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Bonnetain MF, Rougeot-Jung C, Sarret C, Lion-François L, Revol O, Peyric E, Velazquez-Dominguez J, Miret A, Rossi M, Massoud M, Laurichesse-Delmas H, Guibaud L, des Portes V. Normal intellectual skills in patients with Rhombencephalosynapsis. Eur J Paediatr Neurol 2020; 29:92-100. [PMID: 33046393 DOI: 10.1016/j.ejpn.2020.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/07/2020] [Accepted: 09/27/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Rhombencephalosynapsis (RES) is a very rare cerebellar malformation. Neurodevelopmental outcome of apparently isolated RES remains poorly documented and standardized cognitive assessment, reported in only nine published cases so far, is lacking. Prenatal counselling is challenging considering the uncertain prognosis of isolated RES. The aim of this study was to focus on cognitive and motor outcome of isolated RES with a clinical description of six new cases and a detailed review of the literature. METHODS A single-centre retrospective study of all RES patients over a 15-year period. Ataxia and fine motor skills were scored using a five-grade scale, according to the degree of disturbance of daily living. Intelligence Quotient (IQ) was established according to age-related Weschler Intelligence Scales. A systematic literature review included published cases with relevant outcome data. RESULTS Six new cases of apparently isolated RES were reported, including three diagnosed in prenatal settings. The onset age for walking was delayed in four patients. Three patients had head shaking and three had a strabismus. One patient had a mild motor disability, one had subtle ataxia that did not impair daily life and four patients had a normal neurological examination at the last visit. Intellectual abilities were normal in all patients (full IQ score from 90 to 142), although three had ADHD. All received standard schooling. Based on these six new cases, as well as cases from 12 publications in the literature, a total of 28 patients with non-syndromic RES were analysed. Concerning motor outcome, 72% had no complaint or minimal impairment, 16% moderate and 12% severe impairment. Concerning cognitive outcome, 68% had normal cognitive skills, 18% borderline intellectual functioning and 14% moderate to severe disability.
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Affiliation(s)
| | - Christelle Rougeot-Jung
- Department of Pediatric Neurology, Competence Centre for Cerebellar Malformations, Lyon University Hospital, F-69677, Bron, France
| | - Catherine Sarret
- Department of Pediatric Neurology, CEMC Auvergne, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Laurence Lion-François
- Department of Pediatric Neurology, Competence Centre for Cerebellar Malformations, Lyon University Hospital, F-69677, Bron, France
| | - Olivier Revol
- Department of Psychopathology, Lyon University Hospital, F-69677, Bron, France
| | - Emeline Peyric
- Department of Pediatric Neurology, Competence Centre for Cerebellar Malformations, Lyon University Hospital, F-69677, Bron, France
| | - Juan Velazquez-Dominguez
- Department of Pediatric Neurology, Competence Centre for Cerebellar Malformations, Lyon University Hospital, F-69677, Bron, France
| | - Anne Miret
- Department of Pediatric Neurology, CEMC Auvergne, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Massimiliano Rossi
- Genetics Department, Referral Centre for Developmental Abnormalities, Lyon University Hospital, And INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Centre, GENDEV Team, Lyon, France; University Lyon 1, F-69008, Lyon, France
| | - Mona Massoud
- Department of Obstetrics, Lyon University Hospital, F-69677, Bron, France
| | - Hélène Laurichesse-Delmas
- Department of Obstetrics, CEMC Auvergne, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Laurent Guibaud
- Department of Pediatric Radiology and Fetal Medicine, Lyon University Hospital, F-69677, Bron, France; University Lyon 1, F-69008, Lyon, France
| | - Vincent des Portes
- Department of Pediatric Neurology, Competence Centre for Cerebellar Malformations, Lyon University Hospital, F-69677, Bron, France; University Lyon 1, F-69008, Lyon, France.
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2
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Developmental risk for mood dysregulation in a pediatric case of Gómez-López-Hernández syndrome: Neurocognitive considerations. Clin Neurol Neurosurg 2020; 195:105877. [DOI: 10.1016/j.clineuro.2020.105877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 03/17/2020] [Accepted: 04/27/2020] [Indexed: 11/22/2022]
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3
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Cerebellar networks and neuropathology of cerebellar developmental disorders. HANDBOOK OF CLINICAL NEUROLOGY 2018; 154:109-128. [PMID: 29903435 DOI: 10.1016/b978-0-444-63956-1.00007-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The cerebellar system is a series of axonal projections and synaptic circuits as networks, similar to those of the limbic system and those subserving the propagation and spread of seizures. Three principal cerebellar networks are identified and cerebellar disease often affects components of the networks other than just the cerebellar cortex. Contemporary developmental neuropathology of the cerebellum is best considered in the context of alterations of developmental processes: embryonic segmentation and genetic gradients along the three axes of the neural tube, individual neuronal and glial cell differentiation, migration, synaptogenesis, and myelination. Precisely timed developmental processes may be delayed or precocious rhombencephalosynapsis and pontocerebellar hypoplasia exemplify opposite gradients in the horizontal axis. Chiari II malformation may be reconsidered as a disorder of segmentation rather than simply due to mechanical forces upon normally developing hindbrain structures. Cellular nodules in the roof of the fourth ventricle are heterotopia of histologically differentiated but architecturally disoriented and disorganized neurons and glial cells; they often are less mature immunocytochemically than similar cells in adjacent normal folia. Cell rests are nodules of undifferentiated neuroepithelial cells. Both are frequent in human fetuses and neonates. Axonal projections from heterotopia to adjacent cerebellar folia or nuclei are few or absent, hence these nodules are clinically silent despite neuronal differentiation.
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4
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5
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Wagner MW, Poretti A, Benson JE, Huisman TAGM. Neuroimaging Findings in Pediatric Genetic Skeletal Disorders: A Review. J Neuroimaging 2016; 27:162-209. [PMID: 28000960 DOI: 10.1111/jon.12413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 11/01/2016] [Indexed: 12/15/2022] Open
Abstract
Genetic skeletal disorders (GSDs) are a heterogeneous group characterized by an intrinsic abnormality in growth and (re-)modeling of cartilage and bone. A large subgroup of GSDs has additional involvement of other structures/organs beside the skeleton, such as the central nervous system (CNS). CNS abnormalities have an important role in long-term prognosis of children with GSDs and should consequently not be missed. Sensitive and specific identification of CNS lesions while evaluating a child with a GSD requires a detailed knowledge of the possible associated CNS abnormalities. Here, we provide a pattern-recognition approach for neuroimaging findings in GSDs guided by the obvious skeletal manifestations of GSD. In particular, we summarize which CNS findings should be ruled out with each GSD. The diseases (n = 180) are classified based on the skeletal involvement (1. abnormal metaphysis or epiphysis, 2. abnormal size/number of bones, 3. abnormal shape of bones and joints, and 4. abnormal dynamic or structural changes). For each disease, skeletal involvement was defined in accordance with Online Mendelian Inheritance in Man. Morphological CNS involvement has been described based on extensive literature search. Selected examples will be shown based on prevalence of the diseases and significance of the CNS involvement. CNS involvement is common in GSDs. A wide spectrum of morphological abnormalities is associated with GSDs. Early diagnosis of CNS involvement is important in the management of children with GSDs. This pattern-recognition approach aims to assist and guide physicians in the diagnostic work-up of CNS involvement in children with GSDs and their management.
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Affiliation(s)
- Matthias W Wagner
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD.,Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Andrea Poretti
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jane E Benson
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Thierry A G M Huisman
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD
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6
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7
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Abdallah C. Anaesthesia and orphan disease: anaesthesia for Gomez-Lopez-Hernandez syndrome. Eur J Anaesthesiol 2015; 32:218-220. [PMID: 25226063 DOI: 10.1097/eja.0000000000000157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Claude Abdallah
- From the Division of Anaesthesiology, Children's National Medical Center, The George Washington University Medical Center, Washington, District of Columbia, USA
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8
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Kobayashi Y, Kawashima H, Magara S, Akasaka N, Tohyama J. Gómez-López-Hernández syndrome in a Japanese patient: a case report. Brain Dev 2015; 37:356-8. [PMID: 24856766 DOI: 10.1016/j.braindev.2014.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 05/02/2014] [Indexed: 10/25/2022]
Abstract
Gómez-López-Hernández syndrome (GLHS) is a rare neurocutaneous syndrome characterized by the triad of rhombencephalosynapsis, trigeminal anesthesia, and bilateral parieto-occipital alopecia. We herein describe the first Japanese patient with GLHS characterized by the standard triad with typical craniofacial anomaly including hypertelorism, brachyturricephaly and midface retrusion, and a short stature. This female patient had also exhibited fever-induced convulsive seizures and psychomotor developmental delay since infancy. Brain magnetic resonance imaging showed severe rhombencephalosynapsis, supratentorial abnormalities (aplasia of the septum pellucidum, severe ventricular enlargement, and hypoplasia of the corpus callosum), and hippocampus atrophy. Bilateral ectopic cerebellums were also observed. This report describes the long-term clinical outcome of GLHS and a new neuroradiological finding regarding rhombencephalosynapsis.
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Affiliation(s)
- Yu Kobayashi
- Department of Child Neurology, Epilepsy Center, Nishi-Niigata Chuo National Hospital, Niigata, Japan.
| | - Hideshi Kawashima
- Department of Child Neurology, Epilepsy Center, Nishi-Niigata Chuo National Hospital, Niigata, Japan
| | - Shinichi Magara
- Department of Child Neurology, Epilepsy Center, Nishi-Niigata Chuo National Hospital, Niigata, Japan
| | - Noriyuki Akasaka
- Department of Child Neurology, Epilepsy Center, Nishi-Niigata Chuo National Hospital, Niigata, Japan
| | - Jun Tohyama
- Department of Child Neurology, Epilepsy Center, Nishi-Niigata Chuo National Hospital, Niigata, Japan
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9
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Choudhri AF, Patel RM, Wilroy RS, Pivnick EK, Whitehead MT. Trigeminal nerve agenesis with absence of foramina rotunda in Gómez-López-Hernández syndrome. Am J Med Genet A 2014; 167A:238-42. [DOI: 10.1002/ajmg.a.36830] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 09/16/2014] [Accepted: 09/19/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Asim F. Choudhri
- Department of Radiology; University of Tennessee Health Science Center; Memphis Tennessee
- Department of Ophthalmology; University of Tennessee Health Science Center; Memphis Tennessee
- Department of Neurosurgery; University of Tennessee Health Science Center; Memphis Tennessee
- Le Bonheur Children's Hospital; Memphis Tennessee
| | - Rakesh M. Patel
- College of Medicine; University of Tennessee Health Science Center; Memphis Tennessee
| | - Robert S. Wilroy
- Le Bonheur Children's Hospital; Memphis Tennessee
- Department of Pediatrics; Division of Genetics; University of Tennessee Health Science Center; Memphis Tennessee
| | - Eniko K. Pivnick
- Department of Ophthalmology; University of Tennessee Health Science Center; Memphis Tennessee
- Le Bonheur Children's Hospital; Memphis Tennessee
- Department of Pediatrics; Division of Genetics; University of Tennessee Health Science Center; Memphis Tennessee
| | - Matthew T. Whitehead
- Department of Radiology; University of Tennessee Health Science Center; Memphis Tennessee
- Le Bonheur Children's Hospital; Memphis Tennessee
- Department of Radiology; Children's National Medical Center; Washington DC
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10
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Poretti A, Christen HJ, Elton LE, Baumgartner M, Korenke GC, Sukhudyan B, Hethey S, Cross E, Steinlin M, Boltshauser E. Horizontal head titubation in infants with Joubert syndrome: a new finding. Dev Med Child Neurol 2014; 56:1016-20. [PMID: 24814865 DOI: 10.1111/dmcn.12489] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/18/2014] [Indexed: 11/30/2022]
Abstract
AIM Head thrusts are well documented in Joubert syndrome and ocular motor apraxia. We provide a detailed clinical characterization of head titubation in 13 young children with Joubert syndrome. METHOD Detailed characterization of head titubation was assessed by targeted clinical evaluation and/or analysis of videos. RESULTS In 12 of 13 children (eight males, five females; median age 6y, range 2mo-15y) head titubation was first recognized in the first 2 months of age and decreased in severity until spontaneous resolution. In all children, the head titubation was horizontal, high frequency (~3Hz), had small amplitude (5-10°), was never present during sleep, and did not interfere with the neurodevelopment during infancy. In the majority of children, emotion, anxiety, and tiredness were worsening factors for head titubation. INTERPRETATION Head titubation is a benign, early presentation of Joubert syndrome. Head titubation in hypotonic infants should prompt a careful search for Joubert syndrome. Awareness of its occurrence in Joubert syndrome may avoid unnecessary investigations.
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Affiliation(s)
- Andrea Poretti
- Department of Pediatric Neurology, University Children's Hospital, Zurich, Switzerland; Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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11
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Poretti A, Boltshauser E, Doherty D. Cerebellar hypoplasia: Differential diagnosis and diagnostic approach. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2014; 166C:211-26. [DOI: 10.1002/ajmg.c.31398] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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12
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Abdel-Salam GMH, Abdel-Hadi S, Thomas MM, Eid OM, Ali MM, Afifi HH. Gómez-López-hernández syndrome versus rhombencephalosynapsis spectrum: a rare co-occurrence with bipartite parietal bone. Am J Med Genet A 2013; 164A:480-3. [PMID: 24311025 DOI: 10.1002/ajmg.a.36276] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 09/10/2013] [Indexed: 11/12/2022]
Abstract
Rhombencephalosynapsis (RES) is a rare hindbrain malformation that could occur in isolation or as a part of a syndrome for example, Gómez-López-Hernández syndrome (GLH) or VACTERL-H. We identified male patient with severe RES. Ventriculomegaly, agenesis of septum pellucidum, very thin corpus callosum with interhemispheric cyst were additional neuroimaging findings. He had brachyturricephaly, midface retrusion, low-set posteriorly rotated ears and bilateral parietal well circumscribed areas of alopecia. No corneal anesthesia was observed; thus, demonstrating many of the diagnostic criteria of GLH. Interestingly, he additionally had bilateral bipartite parietal bone (BPB) that is an extremely rare anomaly of the parietal sutures. This is the first co-occurrence of this rare anomaly with GLH. We believe the presence of this unique finding could represent an important clue for understanding the pathogenesis of this malformation.
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Affiliation(s)
- Ghada M H Abdel-Salam
- Clinical Genetics Department, Human Genetics and Genome Research Division, National Research Centre, Cairo, Egypt
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13
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Démurger F, Pasquier L, Dubourg C, Dupé V, Gicquel I, Evain C, Ratié L, Jaillard S, Beri M, Leheup B, Lespinasse J, Martin-Coignard D, Mercier S, Quelin C, Loget P, Marcorelles P, Laquerrière A, Bendavid C, Odent S, David V. Array-CGH Analysis Suggests Genetic Heterogeneity in Rhombencephalosynapsis. Mol Syndromol 2013; 4:267-72. [PMID: 24167461 DOI: 10.1159/000353878] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2013] [Indexed: 11/19/2022] Open
Abstract
Rhombencephalosynapsis is an uncommon, but increasingly recognized, cerebellar malformation defined as vermian agenesis with fusion of the hemispheres. The embryologic and genetic mechanisms involved are still unknown, and to date, no animal models are available. In the present study, we used Agilent oligonucleotide arrays in a large series of 57 affected patients to detect candidate genes. Four different unbalanced rearrangements were detected: a 16p11.2 deletion, a 14q12q21.2 deletion, an unbalanced translocation t(2p;10q), and a 16p13.11 microdeletion containing 2 candidate genes. These genes were further investigated by sequencing and in situ hybridization. This first microarray screening of a rhombencephalosynapsis series suggests that there may be heterogeneous genetic causes.
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Affiliation(s)
- F Démurger
- Service de Génétique Clinique, CHU Hôpital Sud, Rouen, France ; Equipe Génétique des Pathologies Liées au Développement, UMR 6290 CNRS, IFR 140 GFAS, Université de Rennes 1, Faculté de Médecine, and Laboratoires de, Rouen, France
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14
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Poretti A, Boltshauser E. Dominantly inherited nonprogressive cerebellar hypoplasia identified in utero: a note of doubt. J Child Neurol 2013; 28:278. [PMID: 23345526 DOI: 10.1177/0883073812466291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Andrea Poretti
- Division of Pediatric Radiology, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Eugen Boltshauser
- Department of Pediatric Neurology, University Children’s Hospital, Zurich, Switzerland
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15
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Rush ET, Adam MP, Clark RD, Curry C, Hartmann JE, Dobyns WB, Olney AH. Four new patients with Gomez-Lopez-Hernandez syndrome and proposed diagnostic criteria. Am J Med Genet A 2013; 161A:320-6. [DOI: 10.1002/ajmg.a.35817] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 11/26/2012] [Indexed: 02/04/2023]
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Poretti A, Meoded A, Rossi A, Raybaud C, Huisman TAGM. Diffusion tensor imaging and fiber tractography in brain malformations. Pediatr Radiol 2013; 43:28-54. [PMID: 23288476 DOI: 10.1007/s00247-012-2428-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 04/09/2012] [Indexed: 01/19/2023]
Abstract
Diffusion tensor imaging (DTI) is an advanced MR technique that provides qualitative and quantitative information about the micro-architecture of white matter. DTI and its post-processing tool fiber tractography (FT) have been increasingly used in the last decade to investigate the microstructural neuroarchitecture of brain malformations. This article aims to review the use of DTI and FT in the evaluation of a variety of common, well-described brain malformations, in particular by pointing out the additional information that DTI and FT renders compared with conventional MR sequences. In addition, the relevant existing literature is summarized.
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Affiliation(s)
- Andrea Poretti
- Division of Pediatric Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 600 N. Wolfe St., Nelson Basement, B-173, Baltimore, MD 21287-0842, USA
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Merlini L, Fluss J, Korff C, Hanquinet S. Partial rhombencephalosynapsis and Chiari type II malformation in a child: a true association supported by DTI tractography. THE CEREBELLUM 2012; 11:227-32. [PMID: 21833660 DOI: 10.1007/s12311-011-0300-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Partial rhombencephalosynapsis (PRECS) has been recently reported in association with Chiari II (CII). However, its existence as a true malformation is challenged due to the anatomical changes potentially induced by CII. The aim of this report was to investigate the contribution of midbrain/hindbrain tractography in this setting. A 13-year-old boy with a known CII malformation and operated myelomeningocele was referred for brain imaging after a first complex partial seizure. In addition to the classical features of CII, MRI showed partially fused cerebellar hemispheres and multiple supratentorial abnormalities. Diffusion tensor imaging (DTI) color map and tractography showed absent transverse fibers on the midsection of the cerebellum, scarce fibers of the middle cerebellar peduncle (MCP), absence of the middle pontine crossing tract, and fibers running vertically in the medial part of the cerebellum. Vertical mediocerebellar fibers are a feature of classical RECS and the paucity or absence of MCP fibers is mainly described in CII. In our patient, DTI and FT therefore demonstrated structural characteristics of both RECS and CII confirming their potential coexistence and suggesting possible shared embryological pathway.
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Affiliation(s)
- Laura Merlini
- Unit of Pediatric Radiology, Geneva University Hospital, 6, Willy-Donzé, 1205 Geneva, Switzerland.
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18
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Ishak GE, Dempsey JC, Shaw DWW, Tully H, Adam MP, Sanchez-Lara PA, Glass I, Rue TC, Millen KJ, Dobyns WB, Doherty D. Rhombencephalosynapsis: a hindbrain malformation associated with incomplete separation of midbrain and forebrain, hydrocephalus and a broad spectrum of severity. Brain 2012; 135:1370-86. [PMID: 22451504 PMCID: PMC3338925 DOI: 10.1093/brain/aws065] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Revised: 01/28/2012] [Accepted: 01/29/2012] [Indexed: 12/11/2022] Open
Abstract
Rhombencephalosynapsis is a midline brain malformation characterized by missing cerebellar vermis with apparent fusion of the cerebellar hemispheres. Rhombencephalosynapsis can be seen in isolation or together with other central nervous system and extra-central nervous system malformations. Gómez-López-Hernández syndrome combines rhombencephalosynapsis with parietal/temporal alopecia and sometimes trigeminal anaesthesia, towering skull shape and dysmorphic features. Rhombencephalosynapsis can also be seen in patients with features of vertebral anomalies, anal atresia, cardiovascular anomalies, trachea-oesophageal fistula, renal anomalies, limb defects (VACTERL) association. Based on a comprehensive evaluation of neuroimaging findings in 42 patients with rhombencephalosynapsis, we propose a spectrum of severity, ranging from mild (the partial absence of nodulus, anterior and posterior vermis), to moderate (the absence of posterior vermis with some anterior vermis and nodulus present), to severe (the absence of posterior and anterior vermis with some nodulus present), to complete (the absence of the entire vermis including nodulus). We demonstrate that the severity of rhombencephalosynapsis correlates with fusion of the tonsils, as well as midbrain abnormalities including aqueductal stenosis and midline fusion of the tectum. Rhombencephalosynapsis is also associated with multiple forebrain abnormalities including absent olfactory bulbs, dysgenesis of the corpus callosum, absent septum pellucidum and, in rare patients, atypical forms of holoprosencephaly. The frequent association between rhombencephalosynapsis and aqueductal stenosis prompted us to evaluate brain magnetic resonance images in other patients with aqueductal stenosis at our institution, and remarkably, we identified rhombencephalosynapsis in 9%. Strikingly, subjects with more severe rhombencephalosynapsis have more severely abnormal neurodevelopmental outcome, as do subjects with holoprosencephaly and patients with VACTERL features. In summary, our data provide improved diagnostic and prognostic information, and support disruption of dorsal-ventral patterning as a mechanism underlying rhombencephalosynapsis.
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Affiliation(s)
- Gisele E. Ishak
- 1 Department of Radiology, University of Washington, Seattle Children’s Hospital, Seattle, WA 98105, USA
| | - Jennifer C. Dempsey
- 2 Division of Genetic Medicine, Department of Paediatrics, University of Washington, Seattle, WA 98195, USA
| | - Dennis W. W. Shaw
- 1 Department of Radiology, University of Washington, Seattle Children’s Hospital, Seattle, WA 98105, USA
- 3 Centre for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA 98101, USA
| | - Hannah Tully
- 3 Centre for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA 98101, USA
- 4 Department of Neurology, University of Washington, Seattle, WA 98195, USA
| | - Margaret P. Adam
- 2 Division of Genetic Medicine, Department of Paediatrics, University of Washington, Seattle, WA 98195, USA
| | - Pedro A. Sanchez-Lara
- 5 Department of Paediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
- 6 Children's Hospital Los Angeles, Los Angeles, CA 90027, USA
| | - Ian Glass
- 2 Division of Genetic Medicine, Department of Paediatrics, University of Washington, Seattle, WA 98195, USA
| | - Tessa C. Rue
- 7 Department of Biostatistics, University of Washington, Seattle, WA 98195, USA
| | - Kathleen J. Millen
- 2 Division of Genetic Medicine, Department of Paediatrics, University of Washington, Seattle, WA 98195, USA
- 3 Centre for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA 98101, USA
| | - William B. Dobyns
- 2 Division of Genetic Medicine, Department of Paediatrics, University of Washington, Seattle, WA 98195, USA
- 3 Centre for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA 98101, USA
| | - Dan Doherty
- 2 Division of Genetic Medicine, Department of Paediatrics, University of Washington, Seattle, WA 98195, USA
- 3 Centre for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA 98101, USA
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Gómez-López-Hernández syndrome: reappraisal of the diagnostic criteria. Eur J Pediatr 2010; 169:1523-8. [PMID: 20652311 DOI: 10.1007/s00431-010-1259-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 07/10/2010] [Accepted: 07/12/2010] [Indexed: 02/02/2023]
Abstract
Gómez-López-Hernández syndrome (GLHS) is a rare and possibly underdiagnosed condition. So far, 21 patients have been reported and all of them were sporadic observations. We report six additional patients. The hallmark triad of GLHS, also named cerebellotrigeminal dermal dysplasia, consists of rhombencephalosynapsis, trigeminal anesthesia (often giving rise to corneal opacities), and bilateral parietal or parieto-occipital alopecia. Our patients had rhombencephalosynapsis and alopecia, but none had trigeminal dysfunction. In this respect, the term cerebellotrigeminal dermal dysplasia is potentially misleading. In conclusion, only rhombencephalosynapsis and alopecia are consistently present in GLHS and are required diagnostic criteria, while trigeminal anesthesia, dysmorphic features, and ataxia are inconsistent findings. A high index of suspicion is required to diagnose GLHS, particularly as alopecia tends to be hidden by surrounding scalp hair.
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Dill P, Poretti A, Boltshauser E, Huisman T. Fetal magnetic resonance imaging in midline malformations of the central nervous system and review of the literature. J Neuroradiol 2009; 36:138-46. [DOI: 10.1016/j.neurad.2008.12.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Rhombencephalosynapsis and related anomalies: a neuropathological study of 40 fetal cases. Acta Neuropathol 2009; 117:185-200. [PMID: 19057916 DOI: 10.1007/s00401-008-0469-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Revised: 11/25/2008] [Accepted: 11/26/2008] [Indexed: 12/12/2022]
Abstract
Rhombencephalosynapsis is an uncommon cerebellar malformation defined by vermian agenesis with fusion of the hemispheres and of the dentate nuclei. Embryologic and genetic mechanisms are still unknown, and to date, no animal models are available. Ultrasound diagnosis is generally suspected after 22 weeks of gestation, and usually the abnormality is suggested by ventriculomegaly. Morphological analysis of 40 fetuses after medical termination of pregnancy allowed us to confirm that rhombencephalosynapsis was always associated with other brain abnormalities or malformations: Purkinje cell heterotopias, fusion of colliculi, forking and/or atresia of the aqueduct and of the third ventricle resulting in a fusion of the thalami, agenesis of the corpus callosum, lobar holoprosencephaly and neural tube defects. Pons and medulla were very infrequently abnormal. Furthermore, complete autopsy made it possible to separate either pure neurologic phenotypes, or associated with extraneural anomalies from syndromic forms: Gomez-Lopez-Hernandez syndrome (1 case) and VACTERL-H syndrome (6 cases). The number of our fetal cases strongly suggests that VACTERL-H association related with rhombencephalosynapsis emerges as a non-random association. Furthermore, recurrence and consanguinity were noted in two different families, which argue for a sporadic or inherited cause. From our results, it could be suggested that rhombencephalosynapsis may be due to defective genes regulating formation of the roof plate and the development of midline cerebellar primordium at the junction of the mesencephalon and of the first rhombomere.
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Fernández-Jaén A, Fernández-Mayoralas DM, Calleja-Pérez B, Muñoz-Jareño N, Moreno N. Gomez-Lopez-Hernandez syndrome: two new cases and review of the literature. Pediatr Neurol 2009; 40:58-62. [PMID: 19068257 DOI: 10.1016/j.pediatrneurol.2008.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Accepted: 09/25/2008] [Indexed: 12/13/2022]
Abstract
Gomez-Lopez-Hernandez syndrome, or cerebellotrigeminal-dermal dysplasia, is a rare neurocutaneous syndrome of trigeminal anesthesia, scalp alopecia and cerebellar anomalies. Other features include craniosynostosis, short stature, hypertelorism, down-slanting palpebral fissures, corneal opacities, mediofacial hypoplasia, and turri-brachycephaly. There have been 19 cases documented to date and we report on two additional male patients, 1 and 6 years of age, with typical features, mild mental retardation and dyspraxia. In both cases, MRI findings included rhombencephalosynapsis, a constant neuroimaging feature in this syndrome, comprising fusion of the cerebellar hemispheres with agenesis of the cerebellar vermis. Based on literature and our experience, we propose the presence of trigeminal anesthesia and/or partial alopecia of the scalp to complete the diagnosis of the syndrome.
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Cognitive outcome in children with rhombencephalosynapsis. Eur J Paediatr Neurol 2009; 13:28-33. [PMID: 18407532 DOI: 10.1016/j.ejpn.2008.02.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Revised: 02/07/2008] [Accepted: 02/10/2008] [Indexed: 11/21/2022]
Abstract
PURPOSE Rhombencephalosynapsis is a rare congenital cerebellar malformation increasingly recognized by prenatal and neonatal neuroimaging. Cognitive outcome seems to be variable but is not well documented. AIMS AND METHODS To study neurological, behavioural, and cognitive functions of patients with non-syndromic rhombencephalosynapsis, five patients (three female and two male, mean age at the time of this study 8.9 years, range 4.3-17.3 years) were assessed by neurological examination and several tests of behaviour and cognitive functions. RESULTS Ataxia was present in all patients, but daily life activities were partly restricted in only one. Other symptoms were muscular hypotonia, abnormal eye movements, and head stereotypies. Three patients had pathological scores on both attention and hyperactivity/impulsivity scales. Only two patients had normal full-scale IQ (IQ value of 109 and 114, respectively). Verbal and/or performance IQ were impaired in three. CONCLUSION In non-syndromic rhombencephalosynapsis the clinical presentation is variable. Attention deficit and hyperactivity disorders are frequent behavioural problems. Cognitive functions are mostly impaired, as mild intellectual impairment without a typical cognitive profile. However, rhombencephalosynapsis is compatible with normal cognitive functions. No definitive correlation between cognitive impairment and additional supratentorial abnormalities could be established.
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Elliott R, Harter DH. Rhombencephalosynapsis associated with autosomal dominant polycystic kidney disease Type 1. J Neurosurg Pediatr 2008; 2:435-7. [PMID: 19035693 DOI: 10.3171/ped.2008.2.12.435] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Rhombencephalosynapsis (RES) is a rare congenital malformation of the cerebellum characterized by hypogenesis or agenesis of the vermis and fusion of the cerebellar hemispheres with or without fusion of the dentate nuclei and superior cerebellar peduncles. No genetic or chromosomal abnormalities have been identified for RES. Although the occurrence of RES is presumed to be sporadic, no clear pattern of inheritance has been identified. The authors report on a 17-year-old girl with autosomal dominant polycystic kidney disease Type 1 as well as RES.
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Affiliation(s)
- Robert Elliott
- Department of Neurosurgery, Division of Pediatric Neurosurgery, New York University Medical Center, New York, New York 10016, USA
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