Central tegmental tract lesion in a girl with holoprosencephaly presenting with West syndrome

Central tegmental tract hyperintensity: follow-up outcomes from a single-center study

PURPOSE

To evaluate the follow-up outcomes of symmetrical central tegmental tract hyperintensity (CTTH) and discuss possible etiological factors involved.

METHODS

Brain MRI scans of 7028 pediatric patients aged 0 to 18 years obtained between July 2015 and May 2020, were reviewed retrospectively for the presence of CTTH. Clinical data of the patients were retrieved from the hospital information system. Patients with follow-up MRI scans were evaluated separately.

RESULTS

A total of 5113 patients meeting the study inclusion criteria were identified in whom the prevalence of CTTH was 4.02% (n = 206). Of the patients with CTTH, 40.3% (n = 83) were girls, and the median age was 19 months (range, 1-108). The most common MRI indication was seizures (40.3%, n = 83), and among those with a definitive diagnosis, epilepsy was the most prevalent etiology (7.8%, n = 16). 40.7% (n = 84) of the patients with CTTH had follow-up MRI scans. CTTH disappeared on follow-up in 28.6% (n = 24) of the patients. The median age at CTTH disappearance was 51.5 months, and the mean (± SD) time to CTTH disappearance was 31.50 (± 19.02) months.

CONCLUSION

CTTH is a radiological finding commonly seen in early childhood but its clinical relevance has not been fully elucidated. While CTTH may be a transient phenomenon representing the maturation process, it may also be associated with a number of clinical conditions. Using a large patient series and follow-up MRI scans, our study shed light on the possible etiological factors of CTTH and its evolution over time.

Central tegmentum tract hyperintensities in pediatric neurological patients: Incidence or coincidence

AIM

The central tegmental tract hyperintensities (CTTH) have been found in many different pediatric neurological conditions. There is only scarce data about the value of this radiological phenomenon. In this study we aimed to show the neurological conditions associated with this radiological finding.

MATERIALS AND METHODS

We performed a retrospective analysis of all pediatric brain MRI's between 2013 and 2015. After finding those patients with CTTH, we evaluated them in the pediatric neurology clinic.

RESULTS

There were 41 out of 1464 brain MRI's with CTTH with 2.8% prevalence. Thirty four patients (23 male, age range 3months-98months) were available for evaluation. CTTH were present in mainly younger age group. There were many different neurological conditions associated with CTTH. These included brain tumors, epilepsy, developmental delay, metabolic disorders and genetic syndromes.

CONCLUSION

CTTH is found in many different pediatric neurological conditions. Further neuropathological and prospective MRI and clinical studies are needed to better understand this interesting radiological finding.

Genoa syndrome and central diabetes insipidus: a case report

Genoa syndrome was first described by Camera et al in 1993 in two patients with semilobar holoprosencephaly (HPE), craniosynostosis and abnormal small hands with cone-shaped epiphyses and hypoplastic terminal phalanges of fingers (OMIM: 601370). In 2001, Lapunzina et al reported a case of craniosynostosis and HPE associated with several other malformations and suggested that these findings could be attributed to a severe form of Genoa syndrome or to a newly recognized syndrome. Endocrinopathies in association with HPE are frequently reported in the literature. Diabetes insipidus, hypothyroidism, hypocortisolism, and growth hormone deficiency are frequently associated with HPE. We here report a case of semilobar HPE, craniosynostosis and cleft lip/palate, possibly a case of Genoa syndrome, associated with central diabetes insipidus.