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Ajmi H, Bouafsoun C, Arifa N, Chemli J, Abroug S. Idiopathic pulmonary hemosiderosis and stroke secondary to protein C deficiency in a child with Down syndrome: a case report. J Med Case Rep 2023; 17:105. [PMID: 36899396 PMCID: PMC10007734 DOI: 10.1186/s13256-023-03807-2] [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: 03/10/2022] [Accepted: 02/03/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Patients with Down syndrome are at a higher risk of developing autoimmune disorders such as thyroiditis, diabetes, and celiac disease compared with the general population. Although some diseases are well known to be associated with Down syndrome, others such as idiopathic pulmonary hemosiderosis and ischemic stroke due to protein C deficiency remain rare. CASE PRESENTATION We report a case of a 2.5-year-old Tunisian girl with Down syndrome and hypothyroiditis admitted with dyspnea, anemia, and hemiplegia. Chest X-ray showed diffuse alveolar infiltrates. Laboratory tests showed severe anemia with hemoglobin of 4.2 g/dl without hemolysis. A diagnosis of idiopathic pulmonary hemosiderosis was confirmed by bronchoalveolar lavage showing numerous hemosiderin-laden macrophages, with a Golde score of 285 confirming the diagnosis of pulmonary hemosiderosis. Concerning hemiplegia, computed tomography showed multiple cerebral hypodensities suggestive of cerebral stroke. The etiology of these lesions was related to protein C deficiency. CONCLUSION Idiopathic pulmonary hemosiderosis remains a severe disease, which is rarely associated with Down syndrome. The management of this disease in Down syndrome patients is difficult, especially when associated with an ischemic stroke secondary to protein C deficiency.
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Affiliation(s)
- Houda Ajmi
- Pediatrics Department, Sahloul University Hospital, 4054, Sousse, Tunisia.
| | - Chahra Bouafsoun
- Pediatrics Department, Sahloul University Hospital, 4054, Sousse, Tunisia
| | - Nadia Arifa
- Radiology Department, Sahloul University Hospital, 4054, Sousse, Tunisia
| | - Jalel Chemli
- Pediatrics Department, Sahloul University Hospital, 4054, Sousse, Tunisia
| | - Saoussen Abroug
- Pediatrics Department, Sahloul University Hospital, 4054, Sousse, Tunisia
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Öğüt E, Şekerci R, Şen H, Çakın H, Gediz T, Keles-Celik N. Anatomo-radiological importance and the incidence of os odontoideum in Turkish subjects: a retrospective study. Surg Radiol Anat 2020; 42:701-710. [DOI: https:/doi.org/10.1007/s00276-020-02421-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 01/13/2020] [Indexed: 07/22/2023]
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Anatomo-radiological importance and the incidence of os odontoideum in Turkish subjects: a retrospective study. Surg Radiol Anat 2020; 42:701-710. [PMID: 31989216 DOI: 10.1007/s00276-020-02421-x] [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: 09/11/2019] [Accepted: 01/13/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE Os odontoideum is a rare anatomical and morphological variation of the odontoid process and associated with a range of symptoms such as spinal cord and vertebral artery injuries. This study aimed to evaluate the frequency of os odontoideum in Turkish cases by sagittal/coronal cervical magnetic resonance imaging (MRI) and computed tomography (CT) and analyze the relationship with age, gender and related symptoms. METHODS The incidence of os odontoideum was retrospectively diagnosed by sagittal/coronal cervical CT and MRI out of 16,122 subjects aged 20-70 years (mean 46) in the period between 2014 and 2018. The relationship of os odontoideum with age, gender, and symptoms was recorded. RESULTS The statistical analysis of the study was performed by the χ² test and two-way mixed ANOVA. Os odontoideum was detected in 18 (0.11%) (11 males; 7 females) out of 16,122 patients. The mean age was 47.5 ± 1.4 years in the females and 43.5 ± 2.5 years in the males (p < 0.05). 6 odontoideum were detected out of 6467 (3756 males, mean 48 ± 0.7, 2711 females, mean 46 ± 1.2) subjects by CT and 12 odontoideum were detected out of 9655 patients (5607 males and 4048 females) by MRI. CONCLUSION Neck pain was the most frequent symptom. The prevalence of os odontoideum especially round type is more frequent in older male patients over 40 years old with head and neck pain or atlantoaxial instability, and is less common in Turkish subjects when compared to various ethnic groups.
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Craniovertebral Junction Instability in Adult Patients with Down Syndrome. World Neurosurg 2015; 83:334-6. [DOI: 10.1016/j.wneu.2014.04.075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 04/30/2014] [Indexed: 11/20/2022]
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Pavone P, Falsaperla R, De Silva K, Taibi R, Verrotti A, Trifiletti RR, Vitaliti G. Down syndrome and arterial ischemic stroke in childhood: a potential immunologic link with selective IgG4 subclass deficiency. Eur J Paediatr Neurol 2014; 18:520-5. [PMID: 24613243 DOI: 10.1016/j.ejpn.2014.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 12/24/2013] [Accepted: 02/16/2014] [Indexed: 11/15/2022]
Abstract
We report four children with Down Syndrome (DS) without evidence of congenital heart disease who sustained cerebral infarction in the context of an infectious disease. In one child, stroke occurred in the context of acute infection with Mycoplasma pneumonia. In another child, stroke occurred in the context of Streptococcus oralis (viridans subgroup) infection. In two other children, stroke occurred in the context of a bibasilar pneumonia for which an etiologic agent was not found. All patients had evidence of selective IgG4 subclass deficiency. We followed 8 other children with down syndrome with infectious diseases, but without stroke and a control group of healthy children, and measured the value of IgG4 for each group. We found a statistical significant difference of levels of IgG4 subclass deficiency in the group of stroke, in comparison with the other two groups (P values <0.001). We, therefore, suggest an association between IgG4 subclass deficiency and stroke in DS patients. IgG4 subclass deficiency could conceivably play a role in the high frequency of para-infectious related stroke in this population.
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Affiliation(s)
- Piero Pavone
- Pediatric Acute and Emergency Operative Unit, Vittorio-Emanuele University Hospital, University of Catania, Via Plebiscito n. 628, 95125 Catania, Italy
| | - Raffaele Falsaperla
- Pediatric Acute and Emergency Operative Unit, Vittorio-Emanuele University Hospital, University of Catania, Via Plebiscito n. 628, 95125 Catania, Italy
| | - Kasun De Silva
- South Western Sydney Clinical School, University of New South Wales, Liverpool, Australia
| | - Rosaria Taibi
- Pediatric Acute and Emergency Operative Unit, Vittorio-Emanuele University Hospital, University of Catania, Via Plebiscito n. 628, 95125 Catania, Italy
| | - Alberto Verrotti
- Department of Pediatrics, Chair of Pediatric Neurology, University G. D'Annunzio of Chieti, Chieti, Italy
| | | | - Giovanna Vitaliti
- Pediatric Acute and Emergency Operative Unit, Vittorio-Emanuele University Hospital, University of Catania, Via Plebiscito n. 628, 95125 Catania, Italy.
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Agostini M, Lupica MM, Mostert M, Deluca N, Cordero di Montezemolo L. Cervical arterial dissection and ischaemic stroke in children: two cases. Acta Paediatr 2013; 102:e142-3. [PMID: 23278682 DOI: 10.1111/apa.12123] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Manuela Agostini
- Department of Pediatrics; Regina Margherita Children's Hospital; University of Turin; Turin Italy
| | - Maria Maddalena Lupica
- Department of Pediatrics; Regina Margherita Children's Hospital; University of Turin; Turin Italy
| | - Michael Mostert
- Department of Pediatrics; Regina Margherita Children's Hospital; University of Turin; Turin Italy
| | - Nicola Deluca
- Department of Neurology; Degli Infermi Hospital; Rivoli Italy
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Cryptogenic embolic stroke in a girl with a trisomy 21 mosaic. Acta Neurol Belg 2012; 112:203-4. [PMID: 22426657 DOI: 10.1007/s13760-012-0010-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 08/16/2011] [Indexed: 10/14/2022]
Abstract
Stroke in trisomy 21 may be due to cardioembolism, atherosclerosis, vasculitis, moyamoya disease, sinus venous thrombosis, internal carotid hypoplasia or infections like endocarditis with septic emboli, meningitis or brain abscess. In rare cases, however, stroke etiology remains unexplained. We present a 19 year old Caucasian girl with trisomy 21 with a 47XX+21 karyotype who suffered at age 11 years from a transient ischemic attack with left hemiparesis, and at age 17 years from an ischemic stroke in the territory of the right cerebral medial artery. She suffered from arterial hypertension, obesity and hypercholesterolemia. Since blood coagulation studies, immunologic parameters, blood cultures, 24-h Holter monitoring, transthoracic and transesophageal echocardiography, magnetic resonance angiography of the extra- and intracranial vessels, thoracic and abdominal aorta and renal arteries did not provide any explanation for the stroke, implantation of a loop recorder is considered in order to detect episodes of clinically silent atrial fibrillation.
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El Beltagi AH, El-Nil H, Norbash A, El-Sheikh A, Asbeutah A. Unilateral Basal Ganglia Infarcts: a Red Flag for Ipsilateral Cranio-Cervical Arterial Occlusive Disease. A Report on Two Children with Moya-moya Disease. Neuroradiol J 2012; 25:89-97. [PMID: 24028882 DOI: 10.1177/197140091202500113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Accepted: 08/13/2011] [Indexed: 11/15/2022] Open
Abstract
Steno-occlusive disease of the internal carotid arteries and/or the circle of Willis with development of collateral perforator vessels attempting to supply under-perfused parenchyma are the basis for moya-moya phenomenon with the classic "puff of smoke" appearance on cerebral angiogram. We describe two cases of moya-moya with unilateral macroangiopathy of the internal carotid artery and ipsilateral middle cerebral artery in two 11-year-old girls: a Down's syndrome patient, and a second idiopathic patient. The arteriopathy in our cases differs from typical or classically described moya-moya disease in that it was exclusively unilateral rather than symmetric and bilateral. The association of predominant deep grey matter (basal ganglia) strokes in children with coexisting ipsilateral parainsular infarcts, as in our cases, is potentially a red flag for ipsilateral macroangiopathy.
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Affiliation(s)
- A H El Beltagi
- Radiology Department, Al-Sabah Hospital; MOH-Kuwait, Sulaibikhat, Kuwait -
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Fluctuating Hemiparesis Secondary to Moyamoya Phenomenon in a Child with Down Syndrome: a case report. CASES JOURNAL 2008; 1:240. [PMID: 18922177 PMCID: PMC2572603 DOI: 10.1186/1757-1626-1-240] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Accepted: 10/15/2008] [Indexed: 11/10/2022]
Abstract
Moyamoya phenomenon is a term used to describe extensive collateralization of the circle of Willis arteries associated with severe unilateral or bilateral internal carotid artery stenosis or occlusion in the presence of certain conditions. Down syndrome is among these conditions. A case is reported of a young girl with Down syndrome who presented with fluctuating right-sided weakness and facial droop found to have cerebral ischemia. Subsequent investigations disclosed characteristic "puff of smoke" patterns on angiographic studies consistent with moyamoya phenomenon. The patient was initially treated with aspirin and eventually underwent an encephalomyosynangiosis. This young patient with Down syndrome and moyamoya phenomenon serves as a reminder of the association between these two conditions.
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Abstract
INTRODUCTION The ligamentous laxities and bony abnormalities associated with Down's syndrome, os odontoideum, achondroplasia, osteogenesis imperfecta, and basilar invagination have been discussed with the imaging of the craniocervical junction. These are significant and require suspicion when dealing with children with the previously mentioned entities. CONCLUSION Previous adverse surgical results in managing these patients reflect the lack of understanding of the underlying pathology and the appropriate surgical treatment.
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Espinosa PS, Baumann RJ, Vaishnav AG. Elastosis perforans serpiginosa, Down syndrome, and moyamoya disease. Pediatr Neurol 2008; 38:287-8. [PMID: 18358411 DOI: 10.1016/j.pediatrneurol.2007.12.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2007] [Revised: 10/15/2007] [Accepted: 12/10/2007] [Indexed: 11/19/2022]
Abstract
A 16-year-old girl with Down syndrome, moyamoya disease, and history of a previous stroke presented with acute onset of left hemiparesis and elastosis perforans serpiginosa. Elastosis perforans serpiginosa in a patient with Down syndrome and moyamoya disease is a novel finding. Development of elastosis perforans serpiginosa in association with progressive vaso-occlusive disease may be a biological marker of progression of moyamoya disease.
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Affiliation(s)
- Patricio S Espinosa
- Department of Neurology, University of Kentucky College of Medicine, Lexington, Kentucky 40536-0284, USA.
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Caner I, Olgun H, Buyukavci M, Tastekin A, Ors R. A giant thrombus in the right ventricle of a newborn with Down syndrome: successful treatment with rt-PA. J Pediatr Hematol Oncol 2006; 28:120-2. [PMID: 16679932 DOI: 10.1097/01.mph.0000210405.82050.dc] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
An association between thromboembolic events and Down syndrome (DS) has been increasingly reported in the literature. It is not clear whether patients with DS have increased risk for thrombotic disorders or there is a coincidence. We present a case of giant right ventricular thrombus in a neonate with DS. Risk factors for thrombosis in the present case were neonatal sepsis and dehydration. There was no congenital heart anomaly. The patient was treated successfully using recombinant tissue plasminogen activator. Recombinant tissue plasminogen activator seems to be a safe and effective thrombolytic therapy in neonates.
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Affiliation(s)
- Ibrahim Caner
- Division of Neonatology, School of Medicine, Atatürk University, Erzurum, Turkey
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