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Hung SC, Guimaraes C. Imaging of Childhood Cerebral Vasculitis. Neuroimaging Clin N Am 2024; 34:149-166. [PMID: 37951700 DOI: 10.1016/j.nic.2023.07.005] [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: 11/14/2023]
Abstract
Childhood cerebral vasculitis is a condition that affects the blood vessels in the brain of children and is rare but life-threatening. Imaging plays a crucial role in the diagnosis and monitoring of the disease. This article describes the classification, diagnostic algorithm, and various imaging modalities used in the evaluation of childhood cerebral vasculitis and the imaging findings associated with primary and secondary vasculitis. Understanding the imaging features of this condition can assist in early diagnosis, effective treatment, and improve outcomes.
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Affiliation(s)
- Sheng-Che Hung
- Department of Radiology, University of North Carolina, 2000 Old Clinic, CB# 7510, Chapel Hill, NC 27599, USA.
| | - Carolina Guimaraes
- Department of Radiology, University of North Carolina, 2000 Old Clinic, CB# 7510, Chapel Hill, NC 27599, USA
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Livingston JH. Childhood-inherited white matter disorders with calcification. HANDBOOK OF CLINICAL NEUROLOGY 2024; 204:95-109. [PMID: 39322397 DOI: 10.1016/b978-0-323-99209-1.00013-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/27/2024]
Abstract
Intracranial calcification (ICC) occurs in many neurologic disorders both acquired and genetic. In some inherited white matter disorders, it is a common or even invariable feature where the presence and pattern of calcification provides an important pointer to the specific diagnosis. This is particularly the case for the Aicardi-Goutières syndrome (AGS) and for Coats plus (CP) and leukoencephalopathy with calcifications and cysts (LCC), which are discussed in detail in this chapter. AGS is a genetic disorder of type 1 interferon regulation, caused by mutations in any of the nine genes identified to date. In its classic form, AGS has very characteristic clinical and neuroimaging features which will be discussed here. LCC is a purely neurologic disorder caused by mutations in the SNORD118 gene, whereas CP is a multisystem disorder of telomere function that may result from mutations in the CTC1, POT1, or STN genes. In spite of the different pathogenetic basis for LCC and CP, they share remarkably similar neuroimaging and neuropathologic features. Cockayne syndrome, in which ICC is usually present, is discussed elsewhere in this volume. ICC may occur as an occasional feature of many other white matter diseases, including Alexander disease, Krabbe disease, X-ALD, and occulodentodigital dysplasia.
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Affiliation(s)
- John H Livingston
- Professor of Paediatric Neurology, University of Leeds, Leeds, United Kingdom; Department of Paediatric Neurology, Leeds Teaching Hospitals, Leeds, United Kingdom.
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Dell'Isola GB, Dini G, Culpepper KL, Portwood KE, Ferrara P, Di Cara G, Verrotti A, Lodolo M. Clinical spectrum and currently available treatment of type I interferonopathy Aicardi-Goutières syndrome. World J Pediatr 2023; 19:635-643. [PMID: 36650407 PMCID: PMC10258176 DOI: 10.1007/s12519-022-00679-2] [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: 04/25/2022] [Accepted: 12/22/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Aicardi-Goutières syndrome (AGS) is a genetically determined disorder with a variable phenotype. Since the original description of AGS, advances in gene sequencing techniques have resulted in a significant broadening of the phenotypic spectrum associated with AGS genes, and new clinical pictures have emerged beyond the classic presentation. The aim of this review is to provide a comprehensive analysis of the clinical spectrum of AGS and report currently available treatments and new immunosuppressive strategies. DATA SOURCES Literature reviews and original research articles were collected from databases, including PubMed and ClinicalTrials.gov. Relevant articles about AGS were included. RESULTS The involvement of the nervous system certainly represents the major cause of mortality and morbidity in AGS patients. However, other clinical manifestations, such as chilblains, hepatosplenomegaly, and hematological disturbances, may lead to the diagnosis and considerably impact the prognosis and overall quality of life of these patients. Therapeutic approaches of AGS are limited to interventions aimed at specific symptoms and the management of multiple comorbidities. However, advances in understanding the pathogenesis of AGS could open new and more effective therapies. CONCLUSIONS The over-activation of innate immunity due to upregulated interferon production plays a critical role in AGS, leading to multi-organ damage with the main involvement of the central nervous system. To date, there is no specific and effective treatment for AGS. New drugs specifically targeting the interferon pathway may bring new hope to AGS patients.
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Affiliation(s)
| | - Gianluca Dini
- Department of Pediatrics, University of Perugia, Giorgio Menghini Square, 06129, Perugia, Italy
| | | | - Katherin Elizabeth Portwood
- Department of Pediatrics, Division of Child Neurology, University of Florida, UF Health Shands Children's Hospital, Gainesville, FL, USA
| | - Pietro Ferrara
- Unit of Pediatrics, Campus Bio-Medico University, Rome, Italy
| | - Giuseppe Di Cara
- Department of Pediatrics, University of Perugia, Giorgio Menghini Square, 06129, Perugia, Italy
| | - Alberto Verrotti
- Department of Pediatrics, University of Perugia, Giorgio Menghini Square, 06129, Perugia, Italy
| | - Mauro Lodolo
- Department of Pediatrics, Division of Child Neurology, University of Florida, UF Health Shands Children's Hospital, Gainesville, FL, USA
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Gupta N, Hiremath SB, Aviv RI, Wilson N. Childhood Cerebral Vasculitis : A Multidisciplinary Approach. Clin Neuroradiol 2023; 33:5-20. [PMID: 35750917 PMCID: PMC9244086 DOI: 10.1007/s00062-022-01185-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/02/2022] [Indexed: 11/26/2022]
Abstract
Cerebral vasculitis is increasingly recognized as a common cause of pediatric arterial stroke. It can present with focal neurological deficits, psychiatric manifestations, seizures, and encephalopathy. The etiopathogenesis of childhood cerebral vasculitis (CCV) is multifactorial, making an inclusive classification challenging. In this review, we describe the common and uncommon CCV with a comprehensive discussion of etiopathogenesis, the role of various imaging modalities, and advanced techniques in diagnosing CCV. We also highlight the implications of relevant clinical, laboratory, and genetic findings to reach the final diagnosis. Based on the clinicoradiological findings, a stepwise diagnostic approach is proposed to facilitate CCV diagnosis and rule out potential mimics. Identification of key clinical manifestations, pertinent blood and cerebrospinal fluid results, and evaluation of central nervous system vessels for common and disease-specific findings will be emphasized. We discuss the role of magnetic resonance imaging, MR angiography, and vessel wall imaging as the imaging investigation of choice, and reservation of catheter angiography as a problem-solving tool. We emphasize the utility of brain and leptomeningeal biopsy for diagnosis and exclusion of imitators and masqueraders.
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Affiliation(s)
- Neetika Gupta
- Department of Medical Imaging, Children’s Hospital of Eastern Ontario (CHEO), University of Ottawa, Ottawa, Ontario Canada
- Clinical Fellow—Pediatric Radiology, Department of Medical Imaging, Children’s Hospital of Eastern Ontario (CHEO), University of Ottawa, Ottawa, Ontario Canada
| | - Shivaprakash B. Hiremath
- Department of Medical Imaging, Division of Neuroradiology, Civic and General Campus, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario Canada
- Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario Canada
| | - Richard I. Aviv
- Department of Medical Imaging, Division of Neuroradiology, Civic and General Campus, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario Canada
| | - Nagwa Wilson
- Department of Medical Imaging, Children’s Hospital of Eastern Ontario (CHEO), University of Ottawa, Ottawa, Ontario Canada
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Benjamin P, Sudhakar S, D’Arco F, Löbel U, Carney O, Roux CJ, Boddaert N, Hemingway C, Eleftheriou D, Mankad K. Spectrum of Neuroradiologic Findings Associated with Monogenic Interferonopathies. AJNR Am J Neuroradiol 2022; 43:2-10. [PMID: 34949589 PMCID: PMC8757560 DOI: 10.3174/ajnr.a7362] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/29/2021] [Indexed: 01/03/2023]
Abstract
The genetic interferonopathies are a heterogeneous group of disorders thought to be caused by the dysregulated expression of interferons and are now commonly considered in the differential diagnosis of children presenting with recurrent or persistent inflammatory phenotypes. With emerging therapeutic options, recognition of these disorders is increasingly important, and neuroimaging plays a vital role. In this article, we discuss the wide spectrum of neuroradiologic features associated with monogenic interferonopathies by reviewing the literature and illustrate these with cases from our institutions. These cases include intracerebral calcifications, white matter T2 hyperintensities, deep WM cysts, cerebral atrophy, large cerebral artery disease, bilateral striatal necrosis, and masslike lesions. A better understanding of the breadth of the neuroimaging phenotypes in conjunction with clinical and laboratory findings will enable earlier diagnosis and direct therapeutic strategies.
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Affiliation(s)
- P. Benjamin
- From the Department of Radiology (P.B., S.S., F.D., U.L., O.C., K.M.), Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, UK
| | - S. Sudhakar
- From the Department of Radiology (P.B., S.S., F.D., U.L., O.C., K.M.), Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, UK
| | - F. D’Arco
- From the Department of Radiology (P.B., S.S., F.D., U.L., O.C., K.M.), Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, UK
| | - U. Löbel
- From the Department of Radiology (P.B., S.S., F.D., U.L., O.C., K.M.), Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, UK
| | - O. Carney
- From the Department of Radiology (P.B., S.S., F.D., U.L., O.C., K.M.), Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, UK
| | - C.-J. Roux
- Department of Paediatric Radiology (C.-J.R., N.B.), Hôpital Necker–Enfants Malades, Paris, France
| | - N. Boddaert
- Department of Paediatric Radiology (C.-J.R., N.B.), Hôpital Necker–Enfants Malades, Paris, France,Institut Imagine (N.B.), Institut National de la Santé et de la Recherche Médicale Union Mutualiste Retraite 1163, Paris, France
| | - C. Hemingway
- Department of Paediatric Neurology (C.H.), Great Ormond Street Hospital, London, UK
| | - D. Eleftheriou
- Infection, Inflammation, and Immunology Section (D.E.), University College London Great Ormond Street Institute of Child Health, London, UK
| | - K. Mankad
- From the Department of Radiology (P.B., S.S., F.D., U.L., O.C., K.M.), Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, UK
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Piccoli C, Bronner N, Gavazzi F, Dubbs H, De Simone M, De Giorgis V, Orcesi S, Fazzi E, Galli J, Masnada S, Tonduti D, Varesio C, Vanderver A, Vossough A, Adang L. Late-Onset Aicardi-Goutières Syndrome: A Characterization of Presenting Clinical Features. Pediatr Neurol 2021; 115:1-6. [PMID: 33307271 PMCID: PMC7856674 DOI: 10.1016/j.pediatrneurol.2020.10.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/23/2020] [Accepted: 10/27/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Aicardi-Goutières syndrome (AGS) is a genetic interferonopathy characterized by early onset of severe neurological injury with intracranial calcifications, leukoencephalopathy, and systemic inflammation. Increasingly, a spectrum of neurological dysfunction and presentation beyond the infantile period is being recognized in AGS. The aim of this study was to characterize late-infantile and juvenile-onset AGS. METHODS We conducted a multi-institution review of individuals with AGS who were older than one year at the time of presentation, including medical history, imaging characteristics, and suspected diagnoses at presentation. RESULTS Thirty-four individuals were identified, all with pathogenic variants in RNASEH2B, SAMHD1, ADAR1, or IFIH1. Most individuals had a history of developmental delay and/or systemic symptoms, such as sterile pyrexias and chilblains, followed by a prodromal period associated with increasing symptoms. This was followed by an abrupt onset of neurological decline (fulminant phase), with a median onset at 1.33 years (range 1.00 to 17.68 years). Most individuals presented with a change in gross motor skills (97.0%), typically with increased tone (78.8%). Leukodystrophy was the most common magnetic resonance imaging finding (40.0%). Calcifications were less common (12.9%). CONCLUSIONS This is the first study to characterize the presentation of late-infantile and juvenile onset AGS and its phenotypic spectrum. Late-onset AGS can present insidiously and lacks classical clinical and neuroimaging findings. Signs of early systemic dysfunction before fulminant disease onset and loss of motor symptoms were common. We strongly recommend genetic testing when there is concern for sustained inflammation of unknown origins or changes in motor skills in children older than one year.
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Affiliation(s)
- Cara Piccoli
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nowa Bronner
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Holly Dubbs
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Micaela De Simone
- ASST Spedali Civili di Brescia, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia, Italy
| | | | | | - Elisa Fazzi
- ASST Spedali Civili di Brescia, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia, Italy
| | - Jessica Galli
- ASST Spedali Civili di Brescia, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia, Italy
| | - Silvia Masnada
- Vittore Buzzi Children’s Hospital, Ospedale dei Bambini Vittore Buzzi, Milan, Italy
| | - Davide Tonduti
- Vittore Buzzi Children’s Hospital, Ospedale dei Bambini Vittore Buzzi, Milan, Italy
| | | | | | | | - Laura Adang
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
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El-Dessouky SH, Abdel-Hamid MS, Abdel-Ghafar SF, Aboulghar MM, Gaafar HM, Fouad M, Ahmed AH, Abdel-Salam GMH. Raine syndrome: Prenatal diagnosis based on recognizable fetal facial features and characteristic intracranial calcification. Prenat Diagn 2020; 40:1578-1597. [PMID: 32833257 DOI: 10.1002/pd.5818] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 08/20/2020] [Accepted: 08/20/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The purpose of this study was to elucidate the facial morphology and the pattern of internal malformations in three fetuses with RS born to first cousins of Egyptian decent. METHODS The fetal ultrasonography findings were highly suggestive of RS leading to targeted Sanger sequencing of FAM20C and postnatal assessment. RESULTS The prenatal ultrasound findings of osteosclerotic skull, exorbitism, hypoplastic nose, midface hypoplasia, small mouth with down-curved corners, and a distinct and recognizable pattern of intracranial calcification were identified in three fetuses with RS. The calcifications were evident specifically around the corpus callosum and/or ventricular walls. Ectopic renal and hepatic calcifications, pulmonary hypoplasia, mild rhizomelic shortening of the upper limbs, intrauterine fractures, and cerebellar hypoplasia were also noted. Molecular analysis identified three novel homozygous variants, two frameshift: [c.456delC (p.Gly153Alafs*34)] in exon 1 and [c.905delT (Phe302Serfs*35)] in exon 4 and one nonsense mutation in exon 10, [c.1557C>G(p.Tyrs519*)]. The three variants were segregated with the phenotype. This is the first description of a phenotype associated with homozygous truncating variants of FAM20C. CONCLUSION RS has characteristic prenatal ultrasound findings which can improve the prenatal identification of this condition and help in guiding the molecular diagnosis and counseling.
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Affiliation(s)
- Sara H El-Dessouky
- Department of Prenatal Diagnosis & Fetal Medicine, Division of Human Genetics and Genome Research, National Research Centre, Cairo, Egypt
| | - Mohamed S Abdel-Hamid
- Department of Medical & Molecular Genetics, Division of Human Genetics and Genome Research, National Research Centre, Cairo, Egypt
| | - Sherif F Abdel-Ghafar
- Department of Medical & Molecular Genetics, Division of Human Genetics and Genome Research, National Research Centre, Cairo, Egypt
| | | | | | - Mona Fouad
- Fetal Medicine Unit, Cairo University, Cairo, Egypt
| | - Adel H Ahmed
- Fetal Medicine Unit, Cairo University, Cairo, Egypt
| | - Ghada M H Abdel-Salam
- Department of Clinical Genetics, Division of Human Genetics and Genome Research, National Research Centre, Cairo, Egypt
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Lambe J, Murphy OC, Mu W, Sondergaard Schatz K, Barañano KW, Venkatesan A. Relapsing-remitting clinical course expands the phenotype of Aicardi-Goutières syndrome. Ann Clin Transl Neurol 2020; 7:254-258. [PMID: 31920009 PMCID: PMC7034496 DOI: 10.1002/acn3.50979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/20/2019] [Accepted: 12/21/2019] [Indexed: 12/11/2022] Open
Abstract
Aicardi-Goutières syndrome (AGS) is a rare and likely underdiagnosed genetic leukoencephalopathy, typically presenting in infancy with encephalopathy and characteristic neuroimaging features, with residual static neurological deficits. We describe a patient who, following an initial presentation at the age of 12 months in keeping with AGS, exhibited a highly atypical relapsing course of neurological symptoms in adulthood with essentially normal neuroimaging. Whole-exome sequencing confirmed a pathogenic RNASEH2B gene variant consistent with AGS. This case highlights the expanding phenotypes associated with AGS and the potential role of whole-exome sequencing in facilitating an increase in the rate of diagnosis.
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Affiliation(s)
- Jeffrey Lambe
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Olwen C Murphy
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Weiyi Mu
- Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Kristin W Barañano
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Arun Venkatesan
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Brain Organoids: Expanding Our Understanding of Human Development and Disease. Results Probl Cell Differ 2018; 66:183-206. [PMID: 30209660 DOI: 10.1007/978-3-319-93485-3_8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Stem cell-derived brain organoids replicate important stages of the prenatal human brain development and combined with the induced pluripotent stem cell (iPSC) technology offer an unprecedented model for investigating human neurological diseases including autism and microcephaly. We describe the history and birth of organoids and their application, focusing on cerebral organoids derived from embryonic stem cells and iPSCs. We discuss new insights into organoid-based model of schizophrenia and shed light on challenges and future applications of organoid-based disease model system. This review also suggests hitherto unrevealed potential applications of organoids in combining with new technologies such as nanophotonics/optogenomics for controlling brain development and atomic force microscopy for studying mechanical forces that shape the developing brain.
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