulating hormone to stimulate an otherwise normal thyroid gland. This condition is often associated with a deficient secretion of other pituitary hormone, and growth hormone deficiency occurs with an increased prevalence in SWS, presumably secondary to involvement of the hypothalamic-pituitary axis. Diagnosis is made by the presence of a facial PWS and evidence of leptomeningeal angioma either by skull X-ray or computed tomography scan that shows intracranial calcifications. Presently, there is no specific treatment for SWS, and the management of the clinical manifestations and complications is still far from adequate. Here, we report the case of hypothyroidism associated with SWS with oral and facial manifestations in an 11-year-old boy. How to cite this article: Saroj G, Gangwar A, Dhillon JK. Hypothyroidism and Sturge-Weber Syndrome associated with Bilateral Port-wine Nevus. Int J Clin Pediatr Dent 2016;9(1): 82-85.
Collapse
Affiliation(s)
- Gyanendra Saroj
- Associate Professor, Department of Pedodontics and Preventive Dentistry Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Anshul Gangwar
- Professor, Department of Pedodontics and Preventive Dentistry, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India
| | - Jatinder Kaur Dhillon
- Assistant Professor, Department of Pedodontics and Preventive Dentistry Maulana Azad Institute of Dental Sciences, New Delhi, India
| |
Collapse
|
48
|
Abstract
Neurocutaneous syndromes (or phakomatoses) are a diverse group of congenital disorders that encompass abnormalities of neuroectodermal and, sometimes, mesodermal development, hence commonly involving the skin, eye, and central nervous system. These are often inherited conditions and typically present in early childhood or adolescence. Some of the abnormalities and clinical symptoms may, however, be progressive, and there is an increased risk of neoplastic formation in many of the syndromes. As a group, neurocutaneous syndromes are characterized by distinctive cutaneous stigmata and neurologic symptomology, the latter often representing the most devastating and debilitating features of these diseases. Many of these syndromes are markedly heterogeneous in nature as they affect many organ systems. Given the incurable nature of these conditions and the broad spectrum of pathologies they comprise, treatments vary on a case-by-case basis and tend to be palliative rather than curative. With the advances in molecular genetics, however, greater understanding of biologic functions of the gene products and the correlative phenotypic expression is being attained, and this knowledge may guide future therapeutic developments. This chapter focuses on the cutaneous and neurologic pathology with emphasis on neuroimaging of selective neurocutaneous syndromes, including tuberous sclerosis, Sturge-Weber syndrome, Klippel-Trenaunay syndrome, ataxia-telangiectasia, and incontinentia pigmenti.
Collapse
Affiliation(s)
- Nitasha Klar
- Division of Neuroradiology, Russell H. Morgan Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bernard Cohen
- Departments of Dermatology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Doris D M Lin
- Division of Neuroradiology, Russell H. Morgan Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| |
Collapse
|
49
|
Abstract
Neurocutaneous syndromes are a diverse group of neurologic disorders with concurrent skin manifestations. Most neurocutaneous syndromes have a genetic basis and are believed to arise from a defect in the differentiation of the primitive ectoderm. In this regard, the skin can be a window into the central nervous system and can aid in the diagnosis of neurologic disease in children. The cutaneous signs may be subtle, which places great importance on the physical examination skills of clinicians providing primary care to children. Early recognition can help with proper diagnosis, formulating a treatment plan, anticipating potential complications, making appropriate referrals, and offering genetic counseling to families.
Collapse
|
50
|
Khanna P, Ray BR, Govindrajan SR, Sinha R, Chandralekha, Talawar P. Anesthetic management of pediatric patients with Sturge-Weber syndrome: our experience and a review of the literature. J Anesth 2015. [PMID: 26194909 DOI: 10.1007/s00540-015-2042-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Sturge-Weber syndrome (SWS) is a rare sporadic congenital neurocutaneous syndrome which is characterized by vascular malformation involving the brain, face and eye. The anesthetic management is complicated by its localized as well as systemic manifestations, associated anomalies and difficult airway due to the presence of angiomas of the oral cavity and airway. We retrospective analyzed the perioperative anesthetic management of children with SWS undergoing ophthalmic surgery and reviewed the literature. METHODS Medical records and anesthetic charts of all the children with SWS who had undergone an ophthalmic procedure under general anesthesia during the past 6 years were reviewed. Information related to the demographic profile, preoperative evaluation, anesthetic techniques, and perioperative complications were collected and analyzed. RESULTS Forty children with SWS received general anesthesia for an ophthalmic procedure within the 6-year period. The median age of the children was 3 years. 30 (92.5%) children had facial port-wine staining, 10 (25%) had facial hypertrophy, 15 (37.5%) had a history of convulsion and 4 (10%) children had mental retardation. Inhalational induction was performed in 34 (85%) children (sevoflurane 82.8%). A laryngeal mask airway (LMA) and endotracheal tube were used in 32 (80%) and 5 (12.5%) cases, respectively. One patient had difficult mask ventilation and difficult LMA insertion. There was no significant problem in any of the other children. CONCLUSION Preoperative evaluation with airway assessment should be performed with the knowledge of local and systemic manifestation of the syndrome. Proconvulsant and anticonvulsant properties of the anesthetics, as well as drug interactions of antiepileptic medications should be considered when planning anesthesia. Avoiding a rise in intracranial and intraocular pressures, vigilant intraoperative monitoring and postoperative care are the key for conducting safe anesthesia in these children. For ophthalmic procedures, LMAs can be used for airway maintenance with minimal complications in children with SWS.
Collapse
Affiliation(s)
- Puneet Khanna
- Department of Anesthesia and Intensive Care, AIIMS, New Delhi, India.
| | - Bikash Ranjan Ray
- Department of Anesthesia and Intensive Care, AIIMS, New Delhi, India
| | | | - Renu Sinha
- Department of Anesthesia and Intensive Care, AIIMS, New Delhi, India
| | - Chandralekha
- Department of Anesthesia and Intensive Care, AIIMS, New Delhi, India
| | - Praveen Talawar
- Department of Anesthesia and Intensive Care, AIIMS, New Delhi, India
| |
Collapse
|