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Vernon LE, Gano D, Pardo AC. Fetal stroke- etiopathogenesis affecting the maternal-placental-fetal triad and neonate. Semin Fetal Neonatal Med 2024; 29:101527. [PMID: 38679532 DOI: 10.1016/j.siny.2024.101527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Affiliation(s)
- Laura E Vernon
- Department of Pediatrics, Northwestern Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Division of Neurology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Dawn Gano
- Department of Neurology and Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Andrea C Pardo
- Department of Pediatrics, Northwestern Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Division of Neurology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
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Ilves N, Pajusalu S, Kahre T, Laugesaar R, Šamarina U, Loorits D, Kool P, Ilves P. High Prevalence of Collagenopathies in Preterm- and Term-Born Children With Periventricular Venous Hemorrhagic Infarction. J Child Neurol 2023; 38:373-388. [PMID: 37427422 PMCID: PMC10467006 DOI: 10.1177/08830738231186233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/12/2023] [Accepted: 06/16/2023] [Indexed: 07/11/2023]
Abstract
INTRODUCTION The aim of this study was to evaluate genetic risk factors in term-born children with antenatal periventricular hemorrhagic infarction (PVHI), presumed antenatal periventricular venous infarction and periventricular hemorrhagic infarction in preterm neonates. METHODS Genetic analysis and magnetic resonance imaging were performed in 85 children: term-born children (≥36 gestational weeks) with antenatal periventricular hemorrhagic infarction (n = 6) or presumed antenatal (n = 40) periventricular venous infarction and preterm children (<36 gestational weeks) with periventricular hemorrhagic infarction (n = 39). Genetic testing was performed using exome or large gene panel (n = 6700 genes) sequencing. RESULTS Pathogenic variants associated with stroke were found in 11 of 85 (12.9%) children with periventricular hemorrhagic infarction/periventricular venous infarction. Among the pathogenic variants, COL4A1/A2 and COL5A1 variants were found in 7 of 11 (63%) children. Additionally, 2 children had pathogenic variants associated with coagulopathy, whereas 2 other children had other variants associated with stroke. Children with collagenopathies had significantly more often bilateral multifocal stroke with severe white matter loss and diffuse hyperintensities in the white matter, moderate to severe hydrocephalus, moderate to severe decrease in size of the ipsilesional basal ganglia and thalamus compared to children with periventricular hemorrhagic infarction/periventricular venous infarction without genetic changes in the studied genes (P ≤ .01). Severe motor deficit and epilepsy developed more often in children with collagenopathies compared to children without genetic variants (P = .0013, odds ratio [OR] = 233, 95% confidence interval [CI]: 2.8-531; and P = .025, OR = 7.3, 95% CI: 1.3-41, respectively). CONCLUSIONS Children with periventricular hemorrhagic infarction/periventricular venous infarction have high prevalence of pathogenic variants in collagene genes (COL4A1/A2 and COL5A1). Genetic testing should be considered for all children with periventricular hemorrhagic infarction/periventricular venous infarction; COL4A1/A2 and COL5A1/A2 genes should be investigated first.
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Affiliation(s)
- Norman Ilves
- Radiology Clinic of Tartu University Hospital; Department of Radiology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Sander Pajusalu
- Department of Laboratory Genetics, Genetics and Personalized Medicine Clinic, Tartu University Hospital, Tartu, Estonia
- Department of Genetics, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Tiina Kahre
- Department of Laboratory Genetics, Genetics and Personalized Medicine Clinic, Tartu University Hospital, Tartu, Estonia
- Department of Genetics, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Rael Laugesaar
- Children's Clinic of Tartu University Hospital; Department of Pediatrics, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Ustina Šamarina
- Genetics and Personalized Medicine Clinic of Tartu University Hospital, Tartu, Estonia
| | - Dagmar Loorits
- Department of Radiology, Radiology Clinic of Tartu University Hospital, Tartu, Estonia
| | - Pille Kool
- Department of Radiology, Radiology Clinic of Tartu University Hospital, Tartu, Estonia
| | - Pilvi Ilves
- Radiology Clinic of Tartu University Hospital; Department of Radiology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
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Lian BX, Ng NBH, Wang F, Nga VDW, Tan AP, Lin J. Diagnosis of hydrocephalus by cranial transillumination. Arch Dis Child Fetal Neonatal Ed 2022; 107:550. [PMID: 34261768 DOI: 10.1136/archdischild-2021-322430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/30/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Berenice Xueli Lian
- Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore
| | - Nicholas Beng Hui Ng
- Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore
| | - Furene Wang
- Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore
| | - Vincent D W Nga
- Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore
| | - Ai Peng Tan
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - Jeremy Lin
- Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore
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Gubana F, Christov C, Coste T, Tournier-Lasserve E, Benachi A, Fallet-Bianco C, Encha-Razavi F, Martinovic J. Prenatal Diagnosis of COL4A1 Mutations in Eight Cases: Further Delineation of the Neurohistopathological Phenotype. Pediatr Dev Pathol 2022; 25:435-446. [PMID: 35382634 DOI: 10.1177/10935266221080134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Increasing number of mutations responsible for vascular lesions, leading to ischemic or hemorrhagic stroke in young adults, has been identified in the recent years. It has been demonstrated in both mice and humans, that mutations in COL4A1 gene promote cerebral hemorrhages. In humans, both adults and children may be affected, and the spectrum has been broadened recently to neonates and fetuses. METHODS We present a cohort of eight COL4A1 mutated fetuses in which cerebral hemorrhages were detected by ultrasound leading to elective terminations of pregnancy. RESULTS Our neuropathological studies demonstrated a strikingly similar pathological pattern, dominated by supra- and infratentorial multifocal hemorrhagic lesions of various abundance and age in the vicinity of enlarged small vessels having a discontinuous wall. This was constantly associated with a spectrum of supratentorial post-ischemic damages of the grey and white matters. Morphometric studies of brain vessels confirmed vascular dilation and hypervascularization in both grey and white matters and severe attenuation of the smooth-muscle actin staining in the white matter. CONCLUSION These observations add to the rare human neuropathological phenotype of COL4A1 mutations. Its recognition is mandatory to enhance the number of tested patients in the future, as well as the genetic counseling of parents.
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Affiliation(s)
- Francesca Gubana
- Unit of Embryo-Fetal Pathology, AP-HP, 36895Antoine Béclère Hospital, Clamart, France.,Department of Obstetrics and Gynecology, AP-HP, 36895Antoine Béclère Hospital, Paris Saclay University, Clamart, France
| | - Christo Christov
- Department of Histology, CHRU, 571075INSERM U1256, NGERE, Nancy, France
| | - Thibault Coste
- Department of Neurovascular Genetics, AP-HP, 571075St Louis Hospital, Paris, France
| | | | - Alexandra Benachi
- Department of Obstetrics and Gynecology, AP-HP, 36895Antoine Béclère Hospital, Paris Saclay University, Clamart, France
| | | | - Ferechte Encha-Razavi
- Unit of Embryo-Fetal Pathology, AP-HP, 36895Antoine Béclère Hospital, Clamart, France
| | - Jelena Martinovic
- Unit of Embryo-Fetal Pathology, AP-HP, 36895Antoine Béclère Hospital, Clamart, France
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Congenital Brain Malformations: An Integrated Diagnostic Approach. Semin Pediatr Neurol 2022; 42:100973. [PMID: 35868725 DOI: 10.1016/j.spen.2022.100973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 11/24/2022]
Abstract
Congenital brain malformations are abnormalities present at birth that can result from developmental disruptions at various embryonic or fetal stages. The clinical presentation is nonspecific and can include developmental delay, hypotonia, and/or epilepsy. An informed combination of imaging and genetic testing enables early and accurate diagnosis and management planning. In this article, we provide a streamlined approach to radiologic phenotyping and genetic evaluation of brain malformations. We will review the clinical workflow for brain imaging and genetic testing with up-to-date ontologies and literature references. The organization of this article introduces a streamlined approach for imaging-based etiologic classification into malformative, destructive, and migrational abnormalities. Specific radiologic ontologies are then discussed in detail, with correlation of key neuroimaging features to embryology and molecular pathogenesis.
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Sheehan L, Bichianu D, Obi O, Mazuru-Witten D. Newborn with a Large Intracranial Mass. Neoreviews 2022; 23:e136-e140. [PMID: 35102387 DOI: 10.1542/neo.23-2-e136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Lucy Sheehan
- University of Missouri School of Medicine, Columbia, MO
| | - Dana Bichianu
- Division of Neonatal Medicine, Department of Child Health, University of Missouri School of Medicine, Columbia, MO
| | - Olugbemisola Obi
- Division of Neonatal Medicine, Department of Child Health, University of Missouri School of Medicine, Columbia, MO
| | - Dana Mazuru-Witten
- Division of Pediatric Radiology, Department of Child Health, University of Missouri School of Medicine, Columbia, MO
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Deletion in COL4A2 is associated with a three-generation variable phenotype: from fetal to adult manifestations. Eur J Hum Genet 2021; 29:1654-1662. [PMID: 33837277 DOI: 10.1038/s41431-021-00880-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 02/04/2021] [Accepted: 03/23/2021] [Indexed: 11/08/2022] Open
Abstract
Genetic alterations in COL4A2 are less common than those of COL4A1 and their fetal phenotype has not been described to date. We describe a three-generation family with an intragenic deletion in COL4A2 associated with a prenatal diagnosis of recurrent fetal intracerebral hemorrhage (ICH), and a myriad of cerebrovascular manifestations. Exome sequencing, co-segregation analysis, and imaging studies were conducted on eight family members including two fetuses with antenatal ICH. Histopathological evaluation was performed on the terminated fetuses. An intragenic heterozygous pathogenic in-frame deletion; COL4A2, c.4151_4168del, (p.Thr1384_Gly1389del) was identified in both fetuses, their father with hemiplegic cerebral palsy (CP), as well as other family members. Postmortem histopathological examination identified microscopic foci of heterotopias and polymicrogyria. The variant segregated in affected individuals demonstrating varying degrees of penetrance and a wide phenotypic spectrum including periventricular venous hemorrhagic infarction causing hemiplegic CP, polymicrogyria, leukoencephalopathy, and lacunar stroke. We present radiographic, pathological, and genetic evidence of prenatal ICH and show, for what we believe to be the first time, a human pathological proof of polymicrogyria and heterotopias in association with a COL4A2 disease-causing variant, while illustrating the variable phenotype and partial penetrance of this disease. We highlight the importance of genetic analysis in fetal ICH and hemiplegic CP.
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AIUM Practice Parameter for the Performance of Neurosonography in Neonates and Infants. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:E57-E61. [PMID: 32162340 DOI: 10.1002/jum.15264] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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D'Adesky N, Ghosh S. Phentermine Use During First and Second Trimesters Associated with Fetal Stroke. Cureus 2019; 11:e6170. [PMID: 31890378 PMCID: PMC6913971 DOI: 10.7759/cureus.6170] [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] [Indexed: 11/05/2022] Open
Abstract
Phentermine is a sympathomimetic amine used for the short-term weight loss that has been associated with ischemic and hemorrhagic strokes in adults. The effects of this medication on a developing fetus are not well studied. We present the case of a woman who was taking phentermine during the first two trimesters of pregnancy and subsequently delivered a child with bilateral porencephalic cysts likely due to a prenatal stroke.
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Affiliation(s)
- Nathan D'Adesky
- Neurology, University of Florida College of Medicine, Gainesville, USA
| | - Suman Ghosh
- Pediatric Neurology, University of Florida College of Medicine, Gainesville, USA
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Cavallin M, Mine M, Philbert M, Boddaert N, Lepage JM, Coste T, Lopez-Gonzalez V, Sanchez-Soler MJ, Ballesta-Martínez MJ, Remerand G, Pasquier L, Guët A, Chelly J, Lascelles K, Prieto-Morin C, Kossorotoff M, Tournier Lasserve E, Bahi-Buisson N. Further refinement of COL4A1 and COL4A2 related cortical malformations. Eur J Med Genet 2018; 61:765-772. [DOI: 10.1016/j.ejmg.2018.10.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 09/27/2018] [Accepted: 10/07/2018] [Indexed: 01/01/2023]
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Kirkham FJ, Zafeiriou D, Howe D, Czarpran P, Harris A, Gunny R, Vollmer B. Fetal stroke and cerebrovascular disease: Advances in understanding from lenticulostriate and venous imaging, alloimmune thrombocytopaenia and monochorionic twins. Eur J Paediatr Neurol 2018; 22:989-1005. [PMID: 30467085 DOI: 10.1016/j.ejpn.2018.08.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 08/28/2018] [Accepted: 08/29/2018] [Indexed: 12/17/2022]
Abstract
Fetal stroke is an important cause of cerebral palsy but is difficult to diagnose unless imaging is undertaken in pregnancies at risk because of known maternal or fetal disorders. Fetal ultrasound or magnetic resonance imaging may show haemorrhage or ischaemic lesions including multicystic encephalomalacia and focal porencephaly. Serial imaging has shown the development of malformations including schizencephaly and polymicrogyra after ischaemic and haemorrhagic stroke. Recognised causes of haemorrhagic fetal stroke include alloimmune and autoimmune thrombocytopaenia, maternal and fetal clotting disorders and trauma but these are relatively rare. It is likely that a significant proportion of periventricular and intraventricular haemorrhages are of venous origin. Recent evidence highlights the importance of arterial endothelial dysfunction, rather than thrombocytopaenia, in the intraparenchymal haemorrhage of alloimmune thrombocytopaenia. In the context of placental anastomoses, monochorionic diamniotic twins are at risk of twin twin transfusion syndrome (TTTS), or partial forms including Twin Oligohydramnios Polyhydramnios Sequence (TOPS), differences in estimated weight (selective Intrauterine growth Retardation; sIUGR), or in fetal haemoglobin (Twin Anaemia Polycythaemia Sequence; TAPS). There is a very wide range of ischaemic and haemorrhagic injury in a focal as well as a global distribution. Acute twin twin transfusion may account for intraventricular haemorrhage in recipients and periventricular leukomalacia in donors but there are additional risk factors for focal embolism and cerebrovascular disease. The recipient has circulatory overload, with effects on systemic and pulmonary circulations which probably lead to systemic and pulmonary hypertension and even right ventricular outflow tract obstruction as well as the polycythaemia which is a risk factor for thrombosis and vasculopathy. The donor is hypovolaemic and has a reticulocytosis in response to the anaemia while maternal hypertension and diabetes may influence stroke risk. Understanding of the mechanisms, including the role of vasculopathy, in well studied conditions such as alloimmune thrombocytopaenia and monochorionic diamniotic twinning may lead to reduction of the burden of antenatally sustained cerebral palsy.
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Affiliation(s)
- Fenella J Kirkham
- Developmental Neurosciences Section and Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, London, United Kingdom; Departments of Child Health, Obstetrics and Gynaecology and Radiology, University Hospital Southampton, United Kingdom; Clinical and Experimental Sciences, University of Southampton, United Kingdom.
| | - Dimitrios Zafeiriou
- 1st Department of Pediatrics, "Hippokratio' General Hospital, Aristotle University, Thessaloniki, Greece
| | - David Howe
- Departments of Child Health, Obstetrics and Gynaecology and Radiology, University Hospital Southampton, United Kingdom; Clinical and Experimental Sciences, University of Southampton, United Kingdom
| | - Philippa Czarpran
- Departments of Child Health, Obstetrics and Gynaecology and Radiology, University Hospital Southampton, United Kingdom
| | - Ashley Harris
- Departments of Child Health, Obstetrics and Gynaecology and Radiology, University Hospital Southampton, United Kingdom
| | - Roxanna Gunny
- Developmental Neurosciences Section and Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, London, United Kingdom; Department of Radiology, St George's hospital, London, United Kingdom
| | - Brigitte Vollmer
- Departments of Child Health, Obstetrics and Gynaecology and Radiology, University Hospital Southampton, United Kingdom; Clinical and Experimental Sciences, University of Southampton, United Kingdom
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Massoud M, Guibaud L. Prenatal imaging of posterior fossa disorders. A review. Eur J Paediatr Neurol 2018; 22:972-988. [PMID: 30143392 DOI: 10.1016/j.ejpn.2018.07.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 07/18/2018] [Accepted: 07/19/2018] [Indexed: 12/23/2022]
Abstract
With advances in fetal imaging, prenatal diagnosis of posterior fossa anomalies has been greatly improved. Based on the anatomical approach proposed by Guibaud and Desportes in 2006, the main anomalies depicted according to the algorithm includes: (1) increased "fluid-filled" space of the posterior fossa, (2) abnormal biometry of the cerebellum, and (3) abnormal cerebellar anatomy. In this review, the spectrum of PF anomalies is covered in an attempt to update this approach in the light of both our experience, more than a decade since this algorithm was published, and the latest data in the literature.
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Affiliation(s)
- Mona Massoud
- Fetal Medicine Unit, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, Bron, 69500, Lyon, France
| | - Laurent Guibaud
- Fetal Medicine Unit, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, Bron, 69500, Lyon, France; Department of Pediatric and Fetal Imaging, Centre de Compétence des Malformations et Maladies congénitales du cervelet, Université Claude Bernard Lyon 1, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, Bron, 69500, Lyon, France.
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Smith AT, Gorassini MA. Hyperexcitability of brain stem pathways in cerebral palsy. J Neurophysiol 2018; 120:1428-1437. [DOI: 10.1152/jn.00185.2018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Individuals with cerebral palsy (CP) experience impairments in the control of head and neck movements, suggesting dysfunction in brain stem circuitry. To examine if brain stem circuitry is altered in CP, we compared reflexes evoked in the sternocleidomastoid (SCM) muscle by trigeminal nerve stimulation in adults with CP and in age/sex-matched controls. Increasing the intensity of trigeminal nerve stimulation produced progressive increases in the long-latency suppression of ongoing SCM electromyography in controls. In contrast, participants with CP showed progressively increased facilitation around the same reflex window, suggesting heightened excitability of brain stem pathways. We also examined if there was altered activation of cortico-brain stem pathways in response to prenatal injury of the brain. Motor-evoked potentials (MEPs) in the SCM that were conditioned by a prior trigeminal afferent stimulation were more facilitated in CP compared with controls, especially in ipsilateral MEPs that are likely mediated by corticoreticulospinal pathways. In some participants with CP, but not in controls, a combined trigeminal nerve and cortical stimulation near threshold intensities produced large, long-lasting responses in both the SCM and biceps brachii muscles. We propose that the enhanced excitatory responses evoked from trigeminal and cortical inputs in CP are produced by heightened excitability of brain stem circuits, resulting in the augmented activation of reticulospinal pathways. Enhanced activation of reticulospinal pathways in response to early injury of the corticospinal tract may provide a compensated activation of the spinal cord or, alternatively, contribute to impairments in the precise control of head and neck functions. NEW & NOTEWORTHY This is the first study to show that in adults with spastic cerebral palsy, activation of brain stem circuits by cortical and/or trigeminal afferents produces excitatory responses in anterior neck muscles compared with inhibitory responses in age/sex-matched controls. This may reflect a more excitable reticulospinal tract in response to early brain injury to provide a compensated activation of postural muscles. On the other hand, a hyperexcitable brain stem may contribute to impairments in the precise control of head and neck functions.
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Affiliation(s)
- A. T. Smith
- Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - M. A. Gorassini
- Department of Biomedical Engineering, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Novel COL4A1 mutation in a fetus with early prenatal onset of schizencephaly. Hum Genome Var 2018; 5:4. [PMID: 29760938 PMCID: PMC5938052 DOI: 10.1038/s41439-018-0005-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 02/26/2018] [Accepted: 03/13/2018] [Indexed: 12/21/2022] Open
Abstract
Porencephaly and schizencephaly are congenital brain disorders that can be caused by COL4A1 mutations, though the underlying mechanism and developmental processes are poorly understood. Here, we report a patient with schizencephaly, detected by fetal ultrasonography and fetal magnetic resonance imaging, with a de novo novel mutation in COL4A1 (c.2645_2646delinsAA, p.Gly882Glu). Our results suggest that the onset of damage that potentially results in schizencephaly occurs mid-pregnancy.
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Harada T, Uegaki T, Arata K, Tsunetou T, Taniguchi F, Harada T. Schizencephaly and Porencephaly Due to Fetal Intracranial Hemorrhage: A Report of Two Cases. Yonago Acta Med 2018; 60:241-245. [PMID: 29434494 DOI: 10.24563/yam.2017.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 10/30/2017] [Indexed: 01/22/2023]
Abstract
Schizencephaly and porencephaly are extremely rare types of cortical dysplasia. Case 1: Prenatal magnetic resonance imaging (MRI) showed wide clefts in the frontal and parietal lobes bilaterally. On postnatal day 3, MRI T2-weighted images showed multiple hypointensities in the clefts and ventricular walls, suggestive of hemosiderosis secondary to intracranial hemorrhage. Case 2: Prenatal MRI showed bilateral cleft and cyst formation in the fetal cerebrum, as well as calcification and hemosiderosis indicative of past hemorrhage. T2-weighted images showed hypointensities in the same regions as the calcification, corresponding with hemosiderosis due to intracranial hemorrhage on postnatal day 10. Thus, prenatal MRI was useful for diagnosing schizencephaly and porencephaly. Schizencephaly and porencephaly were thought to be due to fetal intracranial hemorrhage, which, in the porencephaly case, may have been related to a mutation of COL4A1.
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Affiliation(s)
- Takashi Harada
- Division of Reproductive-Perinatal Medicine and Gynecologic Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Takashi Uegaki
- Division of Reproductive-Perinatal Medicine and Gynecologic Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Kazuya Arata
- Division of Reproductive-Perinatal Medicine and Gynecologic Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Takako Tsunetou
- Division of Reproductive-Perinatal Medicine and Gynecologic Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Fuminori Taniguchi
- Division of Reproductive-Perinatal Medicine and Gynecologic Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Tasuku Harada
- Division of Reproductive-Perinatal Medicine and Gynecologic Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
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Chen X, Li SL, Luo GY, Norwitz ER, Ouyang SY, Wen HX, Yuan Y, Tian XX, He JM. Ultrasonographic Characteristics of Cortical Sulcus Development in the Human Fetus between 18 and 41 Weeks of Gestation. Chin Med J (Engl) 2017; 130:920-928. [PMID: 28397721 PMCID: PMC5407038 DOI: 10.4103/0366-6999.204114] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Fetal brain development is a complicated process that continues throughout pregnancy. Fetal sulcus development has typical morphological features. Assessment of fetal sulcus development to understand the cortical maturation and development by prenatal ultrasound has become widespread. This study aimed to explore a reliable method to assess cortical sulcus and to describe the normal sonographic features of cortical sulcus development in the human fetus between 18 and 41 weeks of gestation. Methods: A cross-sectional study was designed to examine the fetal cortical sulcus development at 18–41 weeks of gestation. Ultrasound was used to examine the insula, sylvian fissure (SF), parieto-occipital fissure (POF), and calcarine fissure (CF). Bland-Altman plots were used for assessing the concordance, and the intraclass correlation coefficient was used for assessing the reliability. Results: SF images were successfully obtained in 100% of participants at 22 weeks of gestation, while the POF images and CF images could be obtained in 100% at 23 weeks of gestation and 24 weeks of gestation, respectively. The SF width, temporal lobe depth, POF depth, and the CF depth increased with the developed gestation. The width of uncovered insula and the POF angle decreased with the developed gestation. By 23 weeks of gestation, the insula was beginning to be covered. Moreover, it completed at 35 weeks of gestation. The intra- and inter-observer agreements showed consistent reproducibility. Conclusions: This study defined standard views of the fetal sulcus as well as the normal reference ranges of these sulcus measurements between 18 and 41 weeks of gestation. Such ultrasonographic measurements could be used to identify fetuses at risk of fetal neurological structural disorders.
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Affiliation(s)
- Xi Chen
- Department of Ultrasound, Shenzhen Maternity and Child Healthcare Hospital, Affiliated to Southern Medical University, Shenzhen, Guangdong 518028, China
| | - Sheng-Li Li
- Department of Ultrasound, Shenzhen Maternity and Child Healthcare Hospital, Affiliated to Southern Medical University, Shenzhen, Guangdong 518028, China
| | - Guo-Yang Luo
- Department of Obstetrics and Gynecology, University of Connecticut, School of Medicine, Farmington, CT 06030-2946, USA
| | - Errol R Norwitz
- Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA 02111, USA
| | - Shu-Yuan Ouyang
- Department of Central Laboratory, Shenzhen Maternity and Child Healthcare Hospital, Affiliated to Southern Medical University, Shenzhen, Guangdong 518028, China
| | - Hua-Xuan Wen
- Department of Ultrasound, Shenzhen Maternity and Child Healthcare Hospital, Affiliated to Southern Medical University, Shenzhen, Guangdong 518028, China
| | - Ying Yuan
- Department of Ultrasound, Shenzhen Maternity and Child Healthcare Hospital, Affiliated to Southern Medical University, Shenzhen, Guangdong 518028, China
| | - Xiao-Xian Tian
- Department of Ultrasound, Maternity and Child Healthcare Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530003, China
| | - Jia-Min He
- Department of Ultrasound, Shenzhen Maternity and Child Healthcare Hospital, Affiliated to Southern Medical University, Shenzhen, Guangdong 518028, China
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Harada T, Uegaki T, Arata K, Tsunetou T, Taniguchi F, Harada T. Schizencephaly and Porencephaly Due to Fetal Intracranial Hemorrhage: A Report of Two Cases. Yonago Acta Med 2017. [DOI: 10.33160/yam.2017.12.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Takashi Harada
- Division of Reproductive-Perinatal Medicine and Gynecologic Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Takashi Uegaki
- Division of Reproductive-Perinatal Medicine and Gynecologic Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Kazuya Arata
- Division of Reproductive-Perinatal Medicine and Gynecologic Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Takako Tsunetou
- Division of Reproductive-Perinatal Medicine and Gynecologic Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Fuminori Taniguchi
- Division of Reproductive-Perinatal Medicine and Gynecologic Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Tasuku Harada
- Division of Reproductive-Perinatal Medicine and Gynecologic Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
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Abstract
OBJECTIVE To characterise the early tissue changes of post encephaloclastic polymicrogyria in the human fetus. METHODS We identified and reviewed the clinical histories and autopsy pathology of post ischemic fetal cerebral cortical injury at less than 30weeks gestational age (GA). The histology of local cortical abnormalities was examined with neuronal, glial, microglial and vascular immunohistochemical markers. RESULTS We identified eight cases ranging from 18 to 29weeks GA: 5 cases show full thickness cortical infarcts and 3 show periSylvian post-ischemic necrosis of the cerebral cortex. The maximal age is less than 10weeks after injury. There are abnormalities in gross fissuration as early as one month after injury. Disruption of the pia limitans was associated with a microglial and glial response and full thickness cortical injury. Macrophages were often seen accumulating deep to abnormal cortex. Hyperplasia of the subpial granular cell layer was universal in perilesional cortex. Cajal Retzius neuron hyperplasia, aggregation, and both superficial and deep displacement were noted. Where there was loss and dispersal of early cortical pyramidal neurons there was usually no pseudolaminar necrosis. Radial glia by 18weeks GA showed altered growth patterns and lateral branching. Altered migration of primitive elements was often prominent. Particularly prior to 20weeks GA subadjacent subplate neurons showed striking hypertrophy. CONCLUSIONS The array of histological changes encompasses all tissue elements of the affected brains, early in the evolution polymicrogyria. Although subpial alterations were ubiquitous, not all changes are referable to alterations in the pia limitans. The role of the necroinflammatory response in the genesis of abnormal cytoarchitecture deserves further study.
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Ilves P, Laugesaar R, Loorits D, Kolk A, Tomberg T, Lõo S, Talvik I, Kahre T, Talvik T. Presumed Perinatal Stroke: Risk Factors, Clinical and Radiological Findings. J Child Neurol 2016; 31:621-8. [PMID: 26446909 DOI: 10.1177/0883073815609149] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 08/22/2015] [Indexed: 12/28/2022]
Abstract
It is unknown why some infants with perinatal stroke present clinical symptoms late during infancy and will be identified as infants with presumed perinatal stroke. The risk factors and clinical and radiological data of 42 infants with presumed perinatal stroke (69% with periventricular venous infarction and 31% with arterial ischemic stroke) from the Estonian Pediatric Stroke Database were reviewed. Children with presumed perinatal stroke were born at term in 95% of the cases and had had no risk factors during pregnancy in 43% of the cases. Children with periventricular venous infarction were born significantly more often (82%) vaginally (P = .0213) compared to children with arterial stroke (42%); nor did they require resuscitation (P = .0212) or had any neurological symptoms after birth (P = .0249). Periventricular venous infarction is the most common type of lesion among infants with the presumed perinatal stroke. Data suggest that the disease is of prenatal origin.
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Affiliation(s)
- Pilvi Ilves
- Radiology Clinic of Tartu University Hospital, Tartu, Estonia Department of Radiology, University of Tartu, Tartu, Estonia
| | - Rael Laugesaar
- Department of Pediatrics, University of Tartu, Tartu, Estonia Children's Clinic of Tartu University Hospital, Tartu, Estonia
| | - Dagmar Loorits
- Radiology Clinic of Tartu University Hospital, Tartu, Estonia
| | - Anneli Kolk
- Department of Pediatrics, University of Tartu, Tartu, Estonia Department of Neurology and Neurorehabilitation, Children's Clinic of Tartu University Hospital, Tartu, Estonia
| | - Tiiu Tomberg
- Radiology Clinic of Tartu University Hospital, Tartu, Estonia
| | - Silva Lõo
- Department of Pediatrics, University of Tartu, Tartu, Estonia
| | - Inga Talvik
- Department of Pediatrics, University of Tartu, Tartu, Estonia Department of Neurology and Neurorehabilitation, Children's Clinic of Tartu University Hospital, Tartu, Estonia
| | - Tiina Kahre
- Department of Genetics, United Laboratories of Tartu University Hospital, Tartu, Estonia
| | - Tiina Talvik
- Department of Pediatrics, University of Tartu, Tartu, Estonia Children's Clinic of Tartu University Hospital, Tartu, Estonia
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Hino-Fukuyo N, Togashi N, Takahashi R, Saito J, Inui T, Endo W, Sato R, Okubo Y, Saitsu H, Haginoya K. Neuroepidemiology of Porencephaly, Schizencephaly, and Hydranencephaly in Miyagi Prefecture, Japan. Pediatr Neurol 2016; 54:39-42.e1. [PMID: 26545857 DOI: 10.1016/j.pediatrneurol.2015.08.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 01/21/2015] [Accepted: 08/22/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND No population-based surveys of porencephaly, schizencephaly, and hydranencephaly have been conducted in Japan or other Asian countries. We performed a neuroepidemiologic analysis to elucidate the incidence of porencephaly, schizencephaly, and hydranencephaly in Miyagi prefecture, Japan, during 2007-2011. METHODS We sent inquiry forms in February 2012 to three neonatal intensive care units, 25 divisions of orthopedic surgery in municipal hospitals, 33 divisions of pediatrics including one university hospital, municipal hospitals, pediatric practitioners, and institutions for physically handicapped children located in Miyagi prefecture. These covered all clinics related to pediatric neurology and orthopedic surgery in Miyagi prefecture. In the inquiry, diagnostic criteria for porencephaly, schizencephaly, and hydranencephaly were described and representative images of magnetic resonance imaging were shown. We obtained an 82% (27 of 33) response rate from the divisions of pediatrics, a 100% (3 of 3) response rate from the neonatal intensive care units, and a 68% (17 of 25) response rate from orthopedic surgery clinics. The magnetic resonance imaging scans of each patient were retrieved and inspected. RESULTS Five, one, and two individuals developed porencephaly, schizencephaly, and hydranencephaly, respectively. The estimated incidence rates of porencephaly, schizencephaly, and hydranencephaly were 5.2 (95% confidence interval [CI], 0.6-9.8), 1.0 (95% CI, 0.0-3.1), and 2.1 (95% CI, 0.0-5.0) per 100,000 live births, respectively. CONCLUSIONS The prevalence rates of porencephaly, schizencephaly, and hydranencephaly at birth reported herein are compatible with results reported previously in the United States and European countries. The overall prevalence rate of these three diseases was 8.3 (95% CI, 2.6-14.1) per 100,000 live births.
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Affiliation(s)
- Naomi Hino-Fukuyo
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Noriko Togashi
- Department of Neurology, Miyagi Children's Hospital, Sendai, Japan
| | - Ritsuko Takahashi
- Neonatal Intensive Care Unit in Perinatal Center, Japanese Red Cross Sendai Hospital, Sendai, Japan
| | - Junko Saito
- Neonatal Intensive Care Unit, Miyagi Children's Hospital, Sendai, Japan
| | - Takehiko Inui
- Department of Pediatric Neurology, Takuto Rehabilitation Center for Children, Sendai, Japan
| | - Wakaba Endo
- Department of Pediatric Neurology, Takuto Rehabilitation Center for Children, Sendai, Japan
| | - Ryo Sato
- Department of Pediatric Neurology, Takuto Rehabilitation Center for Children, Sendai, Japan
| | - Yukimune Okubo
- Department of Pediatric Neurology, Takuto Rehabilitation Center for Children, Sendai, Japan
| | - Hirotomo Saitsu
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kazuhiro Haginoya
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan; Department of Pediatric Neurology, Takuto Rehabilitation Center for Children, Sendai, Japan.
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Chapman T, Mahalingam S, Ishak GE, Nixon JN, Siebert J, Dighe MK. Diagnostic imaging of posterior fossa anomalies in the fetus and neonate: part 2, Posterior fossa disorders. Clin Imaging 2014; 39:167-75. [PMID: 25457569 DOI: 10.1016/j.clinimag.2014.10.012] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 10/16/2014] [Accepted: 10/20/2014] [Indexed: 01/15/2023]
Abstract
This second portion of a two-part review illustrates examples of posterior fossa disorders detectable on prenatal ultrasound and MRI, with postnatal or pathology correlation where available. These disorders are discussed in the context of an anatomic classification scheme described in Part 1 of this posterior fossa anomaly review. Assessment of the size and formation of the cerebellar hemispheres and vermis is critical. Diagnoses discussed here include arachnoid cyst, Blake's pouch cyst, Dandy-Walker malformation, vermian agenesis, Joubert syndrome, rhombencephalosynapsis, Chiari II malformation, ischemia, and tumors.
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Affiliation(s)
- Teresa Chapman
- Department of Radiology, Seattle Children's Hospital, MA.7.220, 4800 Sand Point Way NE, Seattle, WA, 98105; Department of Radiology, University of Washington Medical Center, Box 357115, 1959 NE Pacific Street, Seattle, WA 98195-7117.
| | - Sowmya Mahalingam
- Department of Radiology, University of Washington Medical Center, Box 357115, 1959 NE Pacific Street, Seattle, WA 98195-7117
| | - Gisele E Ishak
- Department of Radiology, Seattle Children's Hospital, MA.7.220, 4800 Sand Point Way NE, Seattle, WA, 98105; Department of Radiology, University of Washington Medical Center, Box 357115, 1959 NE Pacific Street, Seattle, WA 98195-7117
| | - Jason N Nixon
- Department of Radiology, Seattle Children's Hospital, MA.7.220, 4800 Sand Point Way NE, Seattle, WA, 98105; Department of Radiology, University of Washington Medical Center, Box 357115, 1959 NE Pacific Street, Seattle, WA 98195-7117
| | - Joseph Siebert
- Department of Pathology, Seattle Children's Hospital, PC.8.720, 4800 Sand Point Way NE, Seattle, WA, 98105
| | - Manjiri K Dighe
- Department of Radiology, University of Washington Medical Center, Box 357115, 1959 NE Pacific Street, Seattle, WA 98195-7117
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Massoud M, Cagneaux M, Garel C, Varene N, Moutard ML, Billette T, Benezit A, Rougeot C, Jouannic JM, Massardier J, Gaucherand P, Desportes V, Guibaud L. Prenatal unilateral cerebellar hypoplasia in a series of 26 cases: significance and implications for prenatal diagnosis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 44:447-454. [PMID: 24185815 DOI: 10.1002/uog.13217] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Revised: 09/13/2013] [Accepted: 09/16/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To define imaging patterns of unilateral cerebellar hypoplasia (UCH), discuss possible pathophysiological mechanisms and underline the etiology and prognosis associated with these lesions. METHODS In this retrospective study we reviewed the charts of 26 fetuses diagnosed between 2003 and 2011 with UCH, defined by asymmetrical cerebellar hemispheres with or without decreased transverse cerebellar diameter. The review included analysis of the anatomy of the cerebellar hemispheres, including foliation, borders and parenchymal echogenicity, and of the severity of the hypoplasia. Data from clinical and biological work-up and follow-up were obtained. RESULTS Our series could be divided into two groups according to whether imaging features changed progressively or remained constant during follow-up. In Group 1 (n = 8), the progression of imaging features, echogenic cerebellar changes and/or hyposignal in T2*-weighted MR images were highly suggestive of ischemic/hemorrhagic insult. In Group 2 (n = 18), imaging features remained constant during follow-up; UCH was associated with abnormal foliation in three proven cases of clastic lesions, a cystic lesion was noted in three cases of PHACE (posterior fossa anomalies, hemangioma, arterial anomalies, cardiac abnormalities/aortic coarctation, eye abnormalities) syndrome and, in the remaining cases, UCH remained unchanged, with no imaging pattern typical of hemorrhage. In 24 cases the infant was liveborn and follow-up was continued in 23, for a mean period of 3 years. Among these, neurological complications were identified in seven (in one of seven (at a mean of 46 months) in Group 1 and in six of 16 (at a mean of 35 months) in Group 2). The surface loss of cerebellar hemisphere was > 50% in 19/24 fetuses and the vermis was clearly normal in appearance in 19/24. Predisposing factors for fetal vascular insult were identified in eight cases: these included maternal alcohol addiction, diabetes mellitus, congenital cytomegalovirus infection and pathological placenta with thrombotic vasculopathy and infarctions. CONCLUSION UCH is defined as a focal lesion of the cerebellum that may be secondary to hemorrhage and/or ischemic insult, suggesting a clastic origin, particularly when imaging follow-up reveals changes over time. UCH may also be a clue for the prenatal diagnosis of PHACE syndrome. The amount of surface loss of cerebellar hemisphere does not correlate with poor prognosis. UCH with normal vermis is often associated with normal outcome.
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Affiliation(s)
- M Massoud
- Centre Pluridisciplinaire de Diagnostic Prénatal, Hôpital Femme Mère Enfant, Université Claude Bernard Lyon I, Lyon, France
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AIUM practice guideline for the performance of neurosonography in neonates and infants. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:1103-1110. [PMID: 24866621 DOI: 10.7863/ultra.33.6.1103] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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24
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Sarnat HB, Flores-Sarnat L. Radial microcolumnar cortical architecture: maturational arrest or cortical dysplasia? Pediatr Neurol 2013; 48:259-70. [PMID: 23498558 DOI: 10.1016/j.pediatrneurol.2012.10.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 10/10/2012] [Indexed: 12/25/2022]
Abstract
The fetal neocortical plate, from initiation of radial migration at 5 weeks' gestation until midgestation, exhibits radial microcolumnar architecture. Horizontal histologic layering or lamination becomes superimposed in the second half of gestation, although residua of the columnar pattern persist postnatally, particularly where the cortex bends: at the crowns of gyri and in the depths of sulci. Columnar architecture of the cortical plate in the first half of gestation mostly results from radial migration of neuroblasts, but the Cajal-Retzius neurons and GABAergic neuroblasts from tangential migration regulate a transition to horizontal lamination of the mature cortex. In children and adults, prominent columnar architecture is a feature of many focal cortical dysplasias and is now recognized as a distinctive pattern of focal cortical dysplasias in the new International League Against Epilepsy classification. It also occurs, however, in many genetic syndromes and chromosomopathic conditions, including 22q12 deletions (DiGeorge syndrome), in several primary cerebral malformations, in the contralateral cingulate gyrus in hemimegalencephaly, in cortical tubers of tuberous sclerosis, in the margins of porencephalic cysts resulting from prenatal infarcts, and in some inborn metabolic defects such as methylmalonic acidemia. Synaptophysin demonstrates both radial and horizontal lamination of synaptic layers. Persistent fetal cortical architecture is potentially epileptogenic. We conclude that columnar architecture is a maturational arrest in histogenesis of the neocortical plate and becomes a component of cortical dysplasia in the perinatal period. An initially physiological process thus becomes pathologic by virtue of advancing age, but traces of it persist in normal mature brains. It also occurs in many genetic and inborn metabolic diseases and after acquired ischemic insults of the fetal brain.
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Affiliation(s)
- Harvey B Sarnat
- Department of Paediatrics (Neurology), University of Calgary Faculty of Medicine and Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.
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Machado GF, Laranjeira MG, Schweigert A, de Melo GD. Porencephaly and cortical dysplasia as cause of seizures in a dog. BMC Vet Res 2012; 8:246. [PMID: 23269021 PMCID: PMC3538049 DOI: 10.1186/1746-6148-8-246] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 12/20/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Seizures are a common problem in small animal neurology and it may be related to underlying diseases. Porencephaly is an extremely rare disorder, and in Veterinary Medicine it affects more often ruminants, with only few reports in dogs. CASE PRESENTATION A one-year-old intact male Shih-Tzu dog was referred to Veterinary University Hospital with history of abnormal gait and generalized tonic-clonic seizures. Signs included hypermetria, abnormal nystagmus and increased myotatic reflexes. At necropsy, during the brain analysis, a cleft was observed in the left parietal and occipital lobes, creating a communication between the subarachnoid space and the left lateral ventricle, consistent with porencephaly; and also a focal atrophy of the caudal paravermal and vermal portions of the cerebellum. Furthermore, the histological examination showed cortical and cerebellar neuronal dysplasia. CONCLUSIONS Reports of seizures due to porencephaly are rare in dogs. In this case, the dog presented a group of brain abnormalities which per se or in assemblage could result in seizure manifestation.
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Affiliation(s)
- Gisele Fabrino Machado
- Department of Animal Clinics, Surgery and Reproduction, UNESP - Univ Estadual Paulista, College of Veterinary Medicine, Rua Clóvis Pestana, 793, Araçatuba, SP, CEP 16050-680, Brazil.
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Yoneda Y, Haginoya K, Kato M, Osaka H, Yokochi K, Arai H, Kakita A, Yamamoto T, Otsuki Y, Shimizu SI, Wada T, Koyama N, Mino Y, Kondo N, Takahashi S, Hirabayashi S, Takanashi JI, Okumura A, Kumagai T, Hirai S, Nabetani M, Saitoh S, Hattori A, Yamasaki M, Kumakura A, Sugo Y, Nishiyama K, Miyatake S, Tsurusaki Y, Doi H, Miyake N, Matsumoto N, Saitsu H. Phenotypic Spectrum ofCOL4A1Mutations: Porencephaly to Schizencephaly. Ann Neurol 2012; 73:48-57. [DOI: 10.1002/ana.23736] [Citation(s) in RCA: 125] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 08/06/2012] [Accepted: 08/10/2012] [Indexed: 12/14/2022]
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Fetal magnetic resonance imaging and three-dimensional ultrasound in clinical practice: Applications in prenatal diagnosis. Best Pract Res Clin Obstet Gynaecol 2012; 26:593-624. [DOI: 10.1016/j.bpobgyn.2012.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 06/08/2012] [Indexed: 01/09/2023]
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Sepulveda W, Cortes-Yepes H, Wong AE, Dezerega V, Corral E, Malinger G. Prenatal sonography in hydranencephaly: findings during the early stages of disease. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:799-804. [PMID: 22535728 DOI: 10.7863/jum.2012.31.5.799] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The purpose of this report is to describe the prenatal sonographic findings in fetuses with hydranencephaly diagnosed during the early stages of disease. Four cases with characteristics of hydranencephaly were retrospectively identified from 2 Latin American fetal medicine referral centers. Information on maternal demographics, sonographic findings, antenatal courses, and pregnancy outcomes was retrieved from the ultrasound reports and medical records. Cases were diagnosed between 21 and 23 weeks' gestation. The sonographic findings were similar in all cases and included absent cerebral hemispheres, which were replaced by homogeneous echogenic material filling the supratentorial space, and preservation of the thalami, brain stem, and cerebellum. The head circumference measurement was within the normal range, but the transverse cerebellar diameter was below the fifth percentile in 3 of the 4 cases. A follow-up scan in 1 of these cases demonstrated the classic anechoic fluid-filled appearance of hydranencephaly 2 weeks after diagnosis. Confirmation of the diagnosis was available in 2 cases, by postmortem examination in 1 and by fetal magnetic resonance imaging in the other. No further investigations were performed in the 2 women who opted for termination of pregnancy. In conclusion, during the early stages of disease, hydranencephaly is characterized by the presence of a large intracranial saclike structure containing homogeneous echogenic material, representing blood and necrotic debris secondary to massive liquefaction of the developing cerebral hemispheres.
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Meuwissen ME, Mancini GM. Neurological findings in incontinentia pigmenti; a review. Eur J Med Genet 2012; 55:323-31. [DOI: 10.1016/j.ejmg.2012.04.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Accepted: 04/22/2012] [Indexed: 10/28/2022]
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30
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Verbeek E, Meuwissen MEC, Verheijen FW, Govaert PP, Licht DJ, Kuo DS, Poulton CJ, Schot R, Lequin MH, Dudink J, Halley DJ, de Coo RIF, den Hollander JC, Oegema R, Gould DB, Mancini GMS. COL4A2 mutation associated with familial porencephaly and small-vessel disease. Eur J Hum Genet 2012; 20:844-51. [PMID: 22333902 DOI: 10.1038/ejhg.2012.20] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Familial porencephaly, leukoencephalopathy and small-vessel disease belong to the spectrum of disorders ascribed to dominant mutations in the gene encoding for type IV collagen alpha-1 (COL4A1). Mice harbouring mutations in either Col4a1 or Col4a2 suffer from porencephaly, hydrocephalus, cerebral and ocular bleeding and developmental defects. We observed porencephaly and white matter lesions in members from two families that lack COL4A1 mutations. We hypothesized that COL4A2 mutations confer genetic predisposition to porencephaly, therefore we sequenced COL4A2 in the family members and characterized clinical, neuroradiological and biochemical phenotypes. Genomic sequencing of COL4A2 identified the heterozygous missense G1389R in exon 44 in one family and the c.3206delC change in exon 34 leading to frame shift and premature stop, in the second family. Fragmentation and duplication of epidermal basement membranes were observed by electron microscopy in a c.3206delC patient skin biopsy, consistent with abnormal collagen IV network. Collagen chain accumulation and endoplasmic reticulum (ER) stress have been proposed as cellular mechanism in COL4A1 mutations. In COL4A2 (3206delC) fibroblasts we detected increased rates of apoptosis and no signs of ER stress. Mutation phenotypes varied, including porencephaly, white matter lesions, cerebellar and optic nerve hypoplasia and unruptured carotid aneurysm. In the second family however, we found evidence for additional factors contributing to the phenotype. We conclude that dominant COL4A2 mutations are a novel major risk factor for familial cerebrovascular disease, including porencephaly and small-vessel disease with reduced penetrance and variable phenotype, which might also be modified by other contributing factors.
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Affiliation(s)
- Elly Verbeek
- Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, The Netherlands
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Yoneda Y, Haginoya K, Arai H, Yamaoka S, Tsurusaki Y, Doi H, Miyake N, Yokochi K, Osaka H, Kato M, Matsumoto N, Saitsu H. De novo and inherited mutations in COL4A2, encoding the type IV collagen α2 chain cause porencephaly. Am J Hum Genet 2012; 90:86-90. [PMID: 22209246 DOI: 10.1016/j.ajhg.2011.11.016] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 11/04/2011] [Accepted: 11/17/2011] [Indexed: 01/09/2023] Open
Abstract
Porencephaly is a neurological disorder characterized by fluid-filled cysts or cavities in the brain that often cause hemiplegia. It has been suggested that porencephalic cavities result from focal cerebral degeneration involving hemorrhages. De novo or inherited heterozygous mutations in COL4A1, which encodes the type IV α1 collagen chain that is essential for structural integrity for vascular basement membranes, have been reported in individuals with porencephaly. Most mutations occurred at conserved Gly residues in the Gly-Xaa-Yaa repeats of the triple-helical domain, leading to alterations of the α1α1α2 heterotrimers. Here we report on two individuals with porencephaly caused by a heterozygous missense mutation in COL4A2, which encodes the type IV α2 collagen chain. Mutations c.3455G>A and c.3110G>A, one in each of the individuals, cause Gly residues in the Gly-Xaa-Yaa repeat to be substituted as p.Gly1152Asp and p.Gly1037Glu, respectively, probably resulting in alterations of the α1α1α2 heterotrimers. The c.3455G>A mutation was found in the proband's mother, who showed very mild monoparesis of the left upper extremity, and the maternal elder uncle, who had congenital hemiplegia. The maternal grandfather harboring the mutation is asymptomatic. The c.3110G>A mutation occurred de novo. Our study confirmed that abnormalities of the α1α1α2 heterotrimers of type IV collagen cause porencephaly and stresses the importance of screening for COL4A2 as well as for COL4A1.
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MacKillop E. Magnetic resonance imaging of intracranial malformations in dogs and cats. Vet Radiol Ultrasound 2011; 52:S42-51. [PMID: 21392155 DOI: 10.1111/j.1740-8261.2010.01784.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Intracranial malformations may occur because of an inherent developmental defect or secondary to in utero injury to the brain with subsequent hypoplasia and atrophy. They can cause neurologic deficits in growing animals, although some anomalies may not produce clinical signs until adulthood. Malformations of the brain include hydrocephalus, hydranencephaly/porencephaly, holoprosencephaly, corpus callosum agenesis/dysgenesis, lissencephaly, polymicrogyria, meningoencephalocele, intracranial cysts, cerebellar malformations, and hamartomas. These conditions are defined and reviewed with an emphasis on their features in magnetic resonance images.
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Affiliation(s)
- Edward MacKillop
- Pittsburgh Veterinary Specialty and Emergency Center (PVS-EC), Pittsburgh, PA 15237, USA.
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Abstract
INTRODUCTION Pediatric stroke, while increasingly recognized among practitioners as a clinically significant, albeit infrequent entity, remains challenging from the viewpoint of clinicians and researchers. DISCUSSION Advances in neuroimaging have revealed a higher prevalence of pediatric stroke while also provided a safer method for evaluating the child's nervous system and vasculature. An understanding of pathogenic mechanisms for pediatric stroke requires a division of ages (perinatal and childhood) and a separation of mechanism (ischemic and hemorrhagic). This article presents a review of the current literature with the recommended divisions of age and mechanism. CONCLUSION Guidelines for treatment, though limited, are also discussed.
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Arpino C, Compagnone E, Cacciatore D, Coniglio A, Castorina M, Curatolo P. MTHFR C677T and A1298C polymorphisms and cerebral stroke in two twin gestations. Childs Nerv Syst 2011; 27:665-9. [PMID: 21113717 DOI: 10.1007/s00381-010-1340-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 11/09/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Stroke in pediatric age is a rare event with a multifactorial genesis which could involve genetic factors as methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C polymorphism. At the same time, twin gestation with co-twin demise is an important potential risk factor for premature brain damage. PATIENTS AND METHODS We describe two children presenting with presumed cerebral stroke born from two MC twin pregnancies in which the other co-twin had died in utero associated to maternal and fetal homozygosity for MTHFR C677T and MTHFR A1298C, respectively. Brain damage was diagnosed immediately before the delivery. CONCLUSION Our observations underline the necessity to make a thrombophilia workup in women before or during pregnancy and, above all, in twin pregnancy. Data of literature are not clear about what kind of genetic polymorphism is prominent in the genesis of cerebral stroke (factor V leiden, MTHFR, activated protein C resistance, factor II G20210A). A multifactorial genesis for severe fetal and perinatal cerebral vascular alterations has been supposed; for this reason an early folate supplementation both to mother and infant could reduce the risk of brain damage due to fetal/perinatal stroke and eventual recurrence of thrombotic events.
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Affiliation(s)
- Carla Arpino
- Department of Neuroscience, Pediatric Neurology Unit Tor Vergata University of Rome, Rome, Italy
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Tsunematsu R, Shinozaki T, Fukushima K, Yumoto Y, Hidaka N, Morokuma S, Fujita Y, Hojo S, Wake N. Congenital Abdominal Aortic Aneurysm with Porencephaly: A Case Report. Fetal Diagn Ther 2011; 29:248-52. [DOI: 10.1159/000322403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Accepted: 10/25/2010] [Indexed: 11/19/2022]
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