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Yavuz Saricay L, Hoyek S, Ashit Parikh A, Baldwin G, Bodamer OA, Gonzalez E, Patel NA. A case of Aicardi syndrome associated with duplication event of Xp22 including SHOX. Ophthalmic Genet 2023; 44:591-594. [PMID: 36728747 DOI: 10.1080/13816810.2023.2172190] [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: 09/30/2022] [Revised: 12/29/2022] [Accepted: 01/18/2023] [Indexed: 02/03/2023]
Abstract
BACKGROUND Aicardi syndrome is a neurodevelopmental disorder characterized by a triad of partial or complete agenesis of the corpus callosum, infantile spasms, and pathognomonic chorioretinal lacunae. METHODS Examination, multimodal imaging, and genetic testing were used to guide diagnosis. RESULTS We report a case of a pediatric patient who was initially diagnosed with refractory infantile spasms. The patient was unresponsive to conventional antiepileptic therapy, and genetic testing with whole exome and mitochondrial genome sequencing could not identify the underlying cause, so vigabatrin was initiated. The ophthalmic examination under anesthesia for vigabatrin toxicity screening revealed chorioretinal atrophy in the retinal periphery of both eyes, with two 3-disc diameter chorioretinal lacunae superotemporal and inferonasal to the optic nerve in the left eye. Given the neuroimaging findings of corpus callosum hypoplasia with polymicrogyria and ocular findings, the patient was diagnosed with Aicardi syndrome. Genetic testing revealed a novel duplication event at the Xp22 locus. CONCLUSIONS Aicardi syndrome, albeit a rare condition, should always be considered in the differential diagnosis when investigating a female child with refractory seizures in early childhood. Genetic testing may help further our understanding of AIS and the search for a genetic etiology.
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Affiliation(s)
- Leyla Yavuz Saricay
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sandra Hoyek
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Ayush Ashit Parikh
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Grace Baldwin
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Olaf A Bodamer
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Efren Gonzalez
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nimesh A Patel
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
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Sirek S, Filipek E, Wójcik–Niklewska B, Pojda-Wilczek D, Mrukwa-Kominek E. Ocular features in Aicardi syndrome: A case report. Medicine (Baltimore) 2022; 101:e31950. [PMID: 36626525 PMCID: PMC9750684 DOI: 10.1097/md.0000000000031950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
RATIONALE Aicardi syndrome is a genetic malformation syndrome with a triad of dysgenesis or agenesis of the corpus callosum, distinctive chorioretinal lacunae and infantile spasms. It is a rare developmental disorder first described in 1965. The disease affects 1 in 100,000 live births. PATIENT CONCERNS We describe a 34-month-old girl diagnosed with Aicardi Syndrome. DIAGNOSIS Based on the results of color images of the fundus, medical history as well as the analysis of karyotype and DNA microarrays, the patient was diagnosed with Aicardi's syndrome. INTERVENTIONS Additionally an B-scan ultrasonography and an electrophysiological test was performed. OUTCOME Fundoscopic examination revealed optic disc colobomas in both eyes, extensive chorioretinal lacunae at the posterior pole with retinal pigment epithelium regrouping and atrophy. Flash visual evoked potentials (FVEP) P2 amplitude was lower than normal range. B-scan ultrasonography revealed an optic disc lesion consistent with optic disk coloboma. LESSONS Children with congenital central nervous system malformations should undergo regular ophthalmic checkups to facilitate diagnosis and determine prognosis of visual function development.
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Affiliation(s)
- Sebastian Sirek
- Department of Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
- Kornel Gibiński University Clinical Centre, Katowice, Poland
- *Correspondence: Sebastian Sirek, Department of Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Kornel Gibiński University Clinical Centre, Ceglana 35, 40-514 Katowice, Poland (e-mail: )
| | - Erita Filipek
- Department of Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
- Department of Pediatric Ophtalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
| | - Bogumiła Wójcik–Niklewska
- Department of Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
- Department of Pediatric Ophtalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
| | - Dorota Pojda-Wilczek
- Department of Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
- Kornel Gibiński University Clinical Centre, Katowice, Poland
| | - Ewa Mrukwa-Kominek
- Department of Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
- Kornel Gibiński University Clinical Centre, Katowice, Poland
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Yu-Chuan Kang E, Chong YJ, Lien R, Wu WC. A rare case of bilateral vitreoretinopathy of Aicardi syndrome. Am J Ophthalmol Case Rep 2022; 26:101467. [PMID: 35345580 PMCID: PMC8956863 DOI: 10.1016/j.ajoc.2022.101467] [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: 09/03/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To report a rare case of Aicardi syndrome presenting with concurrent peripheral retina nonperfusion with 360-degree neovascularization in the right eye and stalk tissue with a peripapillary fibrovascular membrane and tractional retinal detachment (TRD) in the left eye. Observations A one-month-old girl was referred for an ophthalmic evaluation to confirm the diagnosis of Aicardi syndrome due to abnormal brain magnetic resonance imaging. A 360-degree circumferential peripheral avascular retina with extensive neovascularization was present in the right eye. Stalk tissue with fibrovascular proliferation causing TRD was found in the left fundus. The retina of the right eye became quiescent after completing peripheral laser photocoagulation. The detached retina in the left eye was flattened, and the peripapillary chorioretinal lacunae became visible one year after surgical removal of the traction. In addition, the axial length growth of the left eye regained. Conclusion and importance This is a rare case of Aicardi syndrome with concurrent peripapillary fibrovascular traction in one eye and peripheral retina nonperfusion in the other eye. Surgical intervention is vital not only for removing the traction and flattening the retina but also for promoting continual growth of the eyeball.
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Affiliation(s)
- Eugene Yu-Chuan Kang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ying-Jiun Chong
- Department of Ophthalmology, Penang General Hospital, Malaysia
| | - Reyin Lien
- Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Mavrommatis MA, Friedman AH, Fowkes ME, Hefti MM. Aicardi syndrome in a 20-year-old female. Am J Ophthalmol Case Rep 2018; 12:61-64. [PMID: 30238067 PMCID: PMC6143771 DOI: 10.1016/j.ajoc.2018.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/12/2018] [Accepted: 09/04/2018] [Indexed: 01/28/2023] Open
Abstract
Purpose To describe an unusual case of Aicardi Syndrome that both affirms hallmark characteristics of the condition and introduces new observations. Observations We report the case of a 20-year-old woman with Aicardi Syndrome who presented in respiratory distress with bradycardia and died soon thereafter. She had a history of severe mental retardation, seizure disorder, advanced scoliosis and numerous contractures in addition to congenital ocular malformations resulting in bilateral blindness. The case is notable for her age and longevity, as most patients with Aicardi Syndrome expire much younger, as well as the presence of intact nuclei under the posterior lens capsule. Conclusions and importance Aicardi Syndrome is a rare X-linked cerebro-retinal disorder typified by seizures, agenesis of the corpus callosum, and chorioretinal lacunae. Documenting alterations from and additions to this triad of symptoms is critical to better understanding both the syndrome itself, as well as the full breadth of its clinical impact on the patient.
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Affiliation(s)
- Maria A Mavrommatis
- Icahn School of Medicine at Mount Sinai, 1468 Madison Ave, New York, NY, 10029, USA
| | - Alan H Friedman
- Department of Ophthalmology, Mount Sinai Medical Center, 1468 Madison Ave, New York, NY, 10029, USA.,Department of Pathology, Mount Sinai Medical Center, 1468 Madison Ave, New York, NY, 10029, USA
| | - Mary E Fowkes
- Department of Pathology, Mount Sinai Medical Center, 1468 Madison Ave, New York, NY, 10029, USA
| | - Marco M Hefti
- Department of Pathology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
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Iris cyst in a child with Aicardi syndrome: a novel association. J AAPOS 2016; 20:451-452. [PMID: 27320016 DOI: 10.1016/j.jaapos.2016.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 03/20/2016] [Accepted: 03/29/2016] [Indexed: 11/20/2022]
Abstract
Aicardi syndrome is a rare X-linked cerebro-retinal disorder characterized by agenesis or dysgenesis of the corpus callosum, seizures, and chorioretinal lacunae; microphthalmia or optic nerve coloboma may also be observed. We report the case of an infant born with severe ocular malformations, including an anterior chamber cyst in one eye, which was surgically removed.
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The optic nerve and visual pathways. HANDBOOK OF CLINICAL NEUROLOGY 2013. [PMID: 23622375 DOI: 10.1016/b978-0-444-59565-2.00022-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
We review the clinical examination of the optic disc and assessment of the integrity of the visual pathways: assessment of vision in the infant and child, assessment of disc size and configuration, detection of abnormalities such as cupping or disc swelling and their significance, visual field examination in the child, and the various field defects which result from pathology affecting the visual pathway anywhere along its course. Congenital anomalies of the optic disc, their systemic associations and significance are discussed. We also review the presentation of the visually impaired child, the significance of nystagmus in this context, the differential diagnosis and investigation.
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Abstract
BACKGROUND Aicardi syndrome is a rare X-linked disorder that has been characterized classically by agenesis of the corpus callosum, seizures, and the finding of chorioretinal lacunae. This triad has been augmented more recently by central nervous system and ocular findings. The goal of this study was to determine how frequently other ophthalmologic findings are associated with Aicardi syndrome. METHODS A single ophthalmologist recorded the ocular and adnexal findings of 40 girls with this disorder at the annual meeting of an Aicardi syndrome family support group. For each subject, the examiner performed facial anthropometrics, portable biomicroscopy, and, where feasible, indirect ophthalmoscopy. RESULTS The most common findings were chorioretinal lacunae in 66 (88%) of 75 eyes and optic nerve abnormalities in 61 (81%) of 75 eyes. Other less common findings included persistent pupillary membrane in 4 (5%) of 79 eyes and anterior synechiae in 1 of 79 eyes (1%). CONCLUSIONS Although the ophthalmic hallmark and defining feature of Aicardi syndrome is the cluster of distinctive chorioretinal lacunae surrounding the optic nerve(s), the spectrum of ocular, papillary, and retinal anomalies varies widely, from nearly normal to dysplasia of the optic nerve and to severe microphthalmos.
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Chabchoub I, Kamoun F, Daoued E, Ben Mansour L, Kmiha S, Kamoun T, Mnif Z, Hachicha M. [Aicardi syndrome associated with severe congenital ptosis]. Arch Pediatr 2011; 18:970-3. [PMID: 21820292 DOI: 10.1016/j.arcped.2011.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 03/08/2011] [Accepted: 06/11/2011] [Indexed: 11/19/2022]
Abstract
Aicardi syndrome is a rare neurodevelopmental disorder characterized by corpus callosum agenesis, chorioretinal lacunae and early-onset infantile spasms. We report a particular case of Aicardi syndrome characterized by the association of the classical triad of severe bilateral ptosis, pontocerebellar hypoplasia, and perisylvian polymicrogyria in a girl born to non-consanguineous parents, but whose mother suffered from idiopathic generalized epilepsy.
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Affiliation(s)
- I Chabchoub
- Service de pédiatrie, CHU Hédi-Chaker, Sfax, Tunisie.
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9
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Abstract
The optic disc represents the anterior end of the optic nerve, the most forward extension of the central nervous system (CNS). The optic disc gives a rare glimpse into the CNS. Hence, diseases of the CNS are often manifested on fundus examination. Abnormalities of the optic disc may reflect eye disease (such as glaucoma), problems in development (as in various syndromes), or CNS disease (such as increased intracranial pressure). Each optic nerve is composed of about 1.2 million axons deriving from the retinal ganglion cells of one eye. Optic atrophy is a morphological sequela reflecting the loss of many or all of these axons. Myriad diseases such as hereditary, metabolic, tumor, and increased intracranial pressure can lead to optic atrophy. Some diseases, such as optic disc drusen, intracranial masses, orbital tumors, ischemic optic neuropathies, inflammations, and infiltrations, can produce optic disc edema before leading to optic atrophy. A number of new imaging modalities, such as optical coherence tomography (OCT), quantitate the thickness of the peripapillary retinal nerve fiber layer as an indirect measure of axonal loss or swelling. OCT can therefore be used to quantitate pathology or the response to therapy in various generalized CNS conditions, such as multiple sclerosis.
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Affiliation(s)
- Alfredo A Sadun
- Departments of Ophthalmology and Neurosurgery, Doheny Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
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Wang X, Sutton VR, Eble T, Lewis RA, Gunaratne P, Patel A, Van den Veyver IB. A genome-wide screen for copy number alterations in Aicardi syndrome. Am J Med Genet A 2009; 149A:2113-21. [PMID: 19760649 PMCID: PMC3640635 DOI: 10.1002/ajmg.a.32976] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Aicardi syndrome is a severe neurodevelopmental disorder that affects females or rarely males with a 47,XXY karyotype. Therefore, it is thought to be caused by heterozygous defects in an essential X-linked gene or by defects in an autosomal gene with sex-limited expression. Because all reported cases are sporadic with one exception, traditional linkage analysis to identify the mutant gene is not possible, and the de novo mutation rate must be high. As an alternative approach to localize the mutant gene, we screened the DNA of 38 girls with Aicardi syndrome by high-resolution, genome-wide array comparative genomic hybridization for copy number gains and losses. We found 110 copy number variants (CNVs), 97 of which are known, presumably polymorphic, CNVs; 8 have been seen before in unrelated studies in unaffected individuals. Four previously unseen CNVs on autosomes were each inherited from a healthy parent. One subject with Aicardi syndrome had a de novo loss of X-linked copy number in a region without known genes. Detailed analysis of this and flanking regions did not reveal CNVs or mutations in annotated genes in other affected subjects. We conclude that, in this study population of 38 subjects, Aicardi syndrome is not caused by CNVs detectable with the high-resolution array platform that was used.
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Affiliation(s)
- Xiaoling Wang
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | - V. Reid Sutton
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX
| | - Tanya Eble
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX
| | - Richard Alan Lewis
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX
- Department of Medicine, Baylor College of Medicine, Houston, TX
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Preethi Gunaratne
- Department of Pathology, Baylor College of Medicine, Houston, TX
- Department of Biology and Biochemistry, University of Houston, Houston, TX
| | - Ankita Patel
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX
| | - Ignatia B. Van den Veyver
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX
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Shah PK, Narendran V, Kalpana N. Aicardi syndrome: the importance of an ophthalmologist in its diagnosis. Indian J Ophthalmol 2009; 57:234-6. [PMID: 19384023 PMCID: PMC2683450 DOI: 10.4103/0301-4738.49403] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Aicardi syndrome is a rare genetic disorder. The salient features of this syndrome include agenesis of corpus callosum, chorioretinal lacunae and infantile spasms. Of these three, chorioretinal lacunae is the most constant feature present. This case highlights the importance of fundus findings by an ophthalmologist in making the diagnosis of this rare syndrome.
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Affiliation(s)
- Parag K Shah
- Pediatric Retina Department, Postgraduate Institute of Ophthalmology, Coimbatore, Tamilnadu, India.
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12
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Brodsky MC. Congenital Optic Disc Anomalies. Ophthalmology 2009. [DOI: 10.1016/b978-0-323-04332-8.00159-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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13
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Golnik KC. Cavitary anomalies of the optic disc: Neurologic significance. Curr Neurol Neurosci Rep 2008; 8:409-13. [DOI: 10.1007/s11910-008-0063-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Sutton VR, Hopkins BJ, Eble TN, Gambhir N, Lewis RA, Van den Veyver IB. Facial and physical features of Aicardi syndrome: infants to teenagers. Am J Med Genet A 2008; 138A:254-8. [PMID: 16158440 DOI: 10.1002/ajmg.a.30963] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Aicardi syndrome is a sporadic disorder that affects primarily females and is hypothesized to be caused by heterozygous mutations in an X-linked gene. Its main features include of a triad of infantile spasms, agenesis of the corpus callosum, and distinctive chorioretinal lacunae. Additional common findings include moderate to profound mental retardation, gray matter heterotopia, gyral anomalies, and vertebral and rib defects. To date, no consistent facial dysmorphisms have been described. We examined 40 girls with Aicardi syndrome and determined that consistent facial features appeared in over half the study participants and included a prominent premaxilla, upturned nasal tip, decreased angle of the nasal bridge, and sparse lateral eyebrows. Externally apparent microphthalmia was seen in 10/40 (25%). Various skin lesions (including multiple nevi, skin tags, hemangiomas, one giant melanotic nevus, and a history of a previously removed angiosarcoma) were present in 8/40 (20%). Hand abnormalities were seen in 3/40 (7.5%) and included camptodactyly, proximal placement of the thumb and hypoplasia of the fifth finger. This study clearly delineates the existence of a distinctive facial phenotype of Aicardi syndrome not previously described. We recommend that features of a prominent premaxilla with upturned nasal tip and vascular malformations/vascular tumors be added to the modified diagnostic criteria in order to improve the ability of geneticists to diagnose Aicardi syndrome.
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Affiliation(s)
- V Reid Sutton
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
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Mutlu FM, Akin R, Uysal Y, Unay B, Altinsoy HI, Bayraktar MZ. Aicardi syndrome: an unusual case associated with pineal gland cyst and ventricular septal defect. J Child Neurol 2006; 21:1082-4. [PMID: 17156705 DOI: 10.1177/7010.2006.00233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aicardi syndrome is a cerebroretinal disorder consisting of a heterogeneous spectrum of clinical findings that includes the triad of infantile spasms, agenesis of the corpus callosum, and chorioretinal lacunae. This report describes a 6-month-old girl who has all of the essential features suggestive of Aicardi syndrome, as well as a pineal gland cyst and ventricular septal defect. Although the characteristic features of Aicardi syndrome have been described, its association with pineal gland cyst and ventricular septal defect has not been reported in the literature.
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Affiliation(s)
- Fatih Mehmet Mutlu
- Department of Ophthalmology, Gülhane Military Academy and Medical School, Ankara, Turkey.
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Abstract
The principal congenital abnormalities of the optic disc that can significantly impair visual function are excavation of the optic disc and optic nerve hypoplasia. The excavated optic disc abnormalities comprise optic disc coloboma, morning glory syndrome, and peripapillary staphyloma. Optic nerve hypoplasia manifests as a small optic nerve, which may or may not be accompanied by a peripapillary ring (the double ring sign). In addition, the optic disc cupping, which occurs as a sequel to some cases of periventricular leucomalacia, can arguably be classified as a type of optic nerve hypoplasia. All of these conditions can be unilateral or bilateral and can impair visual function mildly or severely. It is essential that children with poor vision due to any of these conditions are managed by treating refractive errors, giving occlusion therapy in selected cases, and optimising the conditions at home and at school in an attempt to ensure that impaired vision does not impede development or education.
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Affiliation(s)
- G N Dutton
- Tennent Institute of Ophthalmology, Gartnavel, General Hospital, Glasgow, UK.
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Lee SW, Kim KS, Cho SM, Lee SJ. An atypical case of Aicardi syndrome with favorable outcome. KOREAN JOURNAL OF OPHTHALMOLOGY 2004; 18:79-83. [PMID: 15255242 DOI: 10.3341/kjo.2004.18.1.79] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aicardi syndrome is a severe congenital disorder characterized by infantile spasms, chorioretinal lacunae, and agenesis or hypogenesis of the corpus callosum. A 6 month old female had developed abnormal eye movement and seizures of the complex partial type and myoclonic type. MRI pictures of the patient revealed the presence of genu associated with agenesis of the rest of corpus callosum. A funduscopic examination revealed bilateral small, solitary, pale areas with sharp borders, some of which had minimal surrounding pigmentation (chorioretinal lacunae), especially clustered around the disc, and they were more prominent on the left side. We report here on the unusual findings of a complex partial seizure, myoclonic seizure and the atypical EEG finding in addition to the well-known characteristic clinical and imaging findings of a patient with Aicardi syndrome.
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Affiliation(s)
- Seung Woo Lee
- Department of Ophthalmology, Dongguk University College of Medicine, Kyongju, Korea
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Laghmari M, Boutimzine N, Chakir N, Daoudi R, Mohcine Z. Persistance et hyperplasie du vitré primitif et syndrome d’Aicardi. J Fr Ophtalmol 2004; 27:501-5. [PMID: 15179307 DOI: 10.1016/s0181-5512(04)96171-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Aicardi syndrome is characterized by infantile spasms, agenesis of the corpus callosum and chorioretinal lacunae. This disorder affects mostly females, with early embryonic lethality in males. Numerous general and ocular disorders may be associated with this affection. We present here a case of persistent hyperplastic primary vitreous (PHPV) in association with Aicardi syndrome in a 30-year-old woman. CASE REPORT The authors report a case of a 30-year-old woman with Aicardi syndrome associated with persistent hyperplastic primary vitreous. DISCUSSION Aicardi syndrome is a polymalformative disease occurring at an early period of embryogenesis. It can affect many ocular structures. This syndrome is essentially described in female children, who rarely reach an adult age. The observation we report is particular because of the patient's age (30-years-old) and the association with a persistent hyperplastic primary vitreous, exceptional in this context. CONCLUSION With a review of the literature, the Authors discuss the clinical neuroradiological and prognostic aspects of this polymalformative syndrome and different associated general and ocular abnormalities, emphasizing particularly those of persistent hyperplastic primary vitreous in this affection.
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Affiliation(s)
- M Laghmari
- Service Ophtalmologie A, Hôpital des spécialités, Rabat, Maroc
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Jensen AA, Christiansen SP. Aicardi syndrome with Pierre Robin sequence. J AAPOS 2004; 8:187-9. [PMID: 15088056 DOI: 10.1016/j.jaapos.2003.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Allison A Jensen
- Department of Ophthalmology, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455, USA
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Abstract
BACKGROUND The frequent association between optic nerve hypoplasia (ONH) and other central nervous system abnormalities has been widely reported in the literature. Occasional reference has been made to arachnoid cyst as one of the associated findings. METHOD The charts and neuroradiologic findings of the 40 patients with ONH seen in our department as well as the Visually Impaired Program during the past 8 years were reviewed. RESULTS An intracranial arachnoid cyst was present in 5 of the 40 patients (12.5%) with ONH and visual impairment. These patients' clinical and neuroradiologic findings are reported here. CONCLUSION The presence of an intracranial arachnoid cyst in a patient with hypoplastic optic nerves could occur as a coincidental association between these lesions. Alternatively, a common mechanism could give rise to both abnormalities. Three such possibilities-including damage to the developing visual pathway by the arachnoid cyst, absence of an axonal guidance molecule similar to netrin-1 identified in the mouse, or a common genetic mutation involving the myocillin gene causing both abnormalities-are considered.
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Affiliation(s)
- Christopher Lyons
- Department of Ophthalmology, British Columbia Children's Hospital, Bancouver, British Columbia, Canada
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Van den Veyver IB. Microphthalmia with linear skin defects (MLS), Aicardi, and Goltz syndromes: are they related X-linked dominant male-lethal disorders? Cytogenet Genome Res 2004; 99:289-96. [PMID: 12900577 DOI: 10.1159/000071606] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2003] [Accepted: 02/13/2003] [Indexed: 11/19/2022] Open
Abstract
Gene identification for X-linked dominant sporadic disorders is challenging because no extended families exist that can be studied by linkage analysis. Therefore, classic positional cloning approaches are not possible, and other methods have to be used to search for candidate genes. These conditions present the next challenge for disease-gene identification of Mendelian disorders. The various issues and difficulties involved, such as male lethality, X chromosome inactivation, and analysis of phenotypic similarities among different conditions are illustrated through discussion of three X-linked developmental disorders: microphthalmia with linear skin defects (MLS) syndrome, Aicardi syndrome, and Goltz syndrome (focal dermal hypoplasia).
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Affiliation(s)
- I B Van den Veyver
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030, USA.
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22
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Chan RTY, Chan HHL, Collin HB. Morning glory syndrome. Clin Exp Optom 2002; 85:383-8. [PMID: 12452790 DOI: 10.1111/j.1444-0938.2002.tb02390.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2002] [Revised: 06/18/2002] [Accepted: 06/25/2002] [Indexed: 11/26/2022] Open
Abstract
Morning glory syndrome is a congenital optic disc anomaly in which much of the excavated colobomatous optic disc is filled with glial tissue. Ocular complications may include strabismus, reduced visual acuity and retinal detachment and it may have systemic associations as in Aicardi's syndrome. A patient with monocular morning glory syndrome and reduced visual acuity is reported. The pattern reversal visually evoked potential was reduced and the latency increased in the affected eye.
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Affiliation(s)
- Rufina Tin-Yan Chan
- Department of Optometry and Radiography, The Hong Kong Polytechnic University, Hung Hom, Kowloon, China
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23
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Abstract
Septum pellucidum agenesis is frequently associated with other cerebral malformations. Its isolated agenesis is quite rare. In the literature, all reported cases were diagnosed in early childhood. The authors present an unusual case of isolated septum pellucidum agenesis detected in adulthood with computed tomography and magnetic resonance imaging.
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Affiliation(s)
- Mutlu Cihangiroglu
- Department of Radiology, Firat University School of Medicine, 23199 Elazig, Turkey.
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24
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Siatkowski RM, Sanchez JC, Andrade R, Alvarez A. The clinical, neuroradiographic, and endocrinologic profile of patients with bilateral optic nerve hypoplasia. Ophthalmology 1997; 104:493-6. [PMID: 9082278 DOI: 10.1016/s0161-6420(97)30286-3] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE The purpose of the study was to expand on ophthalmologic and endocrinologic data and report the neuroimaging findings of 35 patients with bilateral optic nerve hypoplasia (BONH). METHODS A retrospective chart review of 35 children with BONH was conducted. Data on visual acuity, refractive error, and presence of nystagmus and strabismus were collected. Twenty-six children underwent full-endocrinologic evaluation and magnetic resonance imaging or computed tomography scanning. RESULTS The male:female ratio was 2:1. Ten percent of eyes had visual acuity of 20/60 or better, whereas 34% had no light perception. Eighty-six percent of eyes had acuity less than 20/200, and 80% of patients were legally blind. Most patients (86%) had nystagmus or strabismus or both. Forty-six percent had absence of the septum pellucidum and corpus callosum on neuroimaging. Twenty-seven percent of patients had endocrinologic abnormalities, with growth hormone deficiency being the most common. Panhypopituitarism occurred in 11.5% of children. CONCLUSIONS Although the visual prognosis of children with BONH generally is poor, 10% of such patients have excellent acuity. In contrast to previous reports, endocrine abnormalities were seen in only one quarter of patients, and the full-blown deMorsier syndrome (septo-optic dysplasia with panhypopituitarism) was seen in only 11.5% of patients with BONH.
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Affiliation(s)
- R M Siatkowski
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, USA
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25
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Smith CD, Ryan SJ, Hoover SL, Baumann RJ. Magnetic resonance imaging of the brain in Aicardi's syndrome. Report of 20 patients. J Neuroimaging 1996; 6:214-21. [PMID: 8903072 DOI: 10.1111/jon199664214] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Aicardi's syndrome consists of multiple anomalies of the eye, brain, and axial skeleton in females, and is associated with early-onset infantile spasms and severe developmental delay. For the present study, magnetic resonance images of 20 patients with Aicardi's syndrome were obtained and the neuroimaging findings catalogued. These were compared to previously reported results and the findings correlated with current theories of fetal brain development. The results revealed a high frequency of cortical migration defects (94%) and a wide variability in the callosal defect, migrational abnormalities, and other findings in Aicardi's syndrome.
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Affiliation(s)
- C D Smith
- Department of Neurology, University of Kentucky Medical Center, Lexington 40536, USA
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26
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Aguiar MD, Cavalcanti M, Barbosa H, Vilela SL, Mendonça JL, Horta E. [Aicardi syndrome and choroid plexus papilloma: a rare association. Case report]. ARQUIVOS DE NEURO-PSIQUIATRIA 1996; 54:313-7. [PMID: 8984993 DOI: 10.1590/s0004-282x1996000200022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The authors report a case of a 5 months old female child with clinical features of Aicardi syndrome: agenesis of the corpus callosum, occular abnormalities ("chorioretinal lacunae" and microphthalmus), infantile spasms, mental retardation, vertebral malformations and thoracic deformity. The pacient was submitted to complementary examinations that confirmed the diagnosis. The neuroradiologic images (MRI) showed besides corpus callosum agenesis a tumor located at the left ventricular atrium (choroid plexus papilloma). This association is a rare occurrence and the present case is the seventh described in literature. Furthermore, we suggest that the choroid plexus pappilloma could be a characteristic tumor of the Aicardi syndrome.
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Affiliation(s)
- M D Aguiar
- Neuropediatra do Hospital de Base do Distrito Federal, Brasil
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27
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Abstract
Over the past decade, a wealth of information has accumulated pertaining to the diagnosis and management of patients with congenital optic disk anomalies. As new examples of each entity have been detailed, the diagnostic criteria for each anomaly have become more clearly defined. The advent of sophisticated noninvasive neuroimaging techniques has further refined our ability to accurately detect and categorize the associated CNS anomalies that complicate many of these conditions. In light of recent findings, this review will critically examine many of the well-entrenched concepts pertaining to the diagnosis, evaluation, and treatment of patients with congenital optic disk anomalies. In so doing, it will attempt to dispel some longstanding misconceptions that pervade the literature and obscure our understanding of the pathogenesis, neuroradiological associations, and systemic implications of each anomaly.
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Affiliation(s)
- M C Brodsky
- Department of Ophthalmology, University of Arkansas for Medical Sciences, Little Rock
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28
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