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Masri A, Al Ryalat N, Hadidy A, Al-Shakkah AA, Ali M, Al Jaberi M, Shihadat R, Rayyan A, AlMasri M, Abunameh L. Enhancing Diagnostic Accuracy Through Neuroimaging Revisions in Pediatric Pseudotumor Cerebri Syndrome: A Cross-Sectional Study. Pediatr Neurol 2024; 154:36-43. [PMID: 38460444 DOI: 10.1016/j.pediatrneurol.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 01/20/2024] [Accepted: 02/13/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND This cross-sectional study aimed to report all neuroimaging findings suggestive of raised intracranial pressure in children with pseudotumor cerebri syndrome (PTCS), before and after re-review by two neuroradiologists. METHODS We included 48 children aged <18 years diagnosed with PTCS between 2016 and 2021. Clinical and radiological data were obtained from their medical files. Two neuroradiologists independently re-reviewed all neuroimages, and the average of their assessments was compared with the initial neuroimaging reports; an additional review was done to analyze inter- and intraclass correlation. RESULTS The initial neuroimaging reports showed under-reporting of findings, with only 26 of 48 (54.1%) patients identified with abnormal reports. After revision, the proportion of the reported findings increased to 44 of 48 (91.6%). Distention of the perioptic space was the most commonly reported finding after revision (36.5 of 48; 76%). Flattening of the posterior globe and empty sella were initially under-reported but improved after revision. Moreover, several findings suggestive of increased intracranial pressure not mandated by Friedman criteria were identified, such as narrowing of the Meckel cave, posterior displacement of the pituitary stalk, and narrowing of the cavernous sinus. Analysis of associations between neuroimaging findings and demographic and clinical characteristics yielded no statistically significant results. The inter- and intraclass correlation results demonstrated a significant agreement between raters and within each rater's assessment (P < 0.05). CONCLUSIONS This study highlights the impact of image revision in enhancing PTCS diagnosis. Intra- and interclass correlations underscore the reliability of the review process, emphasizing the importance of meticulous image analysis in clinical practice.
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Affiliation(s)
- Amira Masri
- Faculty of Medicine, Department of Pediatrics, Division of Child Neurology, The University of Jordan, Amman, Jordan.
| | - Nosaiba Al Ryalat
- Faculty of Medicine, Department of Radiology, The University of Jordan, Amman, Jordan
| | - Azmy Hadidy
- Faculty of Medicine, Department of Radiology, The University of Jordan, Amman, Jordan
| | | | - Majd Ali
- Faculty of Medicine, Depatrment of Pediatrics, The University of Jordan, Amman, Jordan
| | - Mira Al Jaberi
- Faculty of Medicine, Depatrment of Pediatrics, The University of Jordan, Amman, Jordan
| | - Raghad Shihadat
- Faculty of Medicine, Depatrment of Pediatrics, The University of Jordan, Amman, Jordan
| | - Abdallah Rayyan
- Faculty of Medicine, Depatrment of Pediatrics, The University of Jordan, Amman, Jordan
| | - Mohammad AlMasri
- Faculty of Medicine, Depatrment of Pediatrics, The University of Jordan, Amman, Jordan
| | - Lina Abunameh
- Faculty of Medicine, Depatrment of Pediatrics, The University of Jordan, Amman, Jordan
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Brugger M, Lauri A, Zhen Y, Gramegna LL, Zott B, Sekulić N, Fasano G, Kopajtich R, Cordeddu V, Radio FC, Mancini C, Pizzi S, Paradisi G, Zanni G, Vasco G, Carrozzo R, Palombo F, Tonon C, Lodi R, La Morgia C, Arelin M, Blechschmidt C, Finck T, Sørensen V, Kreiser K, Strobl-Wildemann G, Daum H, Michaelson-Cohen R, Ziccardi L, Zampino G, Prokisch H, Abou Jamra R, Fiorini C, Arzberger T, Winkelmann J, Caporali L, Carelli V, Stenmark H, Tartaglia M, Wagner M. Bi-allelic variants in SNF8 cause a disease spectrum ranging from severe developmental and epileptic encephalopathy to syndromic optic atrophy. Am J Hum Genet 2024; 111:594-613. [PMID: 38423010 PMCID: PMC10940020 DOI: 10.1016/j.ajhg.2024.02.005] [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] [Received: 09/13/2023] [Revised: 02/07/2024] [Accepted: 02/07/2024] [Indexed: 03/02/2024] Open
Abstract
The endosomal sorting complex required for transport (ESCRT) machinery is essential for membrane remodeling and autophagy and it comprises three multi-subunit complexes (ESCRT I-III). We report nine individuals from six families presenting with a spectrum of neurodevelopmental/neurodegenerative features caused by bi-allelic variants in SNF8 (GenBank: NM_007241.4), encoding the ESCRT-II subunit SNF8. The phenotypic spectrum included four individuals with severe developmental and epileptic encephalopathy, massive reduction of white matter, hypo-/aplasia of the corpus callosum, neurodevelopmental arrest, and early death. A second cohort shows a milder phenotype with intellectual disability, childhood-onset optic atrophy, or ataxia. All mildly affected individuals shared the same hypomorphic variant, c.304G>A (p.Val102Ile). In patient-derived fibroblasts, bi-allelic SNF8 variants cause loss of ESCRT-II subunits. Snf8 loss of function in zebrafish results in global developmental delay and altered embryo morphology, impaired optic nerve development, and reduced forebrain size. In vivo experiments corroborated the pathogenicity of the tested SNF8 variants and their variable impact on embryo development, validating the observed clinical heterogeneity. Taken together, we conclude that loss of ESCRT-II due to bi-allelic SNF8 variants is associated with a spectrum of neurodevelopmental/neurodegenerative phenotypes mediated likely via impairment of the autophagic flux.
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Affiliation(s)
- Melanie Brugger
- Institute of Human Genetics, Technical University of Munich, Munich, Germany
| | - Antonella Lauri
- Molecular Genetics and Functional Genomics, Ospedale Pediatrico Bambino Gesù, IRCCS, 00146 Rome, Italy
| | - Yan Zhen
- Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | - Laura L Gramegna
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Programma Neuroimmagini Funzionali e Molecolari, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Benedikt Zott
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany; Institute of Neuroscience, Technical University of Munich, Munich, Germany
| | - Nikolina Sekulić
- Centre for Molecular Medicine Norway (NCMM), Nordic EMBL Partnership, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Chemistry, University of Oslo, P.O. Box 1033, Blindern, Norway
| | - Giulia Fasano
- Molecular Genetics and Functional Genomics, Ospedale Pediatrico Bambino Gesù, IRCCS, 00146 Rome, Italy
| | - Robert Kopajtich
- Institute of Human Genetics, Technical University of Munich, Munich, Germany; Institute of Neurogenomics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Viviana Cordeddu
- Dipartimento di Oncologia e Medicina Molecolare, Istituto Superiore di Sanità, Rome, Italy
| | | | - Cecilia Mancini
- Molecular Genetics and Functional Genomics, Ospedale Pediatrico Bambino Gesù, IRCCS, 00146 Rome, Italy
| | - Simone Pizzi
- Molecular Genetics and Functional Genomics, Ospedale Pediatrico Bambino Gesù, IRCCS, 00146 Rome, Italy
| | - Graziamaria Paradisi
- Molecular Genetics and Functional Genomics, Ospedale Pediatrico Bambino Gesù, IRCCS, 00146 Rome, Italy
| | - Ginevra Zanni
- Unit of Muscular and Neurodegenerative Disorders and Unit of Developmental Neurology Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Gessica Vasco
- Department of Neurorehabilitation and Robotics, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Rosalba Carrozzo
- Translational Pediatrics and Clinical Genetics Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Flavia Palombo
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Programma di Neurogenetica, Bologna, Italy
| | - Caterina Tonon
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Programma Neuroimmagini Funzionali e Molecolari, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Raffaele Lodi
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Programma Neuroimmagini Funzionali e Molecolari, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Chiara La Morgia
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy; IRCCS Istituto Delle Scienze Neurologiche di Bologna, Programma di Neurogenetica, Bologna, Italy
| | - Maria Arelin
- Department for Women and Child Health, Hospital for Children and Adolescents, University Hospitals, University of Leipzig, Leipzig, Germany
| | | | - Tom Finck
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Vigdis Sørensen
- Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | - Kornelia Kreiser
- Department of Radiology and Neuroradiology, Rehabilitation and University Hospital Ulm, Ulm, Germany
| | | | - Hagit Daum
- Department of Genetics, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Rachel Michaelson-Cohen
- Department of Gynecology, Shaare Zedek Medical Center, Jerusalem, Israel; Medical Genetics Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | | | - Giuseppe Zampino
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica Sacro Cuore, Rome, Italy
| | - Holger Prokisch
- Institute of Human Genetics, Technical University of Munich, Munich, Germany; Institute of Neurogenomics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Rami Abou Jamra
- Institute of Human Genetics, University Medical Center Leipzig, Leipzig, Germany
| | - Claudio Fiorini
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Programma di Neurogenetica, Bologna, Italy
| | - Thomas Arzberger
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University, Munich, Germany; Center for Neuropathology and Prion Research, University Hospital Munich, Ludwig-Maximilians-University, Munich, Germany
| | - Juliane Winkelmann
- Institute of Human Genetics, Technical University of Munich, Munich, Germany; Institute of Neurogenomics, Helmholtz Zentrum München, Neuherberg, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Leonardo Caporali
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy; IRCCS Istituto Delle Scienze Neurologiche di Bologna, Programma di Neurogenetica, Bologna, Italy
| | - Valerio Carelli
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy; IRCCS Istituto Delle Scienze Neurologiche di Bologna, Programma di Neurogenetica, Bologna, Italy
| | - Harald Stenmark
- Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | - Marco Tartaglia
- Molecular Genetics and Functional Genomics, Ospedale Pediatrico Bambino Gesù, IRCCS, 00146 Rome, Italy.
| | - Matias Wagner
- Institute of Human Genetics, Technical University of Munich, Munich, Germany; Institute of Neurogenomics, Helmholtz Zentrum München, Neuherberg, Germany; Division of Pediatric Neurology, LMU Center for Development and Children with Medical Complexity, Ludwig-Maximilians-University Munich, Munich, Germany.
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Ibarra-Ramírez M, Fernandez-de-Luna ML, Campos-Acevedo LD, Arenas-Estala J, Martínez-de-Villarreal LE, Rodríguez-Garza C, DeLagarza-Pineda O, Mohamed-Noriega J. Optic nerve abnormalities in female-restricted Wieacker-Wolff syndrome by a novel variant in the ZC4H2 gene. Ophthalmic Genet 2023; 44:465-468. [PMID: 37519288 DOI: 10.1080/13816810.2023.2237578] [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: 01/09/2023] [Revised: 07/07/2023] [Accepted: 07/12/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Wieacker-Wolff syndrome is an ultra-rare disease with X-linked inheritance characterized by arthrogryposis, intellectual disability, microcephaly, and distal limb muscle atrophy. Ophthalmic abnormalities such as ptosis, strabismus, and oculomotor apraxia have been reported in half of the patients. Wieacker-Wolff syndrome female-restricted (WRWFFR) is an even rarer disease recently used for females with a more severe phenotype. MATERIALS AND METHODS Clinical geneticist and ophthalmic examination, neuroimaging, and exome sequencing. RESULTS A 4 years-old girl with developmental and language delay, microcephaly, camptodactyly, digital pads, and arthrogryposis was identified by the clinical geneticist. Ophthalmic examination revealed deep-set eyes, high hyperopic astigmatism in both eyes, and reduced retinal nerve fiber layer thickness measured by optical coherence tomography. Exome sequencing identified a novel, probably pathogenic variant in the ZC4H2 gene NM_018684.3:c.145A>T p. (Lys49*) in heterozygosis. DISCUSSION WRWFFR is an ultra-rare disease with X-linked inheritance by variants in the ZC4H2 gene. This case reports a girl with a novel nonsense variant in the ZC4H2 gene and a severe phenotype; previous reports have identified WRWFFR in females with large deletions and nonsense mutations which could explain the manifestations in the current case report. A complete ophthalmic examination should be considered in patients with WRWFFR to detect the possibly associated optic nerve involvement and other previously described manifestations such as ptosis and strabismus.
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Affiliation(s)
- Marisol Ibarra-Ramírez
- Department of Genetics, University Hospital and Faculty of Medicine, Autonomous University of Nuevo Leon (UANL), San Nicolas de los Garza, Mexico
| | - Marissa L Fernandez-de-Luna
- Department of Ophthalmology, University Hospital and Faculty of Medicine, Autonomous University of Nuevo Leon (UANL), San Nicolas de los Garza, Mexico
| | - Luis D Campos-Acevedo
- Department of Genetics, University Hospital and Faculty of Medicine, Autonomous University of Nuevo Leon (UANL), San Nicolas de los Garza, Mexico
| | - Joel Arenas-Estala
- Department of Genetics, University Hospital and Faculty of Medicine, Autonomous University of Nuevo Leon (UANL), San Nicolas de los Garza, Mexico
| | - Laura E Martínez-de-Villarreal
- Department of Genetics, University Hospital and Faculty of Medicine, Autonomous University of Nuevo Leon (UANL), San Nicolas de los Garza, Mexico
| | - Claudia Rodríguez-Garza
- Department of Radiology and Imaging, University Hospital and Faculty of Medicine, Autonomous University of Nuevo Leon (UANL), San Nicolas de los Garza, Mexico
| | - Oscar DeLagarza-Pineda
- Department of Neurology, University Hospital and Faculty of Medicine, Autonomous University of Nuevo Leon (UANL), San Nicolas de los Garza, Mexico
| | - Jibran Mohamed-Noriega
- Department of Ophthalmology, University Hospital and Faculty of Medicine, Autonomous University of Nuevo Leon (UANL), San Nicolas de los Garza, Mexico
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Papandreou A, Soo AKS, Spaull R, Mankad K, Kurian MA, Sudhakar S. Expanding the Spectrum of Early Neuroradiologic Findings in β Propeller Protein-Associated Neurodegeneration. AJNR Am J Neuroradiol 2022; 43:1810-1814. [PMID: 36328404 DOI: 10.3174/ajnr.a7693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/01/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND PURPOSE β propeller protein-associated neurodegeneration (BPAN) is the most common neurodegeneration with brain iron accumulation disorder. Typical radiologic findings are T2 hypointensity in the substantia nigra and globus pallidus, as well as a T1 halolike substantia nigra hyperintense signal surrounding a hypointense central area. However, these findings are often subtle or absent on initial scans, risking diagnostic delay. In this study, we sought to investigate radiologic findings that could aid in the early diagnosis of BPAN. MATERIALS AND METHODS A retrospective cohort study was performed in a national referral center, including all pediatric patients with confirmed pathogenic WDR45 mutations and consistent clinical semiology. MR imaging findings were independently reported by 2 pediatric neuroradiologists. RESULTS Fifteen patients were included in the study, and 27 scans were available for review. The initial neuroimaging study was undertaken at a mean age of 3.2 years. Iron deposition was uncommon in patients younger than 4 years of age. Neuroradiologic features from very early on included dentate, globus pallidus, and substantia nigra swelling, as well as a thin corpus callosum and small pontine volume. Optic nerve thinning was also present in all patients. CONCLUSIONS Our study highlights the key early MR imaging features of BPAN. Iron deposition in the globus pallidus and substantia nigra is not common in children younger than 4 years of age; clinicians should not be deterred from suspecting BPAN in the presence of the findings described in this study and the appropriate clinical context.
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Affiliation(s)
- A Papandreou
- From the Molecular Neurosciences (A.P., A.K.S.S., R.S., M.A.K.), Developmental Neurosciences Programme, Zayed Centre for Research into Rare Disease in Children, University College London Great Ormond Street Institute of Child Health, London, UK .,Departments of Neurology (A.P., A.K.S.S., R.S., M.A.K.)
| | - A K S Soo
- From the Molecular Neurosciences (A.P., A.K.S.S., R.S., M.A.K.), Developmental Neurosciences Programme, Zayed Centre for Research into Rare Disease in Children, University College London Great Ormond Street Institute of Child Health, London, UK.,Departments of Neurology (A.P., A.K.S.S., R.S., M.A.K.)
| | - R Spaull
- From the Molecular Neurosciences (A.P., A.K.S.S., R.S., M.A.K.), Developmental Neurosciences Programme, Zayed Centre for Research into Rare Disease in Children, University College London Great Ormond Street Institute of Child Health, London, UK.,Departments of Neurology (A.P., A.K.S.S., R.S., M.A.K.)
| | - K Mankad
- Neuroradiology (K.M., S.S.), Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, UK
| | - M A Kurian
- From the Molecular Neurosciences (A.P., A.K.S.S., R.S., M.A.K.), Developmental Neurosciences Programme, Zayed Centre for Research into Rare Disease in Children, University College London Great Ormond Street Institute of Child Health, London, UK.,Departments of Neurology (A.P., A.K.S.S., R.S., M.A.K.)
| | - S Sudhakar
- Neuroradiology (K.M., S.S.), Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, UK
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Tosun M, Güngör M, Uslu H, Anık Y. Evaluation of optic nerve diameters in individuals with neurofibromatosis and comparison of normative values in different pediatric age groups. Clin Imaging 2022; 85:83-88. [DOI: 10.1016/j.clinimag.2022.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/11/2022] [Accepted: 02/20/2022] [Indexed: 11/24/2022]
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6
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Barboni P, Amore G, Cascavilla ML, Battista M, Frontino G, Romagnoli M, Caporali L, Baldoli C, Gramegna LL, Sessagesimi E, Bonfanti R, Romagnoli A, Scotti R, Brambati M, Carbonelli M, Starace V, Fiorini C, Panebianco R, Parisi V, Tonon C, Bandello F, Carelli V, La Morgia C. The pattern of retinal ganglion cell loss in Wolfram syndrome is distinct from mitochondrial optic neuropathies. Am J Ophthalmol 2022; 241:206-216. [PMID: 35452662 DOI: 10.1016/j.ajo.2022.03.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 03/13/2022] [Accepted: 03/16/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE To describe the clinical phenotype of a cohort of Wolfram syndrome (WS) patients, focusing on the pattern of optic atrophy correlated with brain MRI measurements, as compared to OPA1-associated mitochondrial optic neuropathy. DESIGN Retrospective, comparative cohort study METHODS: 25 WS patients and 33 age-matched patients affected by OPA1-related Dominant Optic Atrophy (DOA). Ophthalmological, neurological, endocrinological and MRI data from WS patients were retrospectively retrieved. Ophthalmological data were compared to OPA1-related DOA and further analyzed for age dependency dividing patients in age quartiles. In a subgroup of WS patients, we correlated the structural damage assessed by optical coherence tomography (OCT) with brain MRI morphological measurements. Visual acuity (VA), visual field mean defect (MD), retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) thickness assessed by OCT, MRI morphological measurements of anterior and posterior visual pathways. RESULTS In our cohort optic atrophy was present in 100% of WS patients. VA, MD and RNFL thickness loss were worse in WS patients with a faster decline since early age as compared to DOA patients, who displayed a more stable visual function over the years. Conversely, GCL sectors were overall thinner in DOA patients since early age compared to WS, in which GCL thickness started to decline later in life. The neuroradiological sub-analysis on 11 WS patients exhibited bilateral thinning of the anterior optic pathway, especially prechiasmatic optic nerves and optic tracts. Optic tract thinning was significantly correlated with the GCL thickness but not with RNFL parameters. CONCLUSIONS Our results showed a generally more severe and diffuse degeneration of both anterior and posterior visual pathways in WS, with fast deterioration of visual function and structural OCT parameters since early age. The pattern observed at OCT suggests that retinal ganglion cells axonal degeneration (i.e. RNFL) precedes of about a decade the cellular body atrophy (i.e. GCL). This differs substantially from DOA, in which a more stable visual function is evident with predominant early loss of GCL, indirectly supporting the lack of a primary mitochondrial dysfunction in WS.
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Affiliation(s)
- Piero Barboni
- From the Department of Ophthalmology (P.B., M.L.C., M.Ba., M.Br., V.S., F.B.), University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy; Studio Oculistico d'Azeglio (P.B.), Bologna, Italy.
| | - Giulia Amore
- Dipartimento di Scienze Biomediche e Neuromotorie (G.A., L.L.G., E.S., M.C., C.T., V.C.), Università di Bologna, Bologna, Italy
| | - Maria Lucia Cascavilla
- From the Department of Ophthalmology (P.B., M.L.C., M.Ba., M.Br., V.S., F.B.), University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Marco Battista
- From the Department of Ophthalmology (P.B., M.L.C., M.Ba., M.Br., V.S., F.B.), University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giulio Frontino
- Department of Pediatrics (G.F., R.B., A.R.), IRCCS San Raffaele Hospital, Milan, Italy; Diabetes Research Institute (G.F., R.B., A.R.), IRCCS San Raffaele Hospital, Milan, Italy
| | - Martina Romagnoli
- IRCCS Istituto delle Scienze Neurologiche di Bologna (M.R., L.C., C.F., V.C., C.L.M.), Programma di Neurogenetica, Bologna, Italy
| | - Leonardo Caporali
- IRCCS Istituto delle Scienze Neurologiche di Bologna (M.R., L.C., C.F., V.C., C.L.M.), Programma di Neurogenetica, Bologna, Italy
| | - Cristina Baldoli
- Neuroradiology Unit (C.B., R.S.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Laura Ludovica Gramegna
- Dipartimento di Scienze Biomediche e Neuromotorie (G.A., L.L.G., E.S., M.C., C.T., V.C.), Università di Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.L.G., E.S., C.T.), Functional and Molecular Neuroimaging Unit, Bologna, Italy
| | - Elisa Sessagesimi
- Dipartimento di Scienze Biomediche e Neuromotorie (G.A., L.L.G., E.S., M.C., C.T., V.C.), Università di Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.L.G., E.S., C.T.), Functional and Molecular Neuroimaging Unit, Bologna, Italy
| | - Riccardo Bonfanti
- Department of Pediatrics (G.F., R.B., A.R.), IRCCS San Raffaele Hospital, Milan, Italy; Diabetes Research Institute (G.F., R.B., A.R.), IRCCS San Raffaele Hospital, Milan, Italy
| | - Andrea Romagnoli
- Department of Pediatrics (G.F., R.B., A.R.), IRCCS San Raffaele Hospital, Milan, Italy; Diabetes Research Institute (G.F., R.B., A.R.), IRCCS San Raffaele Hospital, Milan, Italy
| | - Roberta Scotti
- Neuroradiology Unit (C.B., R.S.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Brambati
- From the Department of Ophthalmology (P.B., M.L.C., M.Ba., M.Br., V.S., F.B.), University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Michele Carbonelli
- Dipartimento di Scienze Biomediche e Neuromotorie (G.A., L.L.G., E.S., M.C., C.T., V.C.), Università di Bologna, Bologna, Italy
| | - Vincenzo Starace
- From the Department of Ophthalmology (P.B., M.L.C., M.Ba., M.Br., V.S., F.B.), University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Claudio Fiorini
- IRCCS Istituto delle Scienze Neurologiche di Bologna (M.R., L.C., C.F., V.C., C.L.M.), Programma di Neurogenetica, Bologna, Italy
| | - Roberta Panebianco
- Department of Ophthalmology (R.P.), University of Catania, Catania, Italy
| | | | - Caterina Tonon
- Dipartimento di Scienze Biomediche e Neuromotorie (G.A., L.L.G., E.S., M.C., C.T., V.C.), Università di Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.L.G., E.S., C.T.), Functional and Molecular Neuroimaging Unit, Bologna, Italy
| | - Francesco Bandello
- From the Department of Ophthalmology (P.B., M.L.C., M.Ba., M.Br., V.S., F.B.), University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Valerio Carelli
- Dipartimento di Scienze Biomediche e Neuromotorie (G.A., L.L.G., E.S., M.C., C.T., V.C.), Università di Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna (M.R., L.C., C.F., V.C., C.L.M.), Programma di Neurogenetica, Bologna, Italy
| | - Chiara La Morgia
- IRCCS Istituto delle Scienze Neurologiche di Bologna (M.R., L.C., C.F., V.C., C.L.M.), Programma di Neurogenetica, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna (C.L.M.), UOC Clinica Neurologica, Bologna, Italy
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Optical Coherence Tomography Identifies Visual Pathway Involvement Earlier than Visual Function Tests in Children with MRI-Verified Optic Pathway Gliomas. Cancers (Basel) 2022; 14:cancers14020318. [PMID: 35053482 PMCID: PMC8774215 DOI: 10.3390/cancers14020318] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/02/2022] [Accepted: 01/04/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary Retrograde degeneration of the eye’s retinal ganglion cells, causing visual loss and even blindness, is a feared consequence of optic pathway gliomas. Optical coherence tomography (OCT) is a patient-friendly, high-resolution imaging technique enabling objective measurements of the integrity of the retinal ganglion cell layer. Children with optic pathway glioma unable to complete formal visual field testing and/or reliable visual acuity testing, may undergo OCT, providing objective information about visual loss and potential clinical progression. By combining visual functional measurements with OCT findings, the clinical examination will be safer and more reliable. By improving the clinical follow-up of the tumor, the treatment choices can be optimized thereby preventing further visual loss and, in the worst case, blindness. Abstract This study investigates whether optical coherence tomography (OCT) could add useful information in the examination of children with optic pathway glioma (OPG) at high risk of developing vision loss. For this purpose, the relationship between ganglion cell-inner plexiform layer (GC-IPL) thickness and visual function, evaluated with tests of visual acuity (VA) and visual field (VF), as well as tumor site according to magnetic resonance imaging (MRI), were examined in a geographically defined group of children with OPG. Methods: Children aged <18 years with OPG underwent ophthalmic examination including VA, VF (Zeiss HFA perimetry) and OCT imaging (Zeiss Cirrus HD-OCT). Results: Out of 51 patients included, 45 provided 77 eyes with MRI-verified OPG, and 19 patients provided 25 eyes without OPG. Significant correlations were found between GC-IPL, VF and VA (p < 0.001). The GC-IPL pattern loss corresponded in 95% to VF defects and in 92% to MRI findings. Conclusions: Our study indicates that GC-IPL measures could serve as an early marker of vision-threatening changes related to OPG and as a valuable link between MRI and visual function tests. Thinning of GC-IPL and differences in topography between eyes are strong indicators of and predictive of vision loss related to OPG.
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Swain CE, Cherubini GB, Mantis P. Low Field MRI Measurements of the Normal Canine Trigeminal Nerve. Front Vet Sci 2020; 7:274. [PMID: 32509809 PMCID: PMC7249853 DOI: 10.3389/fvets.2020.00274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 04/23/2020] [Indexed: 11/13/2022] Open
Abstract
There is no available measuring protocol and reference range for the normal canine trigeminal nerve. This can be problematic in cases of suspected bilateral trigeminal neuropathy since contralateral nerves cannot be a usefully compared. Trigeminal nerves and brain measurements were retrospectively assessed via multiplanar reconstruction (MPR) of 3DT1 post-contrast MR sequences from 137 dogs with no signs or diagnosis of trigeminal disease. Direct measurements of vertical brain height (BH), trigeminal nerves transverse height (TTH) and trigeminal nerves width in dorsal reconstruction (TDW) were made in a plane immediately caudal to the foramen ovale and used to derive trigeminal nerve-to-brain (NB) ratios, including height-to-brain ratio (HBR) and width-to-brain ratio (WBR). HBR (0.09, IQR = 0.08-0.09) and WBR (0.10, IQR = 0.09-0.11) maintained more consistent values across the study population compared to direct measurements of TTH (3.72, IQR = 3.42-4.07) and TDW (4.35 +/− 0.63). Calculated normal reference intervals for HBR and WBR were 0.07-0.11 and 0.08-0.13, respectively and the largest NB ratios recorded in normal dogs were 0.13 and 0.14 for HBR and WBR, respectively. All measurements varied proportionally with weight, including HBR (r = 0.41, p < 0.0001) and small dogs had a significantly smaller HBRs compared to medium (p = 0.0294), large (p < 0.0049) and giant dogs (p < 0.0044). Median HBR was the same across skull types (0.09), however post-hoc analysis detected significantly smaller HBRs in brachycephalic compared to mesaticephalic dogs (p = 0.0494). In conclusion, trigeminal NB ratios may allow for accurate, objective assessment of the canine trigeminal nerves on MRI but further quantification of the effects of weight and skull type on suggested reference intervals is needed.
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The Evaluation of Optic Nerves Using 7 Tesla "Silent" Zero Echo Time Imaging in Patients with Leber's Hereditary Optic Neuropathy with or without Idebenone Treatment. J Clin Med 2020; 9:jcm9041112. [PMID: 32295018 PMCID: PMC7230870 DOI: 10.3390/jcm9041112] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 11/16/2022] Open
Abstract
Magnetic Resonance Imaging (MRI) of the Optic Nerve is difficult due to the fine extended nature of the structure, strong local magnetic field distortions induced by anatomy, and large motion artefacts associated with eye movement. To address these problems we used a Zero Echo Time (ZTE) MRI sequence with an Adiabatic SPectral Inversion Recovery (ASPIR) fat suppression pulse which also imbues the images with Magnetisation Transfer contrast. We investigated an application of the sequence for imaging the optic nerve in subjects with Leber's hereditary optic neuropathy (LHON). Of particular note is the sequence's near-silent operation, which can enhance image quality of the optic nerve by reducing the occurrence of involuntary saccades induced during Magnetic Resonance (MR) scanning.
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Mncube SS, Goodier MD. Normal measurements of the optic nerve, optic nerve sheath and optic chiasm in the adult population. SA J Radiol 2019; 23:1772. [PMID: 31754545 PMCID: PMC6851876 DOI: 10.4102/sajr.v23i1.1772] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 08/29/2019] [Indexed: 11/13/2022] Open
Abstract
Background Imaging assessment of the anterior visual pathway structures, particularly the optic nerves (ON), requires knowledge of normal dimensions. Several studies suggesting techniques and normal ranges have been performed, but most suffer from various methodological flaws. This study is the first to be performed in a South African population. Objectives The aim of this study was to establish normal measurements of the ON, optic nerve sheath (ONS) and optic chiasm (OC) on magnetic resonance imaging (MRI). Method Eighty normal adults between ages of 12 and 65 years were included in this prospective, quantitative, observational, descriptive study to establish normal measurement of the ON, ONS and OC using a T2W 3D MRI sequence. Measurements (width and height) were undertaken by two observers independently. Results A total of 80 participants with a mean age of 35 years were studied: 49 females (61.25%) and 31 males (38.75%). There were no statistical differences in the measurements between gender and age correlation. Interobserver agreement was best for larger structures, that is, OC width and intracranial ON width, respectively. The overall mean of OC width was 13.63 mm (range: 11.13 mm–16.92 mm, standard deviation [s.d.] 1.21); intraorbital ON height at 5 mm behind the globe 2.29 mm (range: 1.63 mm–3.33 mm, s.d. 0.43), and intracranial ON width 4.27 mm (range: 2.46 mm–5.19 mm, s.d. 0.53). Conclusion Normal measurements of the anterior visual pathway structures on MRI are best reflected in the larger structures. Interobserver variability was poor for the orbital ON, ONS, intracranial ON height and OC height. We recommend that measurements be obtained for the OC width and intracranial ON width. The overall mean for the OC width is 13.63 mm and intracranial ON width 4.27 mm.
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Affiliation(s)
- Sanele S Mncube
- Greys Hospital, Radiology Department, College of Health Sciences, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Matthew D Goodier
- Greys Hospital, Radiology Department, College of Health Sciences, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Pietermaritzburg, South Africa
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Magnetic Resonance Imaging Findings in Pediatric Pseudotumor Cerebri Syndrome. Pediatr Neurol 2019; 99:31-39. [PMID: 31303369 PMCID: PMC6890473 DOI: 10.1016/j.pediatrneurol.2019.04.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/13/2019] [Accepted: 04/18/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Revised diagnostic criteria for pseudotumor cerebri syndrome require three of four neuroimaging findings in the absence of papilledema. We examined the sensitivity and specificity of three or more of four of these magnetic resonance imaging (MRI) findings for pseudotumor cerebri syndrome in children. METHODS As part of clinical care, patients in whom there was suspicion for pseudotumor cerebri syndrome underwent neurological and fundoscopic examinations, lumbar puncture, MRI, or magnetic resonance venogram. For this retrospective study, we used this information to classify 119 subjects into definite (n = 66) or probable pseudotumor cerebri syndrome (n = 12), elevated opening pressure without papilledema (n = 23), or controls who had normal opening pressure without papilledema (n = 24). A neuroradiologist, unaware of the clinical findings or original MRI report, reviewed MRIs for pituitary gland flattening, flattening of the posterior sclera, optic nerve sheath distention, and transverse venous sinus stenosis. RESULTS The presence of three or more MRI findings has a sensitivity of 62% (95% confidence interval: 47% to 75%) and a specificity of 95% (95% confidence interval: 77% to 100%), compared with controls. Two of three (transverse venous sinus stenosis, pituitary gland flattening, flattening of the posterior sclera) had a similar sensitivity and specificity. Transverse venous sinus stenosis alone had a slightly higher sensitivity (74%, 95% confidence interval: 60% to 85%) and specificity (100%, 95% confidence interval: 80% to 100%). CONCLUSIONS In children, three of four of the proposed neuroimaging criteria and transverse venous sinus stenosis alone have a moderate sensitivity and robust specificity for pseudotumor cerebri syndrome. MRIs should be reviewed for these criteria, and their presence should raise suspicion for pseudotumor cerebri syndrome in children, particularly if the presence of papilledema is uncertain.
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Muthusamy K, Sudhakar SV, Thomas M, Yoganathan S, Christudass CS, Chandran M, Panwala H, Gibikote S. Revisiting magnetic resonance imaging pattern of Krabbe disease - Lessons from an Indian cohort. J Clin Imaging Sci 2019; 9:25. [PMID: 31448176 PMCID: PMC6702867 DOI: 10.25259/jcis-18-2019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 02/21/2019] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Krabbe disease shows considerable heterogeneity in clinical features and disease progression. Imaging phenotypes are equally heterogeneous but show distinct age-based patterns. It is important for radiologists to be familiar with the imaging spectrum to substantially contribute toward early diagnosis, prognostication, and therapeutic decisions. AIMS The study aims to describe different magnetic resonance imaging (MRI) patterns observed in a cohort of children with Krabbe disease and to assess correlation with age-based clinical phenotypes. MATERIALS AND METHODS This is a retrospective descriptive study done at the Departments of Radiodiagnosis and Neurological Sciences of our institution, a tertiary care hospital in Southern India. Imaging features of children diagnosed with Krabbe disease over a 10-year period (2009-2018) were collected and analyzed. RESULTS A total of 38 MRI brain studies from 27 patients were analyzed. Four distinct MRI patterns were recognizable among the different clinical subtypes. All patients from the early and late infantile group showed deep cerebral and cerebellar white matter and dentate hilum involvement. Optic nerve thickening was, however, more common in the former group. Adult-onset subtype showed isolated involvement of corticospinal tract, posterior periventricular white matter, and callosal splenium with the absence of other supra- and infra-tentorial findings. Juvenile subgroup showed heterogeneous mixed pattern with 78% showing adult subtype pattern and 22% showing patchy involvement of deep cerebral white matter with dentate hilum signal changes. CONCLUSION Krabbe disease shows distinct imaging features which correspond to different clinical age-based subtypes. This article reemphasizes these distinct imaging phenotypes, highlights a novel imaging appearance in juvenile Krabbe, and also alludes to the rare variant of saposin deficiency. Awareness of these patterns is essential in suggesting the appropriate diagnosis and guiding conclusive diagnostic workup. Large multicenter longitudinal studies are needed to further define the role of imaging in predicting the clinical course and thus to guide therapeutic options.
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Affiliation(s)
- Karthik Muthusamy
- Departments of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sniya Valsa Sudhakar
- Departments of Radiodiagnosis, Christian Medical College, Vellore, Tamil Nadu, India
| | - Maya Thomas
- Departments of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sangeetha Yoganathan
- Departments of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Mahalakshmi Chandran
- Departments of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Hirenkumar Panwala
- Departments of Radiodiagnosis, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sridhar Gibikote
- Departments of Radiodiagnosis, Christian Medical College, Vellore, Tamil Nadu, India
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Lecler A, Savatovsky J, Lamirel C. Increasing the Accuracy of Optic Nerve Measurement Using 3D Volumetry. AJNR Am J Neuroradiol 2018; 39:E80. [PMID: 29650779 DOI: 10.3174/ajnr.a5625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | | | - C Lamirel
- Department of Ophthalmology Fondation Ophtalmologique Adolphe de Rothschild Paris, France
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