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Hung SC, Dahmoush H, Lee HJ, Chen HC, Guimaraes CV. Prenatal Imaging of Supratentorial Fetal Brain Malformation. Magn Reson Imaging Clin N Am 2024; 32:395-412. [PMID: 38944430 DOI: 10.1016/j.mric.2024.03.002] [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: 07/01/2024]
Abstract
This review article provides a comprehensive overview of fetal MR imaging in supratentorial cerebral malformations. It emphasizes the importance of fetal MR imaging as an adjunct diagnostic tool used alongside ultrasound, improving the detection and characterization of prenatal brain abnormalities. This article reviews a spectrum of cerebral malformations, their MR imaging features, and the clinical implications of these findings. Additionally, it outlines the growing importance of fetal MR imaging in the context of perinatal care.
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Affiliation(s)
- Sheng-Che Hung
- Division of Neuroradiology, Department of Radiology, School of Medicine, University of North Carolina at Chapel Hill, NC, USA; Biomedical Research Imaging Center, School of Medicine, University of North Carolina at Chapel Hill
| | - Hisham Dahmoush
- Division of Pediatric Neuroradiology, Department of Radiology, Stanford School of Medicine, Stanford, CA, USA
| | - Han-Jui Lee
- Division of Neuroradiology, Department of Radiology, Taipei Veterans General Hospital, Taiwan; National Yang Ming Chiao Tung University, Taiwan
| | - Hung-Chieh Chen
- National Yang Ming Chiao Tung University, Taiwan; Division of Neuroradiology, Department of Radiology, Taichung Veterans General Hospital, Taiwan
| | - Carolina V Guimaraes
- Division of Pediatric Radiology, Department of Radiology, School of Medicine, University of North Carolina at Chapel Hill, NC, USA.
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Galeotti A, De Vincentiis GC, Sitzia E, Marzo G, Maldonato W, Bompiani G, Chiarini Testa MB, Putrino A, Bartuli A, Festa P. Use of an Orthodontic and Otolaryngological Approach in an Infant with Holoprosencephaly. CHILDREN (BASEL, SWITZERLAND) 2024; 11:554. [PMID: 38790549 PMCID: PMC11119934 DOI: 10.3390/children11050554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/19/2024] [Accepted: 04/28/2024] [Indexed: 05/26/2024]
Abstract
Holoprosencephaly is a complex human brain malformation resulting from incomplete cleavage of the prosencephalon into both hemispheres. Congenital nasal pyriform aperture stenosis (CNPAS) is sometimes found in patients with mild forms of holoprosencephaly. Surgical treatment is required. Low-invasive surgical approaches involve balloon dilation of the pyriform opening. We present the case of an 8-day-old girl diagnosed with holoprosencephaly, CNPAS, and the presence of a solitary median maxillary central incisor. Once examined by neonatologist, geneticist, pneumologist, otolaryngologist, and pediatric dentist, a combined otolaryngological-orthodontic approach was used. The obstruction of the right nasal cavity was treated by widening the nasal cavities and stabilizing them with a balloon dilation technique. After surgery, the respiratory space was increased by applying a neonatal palatal expander plate (NPEP) considering the palatal deformity: ogival shaped, anterior vertex growth direction, reduction of transverse diameters. The NPEP promoted distraction of the median palatine suture and assisted the nasal dilation. Therefore, after the insertion of NPEP, the physiological sucking-swallowing mechanism was activated. In infants with CNPAS, NPEP can be useful to ensure the safe stability of nasal dilation. A multidisciplinary approach is fundamental. In our experience, the close collaboration between an otolaryngologist and orthodontist is essential for the management of the patient with CNPAS.
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Affiliation(s)
- Angela Galeotti
- Dentistry Unit, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy
| | | | - Emanuela Sitzia
- Otolaryngology Unit, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy
| | - Giuseppe Marzo
- Department of Life, Health, Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Wanda Maldonato
- Dentistry Unit, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy
| | - Gaia Bompiani
- Dentistry Unit, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy
| | - Maria Beatrice Chiarini Testa
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Acdemic Department of Pediatrics (DPUO), Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy
| | - Alessandra Putrino
- Dentistry Unit, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy
| | - Andrea Bartuli
- Rare Diseases and Medical Genetics Unit, Academic Department of Pediatrics, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy
| | - Paola Festa
- Dentistry Unit, AORN Santobono-Pausilipon, 80100 Naples, Italy;
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Cortes-Albornoz MC, Bedoya MA, Choi JJ, Jaimes C. MR insights into fetal brain development: what is normal and what is not. Pediatr Radiol 2024; 54:635-645. [PMID: 38416183 DOI: 10.1007/s00247-024-05890-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/09/2024] [Accepted: 02/15/2024] [Indexed: 02/29/2024]
Abstract
Fetal brain development is a complex, rapid, and multi-dimensional process that can be documented with MRI. In the second and third trimesters, there are predictable developmental changes that must be recognized and differentiated from disease. This review delves into the key biological processes that drive fetal brain development, highlights normal developmental anatomy, and provides a framework to identify pathology. We will summarize the development of the cerebral hemispheres, sulci and gyri, extra-axial and ventricular cerebrospinal fluid, and corpus callosum and illustrate the most common abnormal findings in the clinical setting.
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Affiliation(s)
- Maria Camila Cortes-Albornoz
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
- Pediatric Imaging Research Center, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - M Alejandra Bedoya
- Department of Radiology, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jungwhan John Choi
- Department of Radiology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Camilo Jaimes
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
- Pediatric Imaging Research Center, Massachusetts General Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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Gergely L, Repiská V, Böhmer D, Korbeľ M, Václavová Z, McCullough L, Melišová K, Priščáková P. Post-mortem rapid aneuploidy testing for holoprosencephaly. Birth Defects Res 2024; 116:e2342. [PMID: 38632851 DOI: 10.1002/bdr2.2342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/27/2024] [Accepted: 04/08/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Abortion and fetal death are common in fetuses with holoprosencephaly, so genetic examinations often have to be made in a post-mortem setting. The efficiency of the conventional karyotyping using cultured fibroblasts in these situations is limited due to frequent culture failure. In the current study, archived cases of holoprosencephaly, where post-mortem genetic evaluation was requested and sufficient frozen material was available, were reevaluated using the quantitative fluorescence polymerase chain reaction (QF-PCR) technique. METHODS Testing for aneuploidies of chromosomes 13, 15, 16, 18, 21, 22, X, and Y with the QF-PCR technique was carried out on DNA isolated from archived frozen chorionic villi in seven cases of holoprosencephaly. RESULTS QF-PCR was successful in all seven cases. Two cases of trisomy 13, two cases of triploidy, and one case of trisomy 18 was found meaning a 71% diagnostic yield. The success rate of QF-PCR (100%, 7/7) was superior compared to conventional karyotyping (43%, 3/7). CONCLUSIONS Rapid aneuploidy testing using the QF-PCR technique is a simple, reliable, time- and cost-effective method sufficient to conclude the etiologic investigation in the majority of holoprosencephaly cases post-mortem.
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Affiliation(s)
- Lajos Gergely
- Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University Bratislava, Bratislava, Slovakia
| | - Vanda Repiská
- Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University Bratislava, Bratislava, Slovakia
| | - Daniel Böhmer
- Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University Bratislava, Bratislava, Slovakia
| | - Miroslav Korbeľ
- 1st Department of Gynaecology and Obstetrics, Faculty of Medicine, Comenius University Bratislava, Bratislava, Slovakia
| | - Zuzana Václavová
- 1st Department of Gynaecology and Obstetrics, Faculty of Medicine, Comenius University Bratislava, Bratislava, Slovakia
| | - Liam McCullough
- 1st Department of Gynaecology and Obstetrics, Faculty of Medicine, Comenius University Bratislava, Bratislava, Slovakia
| | - Katarína Melišová
- Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University Bratislava, Bratislava, Slovakia
| | - Petra Priščáková
- Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University Bratislava, Bratislava, Slovakia
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Chen Y, Pang J, Ye L, Zhang Z, Lin S, Lin N, Lee TH, Liu H. Disorders of the central nervous system: Insights from Notch and Nrf2 signaling. Biomed Pharmacother 2023; 166:115383. [PMID: 37643483 DOI: 10.1016/j.biopha.2023.115383] [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: 05/29/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 08/31/2023] Open
Abstract
The functional complexity of the central nervous system (CNS) is unparalleled in living organisms. It arises from neural crest-derived cells that migrate by the exact route, leading to the formation of a complex network of neurons and glial cells. Recent studies have shown that novel crosstalk exists between the Notch1 and Nrf2 pathways and is associated with many neurological diseases. The Notch1-Nrf2 axis may act on nervous system development, and the molecular mechanism has recently been reported. In this review, we summarize the essential structure and function of the CNS. The significance of interactions between signaling pathways and between developmental processes like proliferation, apoptosis and migration in ensuring the correct development of the CNS is also presented. We primarily focus on research concerning possible mechanism of interaction between Notch1 and Nrf2 and the functions of Notch1-Nrf2 in neurons. There may be a direct interaction between Notch1 and NRF2, which is closely related to the crosstalk that occurs between them. The significance and potential applications of the Notch1-Nrf2 axis in abnormal development of the nervous system are been highlighten. We also discuss the molecular mechanisms by which the Notch1-Nrf2 axis controls the apoptosis, antioxidant pathway and differentiation of neurons to modulate the development of the nervous system. This information will lead to a better understanding of Notch1-Nrf2 axis signaling pathways in the nervous system and may facilitate the development of new therapeutic strategies.
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Affiliation(s)
- Yuwen Chen
- Fujian Key Laboratory of Translational Research in Cancer and Neurodegenerative Diseases, The School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian 350122, China
| | - Jiao Pang
- Fujian Key Laboratory of Translational Research in Cancer and Neurodegenerative Diseases, The School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian 350122, China
| | - Lu Ye
- Fujian Key Laboratory of Translational Research in Cancer and Neurodegenerative Diseases, The School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian 350122, China
| | - Zhentao Zhang
- Fujian Key Laboratory of Translational Research in Cancer and Neurodegenerative Diseases, The School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian 350122, China
| | - Suijin Lin
- Fujian Key Laboratory of Translational Research in Cancer and Neurodegenerative Diseases, The School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian 350122, China
| | - Na Lin
- Fujian Key Laboratory of Translational Research in Cancer and Neurodegenerative Diseases, The School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian 350122, China
| | - Tae Ho Lee
- Fujian Key Laboratory of Translational Research in Cancer and Neurodegenerative Diseases, The School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian 350122, China
| | - Hekun Liu
- Fujian Key Laboratory of Translational Research in Cancer and Neurodegenerative Diseases, The School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian 350122, China.
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Malta M, AlMutiri R, Martin CS, Srour M. Holoprosencephaly: Review of Embryology, Clinical Phenotypes, Etiology and Management. CHILDREN 2023; 10:children10040647. [PMID: 37189898 DOI: 10.3390/children10040647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/21/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023]
Abstract
Holoprosencephaly (HPE) is the most common malformation of the prosencephalon in humans. It is characterized by a continuum of structural brain anomalies resulting from the failure of midline cleavage of the prosencephalon. The three classic subtypes of HPE are alobar, semilobar and lobar, although a few additional categories have been added to this original classification. The severity of the clinical phenotype is broad and usually mirrors the radiologic and associated facial features. The etiology of HPE includes both environmental and genetic factors. Disruption of sonic hedgehog (SHH) signaling is the main pathophysiologic mechanism underlying HPE. Aneuploidies, chromosomal copy number variants and monogenic disorders are identified in a large proportion of HPE patients. Despite the high postnatal mortality and the invariable presence of developmental delay, recent advances in diagnostic methods and improvements in patient management over the years have helped to increase survival rates. In this review, we provide an overview of the current knowledge related to HPE, and discuss the classification, clinical features, genetic and environmental etiologies and management.
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Sarma A, Pruthi S. Congenital Brain Malformations- Update on Newer Classification and Genetic Basis. Semin Roentgenol 2023; 58:6-27. [PMID: 36732012 DOI: 10.1053/j.ro.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 11/16/2022] [Indexed: 12/31/2022]
Affiliation(s)
- Asha Sarma
- Department of Radiology, Vanderbilt University Medical Center, Monroe Carell Children's Hospital, Nashville, TN.
| | - Sumit Pruthi
- Department of Radiology, Vanderbilt University Medical Center, Monroe Carell Children's Hospital, Nashville, TN
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Jacobs E, Whitehead MT. Clinical spectrum of orbital and ocular abnormalities on fetal MRI. Pediatr Radiol 2023; 53:121-130. [PMID: 35867110 DOI: 10.1007/s00247-022-05439-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/13/2022] [Accepted: 06/17/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Fetal magnetic resonance imaging (MRI) may reveal sonographically occult ocular abnormalities. When discovered, acquired causes and genetic associations must be sought. OBJECTIVE We aim to evaluate a fetal cohort with orbit and/or globe malformations to determine whether there are imaging patterns that suggest the underlying cause. MATERIALS AND METHODS We searched all fetal MRI reports performed at an academic children's hospital over 9 consecutive years for orbit and/or globe abnormalities. Each positive exam and all follow-up MRIs were evaluated for interocular distance, globe size, shape and signal, and brain malformations. Genetic and clinical diagnoses were recorded from the medical record. RESULTS Seventy-six of 3,085 fetuses (2.5%) were diagnosed with ocular and/or globe abnormalities; 50% had postnatal follow-up MR exams, all confirming the fetal MRI findings. Ninety-two percent (70/76) had concurrent brain malformations. Sixty-seven percent (51/76) were diagnosed with an underlying disorder and 39% of these were genetically proven. The most common diagnoses with ocular globe abnormalities included CHARGE (coloboma of the eye, heart anomaly, choanal atresia, retardation and genital and ear anomalies) syndrome, trisomy 13 syndrome, dystroglycanopathy, holoprosencephaly and diencephalic-mesencephalic junction dysplasia. Genetic diagnoses were more likely with ocular globe abnormalities than isolated orbital abnormalities (P=0.04). Sixty-seven percent of fetuses with ocular calcifications, hemorrhage and/or lens abnormalities had potential maternal risk factors (P=0.03). CONCLUSION Malformed ocular globes are associated with brain malformations and genetic abnormalities. Ocular calcifications, hemorrhage and/or lens abnormalities may be associated with maternal risk factors. Genetic work-up should be considered when an ocular globe size or shape abnormality is detected.
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Affiliation(s)
- Erica Jacobs
- The George Washington University School of Medicine and Health Sciences, 2300 I Street NW, Washington, DC, 20052, USA.
| | - Matthew T Whitehead
- The George Washington University School of Medicine and Health Sciences, 2300 I Street NW, Washington, DC, 20052, USA.,Department of Neuroradiology, Children's National Hospital, Washington, DC, USA
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Raafat M, Hosny SM, Sheta GA, Talaat SH, Ali EA. Role of fetal MRI to diagnose abnormal cerebral ventricular system and associated fetal brain anomalies. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00757-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Abnormal cerebral ventricular system is one of the most common clinical indications for fetal MRI, mainly to detect other associated abnormalities that can be occult on prenatal ultrasonography. Although using ultrasound can identify most anomalies, MRI is known to be superior in identifying CNS anomalies as it has higher contrast resolution for brain parenchymal assessment added to the fact of being less affected by fetal positioning, oligohydramnios, maternal obesity, and reverberation artifacts. Fetal brain ventriculomegaly is defined as atrial width of > 10 mm on sonography, measured in the axial plane, at the level of the frontal horns, cavum septi pellucidi, and glomus of the choroid plexus perpendicular to the long axis of the lateral ventricle. One of the most important factors determining the fetal neurological outcome is the presence and severity of additional CNS anomalies that are better clarified by MRI. The aim of this study is to establish the role of fetal MRI in detecting the association between abnormal cerebral ventricular system and other CNS anomalies, correlation with the severity of ventriculomegaly and ventricle asymmetry.
Results
Thirty pregnancies with fetal brain abnormal ventricular system were included in this study, 5 cases with isolated corpus callosum (CC) agenesis (16.666%); 2 cases with cystic lesions [one interhemispheric and the other dorsal] (6.666%) both associated with CC agenesis; 1 case with alobar holoprosencephaly (3.333%) associated with CC agenesis; 2 cases with semi-lobar holoprosencephaly (6.666%) [associated with CC agenesis and one of them is also associated with lissencephaly]; 3 cases with Dandy–Walker Malformation (DWM) (10%) [2 isolated and 1 associated with CC agenesis]; 3 cases with Dandy–Walker Variants (DWV) (10%) [1 isolated and 2 associated with CC agenesis]; 2 cases with Joubert syndrome (6.666%); 1 case isolated lissencephaly (3.333%); 4 cases of obstructive ventriculomegaly (13.333%) (1 of which associated with CC agenesis); 1 case of Arnold Chiari malformation type II (3.333%) associated with CC agenesis; 2 cases with meningoceles (6.666%) (occipital and parieto-occipital); 1 case with Mega cisterna Magna (3.333%); 1 case with anencephaly (3.333%); 1 case with right hemimegalencephaly (3.333%) (associated with frontal meningocele and CC agenesis); and 1 case with grade IV germinal matrix hemorrhage (3.333%). The pregnancies resulted in 20 births (66.66%), 2 died directly after birth (6.66%), 5 terminations (16.66%), and 3 intrauterine fetal deaths (IUFD) (10%). We found that the frequency of associated CNS anomalies was strongly related to the width of the ventricle. The association between CNS findings and ventricle width was particularly evident in sever ventriculomegaly. The greater the width of the ventricular system, the more the risk of associated CNS anomalies. Only one case showed diffusion restriction and was diagnosed to be of hemorrhagic nature. The relation between symmetry and degree of ventriculomegaly was found to be statistically insignificant (P = 0.115). Assessment of different fetal brain congenital anomalies was not significantly affected by the using of DWI sequence as it is a functional modality rather than being a tool for assessment of anatomical gross abnormalities.
Conclusions
Fetal MRI is an important adjuvant to US in cases of ventriculomegaly particularly those associated with complex CNS anomalies. The association between CNS findings and ventricular dilatation was particularly evident in sever ventriculomegaly. The greater the width of the ventricular system, the more the risk of associated CNS anomalies. Fetal MRI may also be helpful in doubtful cases that could be misdiagnosed as ventriculomegaly including holoprosencephaly, hydranencephaly, porencephaly, and various supratentorial cystic lesions. DWI confirms the diagnosis of hemorrhage.
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Bardi F, Bergman JEH, Siemensma‐Mühlenberg N, Elvan‐Taşpınar A, de Walle HEK, Bakker MK. Prenatal diagnosis and pregnancy outcome of major structural anomalies detectable in the first trimester: A population-based cohort study in the Netherlands. Paediatr Perinat Epidemiol 2022; 36:804-814. [PMID: 35821640 PMCID: PMC9796468 DOI: 10.1111/ppe.12914] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/10/2022] [Accepted: 06/18/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Prenatal diagnosis of several major congenital anomalies can be achieved in the first trimester of pregnancy. OBJECTIVE This study investigates the timing of diagnosis and pregnancy outcome of foetuses and neonates with selected structural anomalies in the Northern Netherlands over a 10-year period when the prenatal screening programme changed significantly, but no first-trimester anatomical screening was implemented. METHODS We performed a population-based retrospective cohort study with data from the EUROCAT Northern Netherlands database on pregnancies with delivery or termination of pregnancy for fetal anomaly (TOPFA) date between 2010 and 2019. The analysis was restricted to anomalies potentially detectable in the first trimester of pregnancy in at least 50% of cases, based on previously published data. These included: anencephaly, encephalocele, spina bifida, holoprosencephaly, tricuspid/pulmonary valve atresia, hypoplastic left heart, abdominal wall and limb reduction defects, lethal skeletal dysplasia, megacystis, multiple congenital anomalies. The primary outcome was the timing of diagnosis of each structural anomaly. Information on additional investigations, genetic testing and pregnancy outcome (live birth, TOPFA and foetal/neonatal death) was also collected. RESULTS A total of 478 foetuses were included; 95.0% (n = 454) of anomalies were detected prenatally and 5.0% (n = 24) postpartum. Among the prenatally detected cases, 31% (n = 141) were diagnosed before 14 weeks of gestation, 65.6% (n = 298) between 14-22 weeks and 3.3% (n = 15) after 22 weeks. Prenatal genetic testing was performed in 80.4% (n = 365) of cases with prenatally diagnosed anomalies, and the results were abnormal in 26% (n = 95). Twenty-one% (n = 102) of pregnancies resulted in live births and 62.8% (n = 300) in TOPFA. Spontaneous death occurred in 15.9% (n = 76) of cases: in-utero (6.1%, n = 29), at delivery (7.7%, n = 37) or in neonatal life (2.1%, n = 10). CONCLUSION Major structural anomalies amenable to early diagnosis in the first trimester of pregnancy are mostly diagnosed during the second trimester in the absence of a regulated first-trimester anatomical screening programme in the Netherlands and are associated with TOPFA and spontaneous death, especially in cases with underlying genetic anomalies.
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Affiliation(s)
- Francesca Bardi
- University of Groningen University Medical Centre Groningen, University of GroningenDepartment of Obstetrics and GynecologyGroningenNetherlands
| | | | - Nicole Siemensma‐Mühlenberg
- Department of Genetics, EUROCAT Northern NetherlandsUniversity of Groningen, University Medical Centre GroningenGroningenNetherlands
| | - Ayten Elvan‐Taşpınar
- University of Groningen University Medical Centre Groningen, University of GroningenDepartment of Obstetrics and GynecologyGroningenNetherlands
| | - Hermien Evelien Klaaske de Walle
- Department of Genetics, EUROCAT Northern NetherlandsUniversity of Groningen, University Medical Centre GroningenGroningenNetherlands
| | - Marian Karolien Bakker
- Department of Genetics, EUROCAT Northern NetherlandsUniversity of Groningen, University Medical Centre GroningenGroningenNetherlands
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Imaging of Congenital Malformations of the Brain. Clin Perinatol 2022; 49:587-601. [PMID: 36113924 DOI: 10.1016/j.clp.2022.05.002] [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: 11/22/2022]
Abstract
Brain formation is a continuous and complicated process that is historically categorized by the timing of development. The earliest disorders of dorsal induction occur in the first month of gestation and include anencephaly and cephalocele. Disorders of ventral induction occur during the second month of gestation and include the holoprosencephaly and septo-optic dysplasia spectrums. The third and longest timeframe include the disorders of neuronal migration and proliferation (gestational weeks eight-25) and include malformations of cortical development: lissencephaly, polymicrogyria, schizencephaly, gray matter heterotopia, and corpus callosal dysgenesis. This review will highlight the neuroimaging of these malformations.
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Nagaraj UD, Venkatesan C, Bierbrauer KS, Kline-Fath BM. Value of pre- and postnatal magnetic resonance imaging in the evaluation of congenital central nervous system anomalies. Pediatr Radiol 2022; 52:802-816. [PMID: 34232351 DOI: 10.1007/s00247-021-05137-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/30/2021] [Accepted: 06/10/2021] [Indexed: 12/12/2022]
Abstract
Fetal MRI and neonatal MRI of the central nervous system (CNS) are complementary tools that can help to accurately counsel and direct the management of children with anomalies of the central nervous system. Postnatal MRI can add to fetal MRI by allowing for monitoring of changes in the severity of disease, better delineation of a suspected prenatal anomaly, evaluation for secondary pathologies related to the primary diagnosis, and surgical management direction. In this review we discuss the roles of fetal and neonatal MRI in the diagnosis and treatment of congenital anomalies of the CNS through a series of case examples and how both are important in patient management.
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Affiliation(s)
- Usha D Nagaraj
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA. .,University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Charu Venkatesan
- University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Department of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Karin S Bierbrauer
- University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Department of Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Beth M Kline-Fath
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Montaguti E, Cariello L, Brunelli E, Youssef A, Livi A, Salsi G, Pilu G. Sonography of fetal holoprosencephaly: a guide to recognize the lesser varieties. J Matern Fetal Neonatal Med 2022; 35:9717-9723. [PMID: 35272544 DOI: 10.1080/14767058.2022.2050900] [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: 10/18/2022]
Abstract
BACKGROUND Alobar holoprosencephaly (HPE) is easily detected during a first-trimester screening examination, conversely, recognizing the lesser varieties may be difficult even in the second trimester. OBJECTIVES To describe the imaging findings of a cohort of fetuses with holoprosencephaly (HPE) and to elucidate the appearances of the different anatomical varieties. MATERIALS AND METHODS We reviewed medical records and stored images of pregnant women referred to our clinic because of a diagnosis or the suspicion of various forms of HPE. We reported the imaging characteristics, the presence of other associated anomalies, magnetic resonance findings, karyotype and autoptic examinations when available. RESULTS Alobar forms show great distortion of normal brain anatomy, with a single ventricle detectable during the first trimester of pregnancy. Extracerebral, face and karyotype abnormalities are often associated. In semilobar and lobar forms the septum pellucidum is typically absent in axial planes, with fused frontal horns, while posterior fossa is often normal. At multiplanar neurosonogram, anomalies involving corpus callosum and cortex development can be detected. Face abnormalities are mild in lobar forms: receding forehead, various degrees of hypotelorism and the presence of a single central maxillary incisor are reported. CONCLUSIONS The alobar forms are detectable since the first trimester, with a peculiar single ventricle and extremely frequent extracerebral and karyotype abnormalities. The semilobar and lobar forms are more challenging and the diagnosis is easily missed in a mid-trimester screening exam unless a careful evaluation of both cavum septi pellucidi and frontal horns as well is conducted.
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Affiliation(s)
- Elisa Montaguti
- Obstetric Unit, Department of Medical and Surgical Sciences, University of Bologna and IRCCS Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Bologna, Italy
| | - Luisa Cariello
- Obstetric Unit, Department of Medical and Surgical Sciences, University of Bologna and IRCCS Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Bologna, Italy
| | - Elena Brunelli
- Obstetric Unit, Department of Medical and Surgical Sciences, University of Bologna and IRCCS Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Bologna, Italy
| | - Aly Youssef
- Obstetric Unit, Department of Medical and Surgical Sciences, University of Bologna and IRCCS Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Bologna, Italy
| | - Alessandra Livi
- Obstetric Unit, Department of Medical and Surgical Sciences, University of Bologna and IRCCS Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Bologna, Italy
| | - Ginevra Salsi
- Obstetric Unit, Department of Medical and Surgical Sciences, University of Bologna and IRCCS Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Bologna, Italy
| | - Gianluigi Pilu
- Obstetric Unit, Department of Medical and Surgical Sciences, University of Bologna and IRCCS Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Bologna, Italy
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Elfarawi H, Tolusso L, McGowan ML, Cortezzo D, Vawter‐Lee M. Alobar Holoprosencephaly: Exploring Mothers’ Perspectives on Prenatal Decision‐making and Prognostication. Prenat Diagn 2022; 42:617-627. [DOI: 10.1002/pd.6130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Hunaydah Elfarawi
- University of Cincinnati College of Medicine Department of Molecular Genetics, Biochemistry and Microbiology
- Cincinnati Children’s Hospital Medical Center Division of Human Genetics
| | - Leandra Tolusso
- Cincinnati Children’s Hospital Medical Center Division of Human Genetics
| | - Michelle L. McGowan
- University of Cincinnati College of Medicine Department of Pediatrics
- Cincinnati Children’s Hospital Medical Center Ethics Center
- University of Cincinnati College of Arts and Sciences Department of Women’s, Gender, and Sexuality Studies
| | - DonnaMaria Cortezzo
- University of Cincinnati College of Medicine Department of Pediatrics
- Cincinnati Children’s Hospital Medical Center Division of Neonatal and Pulmonary Biology
- Cincinnati Children’s Hospital Medical Center Division of Pain and Palliative Medicine
- University of Cincinnati College of Medicine Department of Anesthesiology
| | - Marissa Vawter‐Lee
- University of Cincinnati College of Medicine Department of Pediatrics
- Cincinnati Children’s Hospital Medical Center Division of Child Neurology
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Barratt KS, Drover KA, Thomas ZM, Arkell RM. Patterning of the antero-ventral mammalian brain: Lessons from holoprosencephaly comparative biology in man and mouse. WIREs Mech Dis 2022; 14:e1552. [PMID: 35137563 DOI: 10.1002/wsbm.1552] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/30/2021] [Accepted: 12/21/2021] [Indexed: 12/13/2022]
Abstract
Adult form and function are dependent upon the activity of specialized signaling centers that act early in development at the embryonic midline. These centers instruct the surrounding cells to adopt a positional fate and to form the patterned structures of the phylotypic embryo. Abnormalities in these processes have devastating consequences for the individual, as exemplified by holoprosencephaly in which anterior midline development fails, leading to structural defects of the brain and/or face. In the 25 years since the first association between human holoprosencephaly and the sonic hedgehog gene, a combination of human and animal genetic studies have enhanced our understanding of the genetic and embryonic causation of this congenital defect. Comparative biology has extended the holoprosencephaly network via the inclusion of gene mutations from multiple signaling pathways known to be required for anterior midline formation. It has also clarified aspects of holoprosencephaly causation, showing that it arises when a deleterious variant is present within a permissive genome, and that environmental factors, as well as embryonic stochasticity, influence the phenotypic outcome of the variant. More than two decades of research can now be distilled into a framework of embryonic and genetic causation. This framework means we are poised to move beyond our current understanding of variants in signaling pathway molecules. The challenges now at the forefront of holoprosencephaly research include deciphering how the mutation of genes involved in basic cell processes can also cause holoprosencephaly, determining the important constituents of the holoprosencephaly permissive genome, and identifying environmental compounds that promote holoprosencephaly. This article is categorized under: Congenital Diseases > Stem Cells and Development Congenital Diseases > Genetics/Genomics/Epigenetics Congenital Diseases > Molecular and Cellular Physiology Congenital Diseases > Environmental Factors.
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Affiliation(s)
- Kristen S Barratt
- John Curtin School of Medical Research, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Kyle A Drover
- John Curtin School of Medical Research, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Zoe M Thomas
- John Curtin School of Medical Research, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Ruth M Arkell
- John Curtin School of Medical Research, The Australian National University, Canberra, Australian Capital Territory, Australia
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16
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Parizad N, Faraji N, Hassanpour A, Goli R, Rostami S, Amanollahzadeh A. Cyclopia, a newborn with a single eye, a rare but lethal congenital anomaly: A case report. Int J Surg Case Rep 2021; 88:106548. [PMID: 34741865 PMCID: PMC8581486 DOI: 10.1016/j.ijscr.2021.106548] [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: 10/01/2021] [Revised: 10/19/2021] [Accepted: 10/27/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction and importance Cyclopia is a rare congenital disorder characterized by facial abnormalities. In this condition, the orbits of the eye are not properly divided into two cavities so that they can be seen either as a single eye field or two bilateral fields that are very close to each other. This syndrome affects the embryos that are either aborted or stillborn upon delivery or, at best, die shortly after birth. Case presentation This case report is of a 37-week- and 5-day-old female fetus with a birth weight of 2300 g, a height of 43 cm, and a head circumference of 31 cm. She was born to a 44-year-old mother through normal vaginal delivery at Mahzad Hospital, Urmia, Iran. In the physical examination, an eye and a 4-cm proboscis were seen in the middle of the forehead. The newborn also had no nose, and his outer ears were normal. No cleft lip or cleft palate was observed. Unfortunately, the newborn expired 13 h after birth. Clinical discussion Cyclopia leads to a stillbirth since the brain and other parts of the body do not grow normally in fetuses with this disorder. Moreover, it can be diagnosed using ultrasonography while the fetus is growing inside the uterus. Conclusion Early diagnosis during pregnancy using diagnostic methods and proper management of this abnormality should be emphasized to prevent further harm to the newborn and the mother with this syndrome. Moreover, many of these newborns should be offered early neonatal palliative care. Cyclopia is a rare congenital disorder with life-threatening complications. Cyclopia mostly affects the embryos that are either aborted or stillborn. Early diagnosis during pregnancy should be emphasized to prevent its complications. Prenatal palliative care emphasizes the importance of planning for the experience of losing an infant. Parental involvement in end-of-life care for their infant is an important aspect of neonatal palliative care.
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Affiliation(s)
- Naser Parizad
- Patient Safety Research Center, Clinical Research Institute, Nursing & Midwifery School, Urmia University of Medical Sciences, Urmia, Iran
| | - Navid Faraji
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| | - Amireh Hassanpour
- Department of Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| | - Rasoul Goli
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran.
| | - Sajjad Rostami
- Department of Nursing, School of Nursing and Midwifery, Islamic Azad university of Zanjan, Zanjan, Iran
| | - Akram Amanollahzadeh
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
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Riddle A, Nagaraj U, Hopkin RJ, Kline-Fath B, Venkatesan C. Fetal Magnetic Resonance Imaging (MRI) in Holoprosencephaly and Associations With Clinical Outcome: Implications for Fetal Counseling. J Child Neurol 2021; 36:357-364. [PMID: 33226281 DOI: 10.1177/0883073820972290] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Holoprosencephaly is the most common malformation of forebrain development and includes a wide spectrum of severity. The objective of this retrospective study was to evaluate fetal magnetic resonance imaging (MRI) associations with outcome. Of the 63 cases identified on antenatal ultrasonography, 28 cases were confirmed on fetal MRI. There were 17 live births; 9 patients died within the first month of life. There were 7 survivors. The vast majority were nonambulatory and required feeding support; none required respiratory support. We found that presence and number of non-holoprosencephaly-associated malformations was also associated with survival. Of 5 patients with 3 or more systemic anomalies, 4 died regardless of holoprosencephaly subtype and 1 was lost to follow-up. Patients with suspected holoprosencephaly on ultrasonography should have full body fetal MRI and echocardiogram to better evaluate systemic anomalies. Counseling should involve pediatric palliative care services to prepare families in caring for babies with limited life span.
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Affiliation(s)
- Artur Riddle
- Division of Neurology, 2518Cincinnati Children's Hospital, Cincinnati, OH, USA.,Division of Human Genetics, 2518Cincinnati Children's Hospital, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Pediatric Neurology, 6684Oregon Health & Science University, Portland, OR, USA
| | - Usha Nagaraj
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Radiology and Medical Imaging, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Robert J Hopkin
- Division of Human Genetics, 2518Cincinnati Children's Hospital, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Beth Kline-Fath
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Radiology and Medical Imaging, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Charu Venkatesan
- Division of Neurology, 2518Cincinnati Children's Hospital, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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19
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Kisipan ML, Nyaga SN, Thuo JN, Nyakego PO, Orenge CO, Ojoo RO. Lobar holoprosencephaly with craniofacial defects in a Friesian calf: A case report. Vet Med Sci 2020; 6:454-461. [PMID: 31972069 PMCID: PMC7397892 DOI: 10.1002/vms3.244] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/04/2019] [Accepted: 01/08/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Holoprosencephaly is a forebrain deformity that results from varying degrees of separation failure of cerebral hemispheres. The condition is classified based on the degree of non-separation of the hemispheres which, in turn, determines its severity. Holoprosencephaly is usually accompanied by craniofacial defects whose severity tends to reflect the extent of brain deformities. In humans, holoprosencephaly is one of the commonest congenital brain anomalies but in animals, reported cases are scarce. The condition has multifactorial aetiology that involves interactions between several genetic and environmental factors. CASE PRESENTATION A 4-day-old female Friesian calf with a deformed face was reported to the Faculty of veterinary medicine and surgery, Egerton University. The calf and the dam were sired by the same bull. On clinical and radiographic examination, the calf had a short snout that curved dorsally with bilateral cleft lip, right-sided cleft jaw and a largely absent primary palate. Anatomopathological examination revealed brain deformities which included ventral fusion of frontal lobes of cerebral hemispheres, large merged lateral ventricles without septum pellucidum and fornix, hypoplastic corpus callosum, high degree of non-separation between diencephalic structures, poorly developed hippocampal formation and hypoplastic olfactory lobe, optic chiasma, and nerve. CONCLUSION The case was confirmed as lobar holoprosencephaly based on characteristic anatomopathological findings. The aetiology of the defects in the present case could not be determined though they are thought to be either a result of recessive inheritance or exposure to teratogenic steroid alkaloids through materials fed to the dam during early pregnancy.
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Affiliation(s)
- Mosiany L Kisipan
- Department of Veterinary Anatomy and Physiology, Egerton University, Egerton, Kenya
| | - Samuel N Nyaga
- Department of Veterinary Anatomy and Physiology, Egerton University, Egerton, Kenya
| | - Jesse N Thuo
- Department of Veterinary Anatomy and Physiology, Egerton University, Egerton, Kenya
| | - Phillip O Nyakego
- Department of Veterinary Anatomy and Physiology, Egerton University, Egerton, Kenya
| | - Caleb O Orenge
- Department of Veterinary Anatomy and Physiology, Egerton University, Egerton, Kenya
| | - Rodi O Ojoo
- Department of Veterinary Anatomy and Physiology, University of Nairobi, Nairobi, Kenya
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20
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Muenke M. Onward and upward. Am J Med Genet A 2019; 179:1119-1121. [PMID: 31140673 DOI: 10.1002/ajmg.a.61207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 05/14/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Maximilian Muenke
- Medical Genetics Branch, National Genome Research Institute, National Institutes of Health, Bethesda, Maryland
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21
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Chuang TY, Chang SY, Chen CP, Lin MH, Chen CY, Chen SW, Chern SR, Lee CC, Town DD, Wang W. Digynic triploidy in a fetus presenting with semilobar holoprosencephaly. Taiwan J Obstet Gynecol 2019; 57:881-884. [PMID: 30545546 DOI: 10.1016/j.tjog.2018.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2018] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE We present digynic triploidy in a fetus with semilobar holoprosencephaly (HPE). CASE REPORT A 32-year-old, gravid 1, para 0, woman underwent prenatal ultrasound examination at 12 weeks of gestation, and the ultrasound showed relative macrocephaly, a small non-cystic placenta, and a fetus with absent nasal bone and semilobar HPE. The pregnancy was terminated subsequently, and a 50-g fetus was delivered with a relatively enlarged head and premaxillary agenesis. The placenta was small and non-cystic. Postnatal cytogenetic analysis of the umbilical cord revealed a karyotype of 69, XXX. Postnatal DNA marker analysis using quantitative fluorescent polymerase chain reaction assays and the polymorphic short tandem repeat markers for chromosome 18 and 20 on the placental tissues showed a diallelic pattern with a dosage of 1:2 (paternal allele to maternal allele ratio), indicating a maternal origin of the triploidy. CONCLUSION Fetuses with digynic triploidy may present relative macrocephaly, semilobar HPE and a small placenta on prenatal ultrasound.
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Affiliation(s)
- Tzu-Yun Chuang
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Shu-Yuan Chang
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chih-Ping Chen
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan; Department of Biotechnology, Asia University, Taichung, Taiwan; School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan; Institute of Clinical and Community Health Nursing, National Yang-Ming University, Taipei, Taiwan; Department of Obstetrics and Gynecology, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Ming-Huei Lin
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan; MacKay Medical College, New Taipei City, Taiwan
| | - Cheng-Yu Chen
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Shin-Wen Chen
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Schu-Rern Chern
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chen-Chi Lee
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Dai-Dyi Town
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Wayseen Wang
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan; Department of Bioengineering, Tatung University, Taipei, Taiwan
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