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Kolman SE, Ohara SY, Bhatia A, Feygin T, Colo D, Baldwin KD, Mcdonald-Mcginn D, Spiegel DA. The Clinical Utility of Flexion-extension Cervical Spine MRI in 22q11.2 Deletion Syndrome. J Pediatr Orthop 2019; 39:e674-e679. [PMID: 31503223 DOI: 10.1097/bpo.0000000000000994] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Our goal is to correlate the findings on flexion and extension radiographs with dynamic magnetic resonance imaging (MRI), and the clinical history, in a nonrandomly selected cohort of patients with 22q11.2 deletion syndrome (22q). METHODS All patients with the 22q who had a dynamic MRI from January 2004 to March 2015 were included. We analyzed multiple radiographic measurements on both the dynamic plain films and the MRIs, and correlated these findings with a review of each patient's medical record. RESULTS Multiple congenital anomalies were identified as noted in previous studies, and 61% of the patients had a failure of fusion of the anterior (n=2, 9%), posterior (n=2, 9%), or anterior and posterior arches (n=10, 43%). Quantitative measurements were impossible to report with certainty because of the upper cervical anomalies, and no cases of instability were identified using a qualitative assessment. We identified spinal cord encroachment (30%) and impingement (18%); however, none of the patients had any signal change in their spinal cord. None of these findings could be definitively correlated with any clinical symptoms. A single patient was diagnosed with a Chiari I malformation, while another had cerebellar ectopia. CONCLUSIONS Although the upper cervical anomalies are extremely common in 22q, we did not identify cases of instability on dynamic plain radiographs and MRI. Although our findings do not support routine screening with flexion and extension MRI, this study may be required in patients with neurological symptoms and/or findings or abnormalities on dynamic plain radiographs. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | | | - Aashim Bhatia
- Monroe Carell Jr. Children's Hospital, Nashville, TN
| | - Tamara Feygin
- The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Dino Colo
- University Medical Center Utrecht, Utrecht, The Netherlands
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Homans JF, Tromp IN, Colo D, Schlösser TPC, Kruyt MC, Deeney VFX, Crowley TB, McDonald-McGinn DM, Castelein RM. Orthopaedic manifestations within the 22q11.2 Deletion syndrome: A systematic review. Am J Med Genet A 2017; 176:2104-2120. [DOI: 10.1002/ajmg.a.38545] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 09/07/2017] [Accepted: 10/27/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Jelle F. Homans
- Department of Orthopaedic Surgery; University Medical Center Utrecht; Utrecht The Netherlands
| | - Isabel N. Tromp
- Department of Orthopaedic Surgery; University Medical Center Utrecht; Utrecht The Netherlands
| | - Dino Colo
- Department of Orthopaedic Surgery; University Medical Center Utrecht; Utrecht The Netherlands
| | - Tom P. C. Schlösser
- Department of Orthopaedic Surgery; University Medical Center Utrecht; Utrecht The Netherlands
| | - Moyo C. Kruyt
- Department of Orthopaedic Surgery; University Medical Center Utrecht; Utrecht The Netherlands
| | - Vincent F. X. Deeney
- Department of Orthopaedic Surgery; The Children's Hospital of Philadelphia (CHOP) and The Perelman School of Medicine at the University of Pennsylvania; Philadelphia Pennsylvania
| | - Terrence B. Crowley
- Division of Human Genetics and 22q and You Center; The Children's Hospital of Philadelphia (CHOP); Philadelphia Pennsylvania
| | - Donna M. McDonald-McGinn
- Division of Human Genetics and 22q and You Center; The Children's Hospital of Philadelphia (CHOP); Philadelphia Pennsylvania
- The Perelman School of Medicine at the University of Pennsylvania; Philadelphia Pennsylvania
| | - René M. Castelein
- Department of Orthopaedic Surgery; University Medical Center Utrecht; Utrecht The Netherlands
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Boot E, Butcher NJ, van Amelsvoort TAMJ, Lang AE, Marras C, Pondal M, Andrade DM, Fung WLA, Bassett AS. Movement disorders and other motor abnormalities in adults with 22q11.2 deletion syndrome. Am J Med Genet A 2015; 167A:639-45. [PMID: 25684639 PMCID: PMC4459830 DOI: 10.1002/ajmg.a.36928] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 11/26/2014] [Indexed: 12/13/2022]
Abstract
Movement abnormalities are frequently reported in children with 22q11.2 deletion syndrome (22q11.2DS), but knowledge in this area is scarce in the increasing adult population. We report on five individuals illustrative of movement disorders and other motor abnormalities in adults with 22q11.2DS. In addition to an increased susceptibility to neuropsychiatric disorders, seizures, and early-onset Parkinson disease, the underlying brain dysfunction associated with 22q11.2DS may give rise to an increased vulnerability to multiple movement abnormalities, including those influenced by medications. Movement abnormalities may also be secondary to treatable endocrine diseases and congenital musculoskeletal abnormalities. We propose that movement abnormalities may be common in adults with 22q11.2DS and discuss the implications and challenges important to clinical practice.
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Affiliation(s)
- Erik Boot
- The Dalglish Family Hearts and Minds Clinic for Adults with 22q11.2 Deletion Syndrome, Toronto, Ontario, Canada
- Department of Nuclear Medicine, Academic Medical Centre, Amsterdam, The Netherlands
- Department of Psychiatry, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Nancy J Butcher
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Thérèse AMJ van Amelsvoort
- Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Anthony E Lang
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada
- Toronto Western Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- Morton and Gloria Shulman Movement Disorder Centre and the Edmond J. Safra Program in Parkinson’s Disease, Toronto Western Hospital, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Connie Marras
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
- Morton and Gloria Shulman Movement Disorder Centre and the Edmond J. Safra Program in Parkinson’s Disease, Toronto Western Hospital, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Margarita Pondal
- Morton and Gloria Shulman Movement Disorder Centre and the Edmond J. Safra Program in Parkinson’s Disease, Toronto Western Hospital, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Danielle M Andrade
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
- Epilepsy Genetics Program, Toronto Western Hospital, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Wai Lun Alan Fung
- The Dalglish Family Hearts and Minds Clinic for Adults with 22q11.2 Deletion Syndrome, Toronto, Ontario, Canada
- Department of Psychiatry, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Anne S Bassett
- The Dalglish Family Hearts and Minds Clinic for Adults with 22q11.2 Deletion Syndrome, Toronto, Ontario, Canada
- Department of Psychiatry, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, Division of Cardiology, University Health Network, Toronto, Ontario, Canada
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Hamidi M, Nabi S, Husein M, Mohamed ME, Tay KY, McKillop S. Cervical spine abnormalities in 22q11.2 deletion syndrome. Cleft Palate Craniofac J 2013; 51:230-3. [PMID: 24003836 DOI: 10.1597/12-318] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The 22q11.2 deletion syndrome is among the most common head-and-neck-related syndromes. The literature has examined many of the phenotypic features of 22q11.2 deletion syndrome; however, few studies have explored the manifestation of cervical spine abnormalities. In this study, we compared the cervical spines of individuals with and without 22q11.2 deletion syndrome using diagnostic imaging. DESIGN A retrospective case-control study, with age- and sex-matched control participants who underwent flexion/extension x-rays and either a computed tomography or MRI scan. SETTING PARTICIPANTS presented to the velopharyngeal insufficiency clinic at Victoria Hospital in London, Ontario, Canada, a tertiary care center. PARTICIPANTS Sixteen pediatric patients (<age 18 at presentation) who had genetically confirmed 22q11.2 deletion syndrome were age- and sex-matched to 16 patients who presented with head and neck trauma without radiographic evidence of injury to the cervical spine. The mean age was 11.7 years (range, 2 to 21 years). MAIN OUTCOME MEASURE Radiographic evidence of cervical spine abnormalities ± evidence of instability. RESULTS Patients with 22q11.2 deletion syndrome were significantly more likely to have an open posterior arch of C1 (P < .0001), anterior arch cleft of C1 (P < .0001), and platybasia (P = .001). There was also a positive trend for fusion of the C2-C3 vertebrae (P = .051). CONCLUSION Significant differences in radiographic cervical spine measurements were found between 22q11.2 deletion syndrome patients and controls. Cervical spine abnormalities are common phenotypic features of 22q11.2 deletion syndrome, but the clinical consequences are poorly understood. Further investigation is necessary to understand the possible ramifications of these abnormalities, including precautions during medically necessary interventions, and lifestyle limitations for these individuals.
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Tremolada G, Longeri M, Polli M, Parma P, Acocella F. Persistent right aortic arch and associated axial skeletal malformations in cats. J Feline Med Surg 2013; 15:68-73. [PMID: 22989559 PMCID: PMC10816655 DOI: 10.1177/1098612x12459736] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Persistent right aortic arch (PRAA) in cats is an uncommon vascular anomaly with clinical signs referable to oesophageal obstruction. To our knowledge no reports of axial skeletal malformations concomitant to PRAA have been reported in cats. The aim of this study is to depict a new clinical feature in cats affected by PRAA. In the study six cats with a diagnosis of vascular ring anomaly were enrolled. A complete physical examination, a neurological examination and a total body radiograph were performed on each animal. Four of the six cats showed contemporary PRAA and skeletal malformations. Additionally, for the first time, a genetic test was performed on one subject to detect DNA alterations in the homologous DiGeorge region of cat. The percentage of skeletal malformations reported in the normal population was compared with animals with PRAA and showed a higher frequency. Genetic testing failed to demonstrate a correlation between PRAA and DiGeorge genomic deletion. A review of veterinary and human diseases that presented both conditions was assessed. The few animals enrolled do not allow definitive conclusions. Further studies are required to corroborate the correlation between PRAA and axial skeletal malformations in cats.
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Affiliation(s)
- Giovanni Tremolada
- Department of Veterinary Medical Science, University of Milan, Milan, Italy
| | - Maria Longeri
- Department of Veterinary Science and Public Health, University of Milan, Milan, Italy
| | - Michele Polli
- Department of Veterinary Science and Public Health, University of Milan, Milan, Italy
| | - Pietro Parma
- Department of Animal Science, Agronomy Faculty, University of Milan, Milan, Italy
| | - Fabio Acocella
- Department of Veterinary Medical Science, University of Milan, Milan, Italy
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McDonald-McGinn DM, Sullivan KE. Chromosome 22q11.2 deletion syndrome (DiGeorge syndrome/velocardiofacial syndrome). Medicine (Baltimore) 2011; 90:1-18. [PMID: 21200182 DOI: 10.1097/md.0b013e3182060469] [Citation(s) in RCA: 268] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Chromosome 22q11.2 deletion syndrome is a common syndrome also known as DiGeorge syndrome and velocardiofacial syndrome. It occurs in approximately 1:4000 births, and the incidence is increasing due to affected parents bearing their own affected children. The manifestations of this syndrome cross all medical specialties, and care of the children and adults can be complex. Many patients have a mild to moderate immune deficiency, and the majority of patients have a cardiac anomaly. Additional features include renal anomalies, eye anomalies, hypoparathyroidism, skeletal defects, and developmental delay. Each child's needs must be tailored to his or her specific medical problems, and as the child transitions to adulthood, additional issues will arise. A holistic approach, addressing medical and behavioral needs, can be very helpful.
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Faivre L, Masurel-Paulet A, Callier P, Mejean N, Gay S, Grimaldi M, Mugneret F, Huet F, Thauvin-Robinet C. Vertebral defects as an unusual mode of presentation of 22q11.2 deletion. Am J Med Genet A 2009; 149A:2865-6. [PMID: 19921642 DOI: 10.1002/ajmg.a.32974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- L Faivre
- Centre de Référence Maladies Rares Anomalies du Développement et Syndromes Malformatifs, Hôpital d'Enfants, CHU Dijon, France.
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Yang C, Huang CH, Cheong ML, Hung KL, Lin LH, Yu YS, Chien CC, Huang HC, Chen CW, Huang CJ. Unambiguous molecular detections with multiple genetic approach for the complicated chromosome 22q11 deletion syndrome. BMC MEDICAL GENETICS 2009; 10:16. [PMID: 19243607 PMCID: PMC2656481 DOI: 10.1186/1471-2350-10-16] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2008] [Accepted: 02/25/2009] [Indexed: 12/24/2022]
Abstract
Background Chromosome 22q11 deletion syndrome (22q11DS) causes a developmental disorder during the embryonic stage, usually because of hemizygous deletions. The clinical pictures of patients with 22q11DS vary because of polymorphisms: on average, approximately 93% of affected individuals have a de novo deletion of 22q11, and the rest have inherited the same deletion from a parent. Methods using multiple genetic markers are thus important for the accurate detection of these microdeletions. Methods We studied 12 babies suspected to carry 22q11DS and 18 age-matched healthy controls from unrelated Taiwanese families. We determined genomic variance using microarray-based comparative genomic hybridization (array-CGH), quantitative real-time polymerase chain reaction (qPCR) and multiplex ligation-dependent probe amplification (MLPA). Results Changes in genomic copy number were significantly associated with clinical manifestations for the classical criteria of 22q11DS using MPLA and qPCR (p < 0.01). An identical deletion was shown in three affected infants by MLPA. These reduced DNA dosages were also obtained partially using array-CGH and confirmed by qPCR but with some differences in deletion size. Conclusion Both MLPA and qPCR could produce a clearly defined range of deleted genomic DNA, whereas there must be a deleted genome that is not distinguishable using MLPA. These data demonstrate that such multiple genetic approaches are necessary for the unambiguous molecular detection of these types of complicated genomic syndromes.
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Affiliation(s)
- Chen Yang
- Division of Genetics, Department of Pediatrics, Taipei Medical University Hospital, Taipei 11031, Taiwan.
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