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Giuffrida FP, Nassisi M, Osnaghi S. Morning Glory Syndrome in a Newborn Aged 2 Weeks. JAMA Ophthalmol 2024; 142:e234844. [PMID: 38634923 DOI: 10.1001/jamaophthalmol.2023.4844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
This case report describes a diagnosis of morning glory syndrome in a 2-week-old infant who presented with divergent strabismus, cleft lip, and hypertelorism.
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Affiliation(s)
- Francesco Pozzo Giuffrida
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Ophthalmological Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Nassisi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Ophthalmological Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvia Osnaghi
- Ophthalmological Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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2
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Khan HM, Lo J, Sarunic MV, Gooderham PA, Yip S, Sheldon CA, Wirth MA. Quantitative Optical Coherence Tomography Angiography in Patients with Moyamoya Vasculopathy: A Pilot Study. Neuroophthalmology 2021; 45:386-390. [PMID: 34720269 DOI: 10.1080/01658107.2021.1959619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Moyamoya (MM) disease is a chronic cerebrovascular disease that can lead to progressive stenosis of the terminal portions of the internal carotid arteries and their proximal branches. We sought to investigate and quantify retinal vascular changes in patients with MM vasculopathy (MMV) using optical coherence tomography angiography (OCTA) compared to healthy controls. Our findings reveal retinal microvascular changes in patients with MMV and highlights the potential of OCTA imaging for the detection of subclinical retinal pathology.
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Affiliation(s)
- Haaris M Khan
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Julian Lo
- School of Engineering Science, Simon Fraser University, Burnaby, Canada
| | - Marinko V Sarunic
- School of Engineering Science, Simon Fraser University, Burnaby, Canada
| | - Peter A Gooderham
- Department of Neurosurgery, University of British Columbia, Vancouver, Canada
| | - Samuel Yip
- Department of Neurology, University of British Columbia, University of British Columbia, Koerner Pavilion, UBC Hospital, Vancouver, Canada
| | - Claire A Sheldon
- Department of Ophthalmology & Visual Sciences, University of British Columbia, Vancouver, Canada
| | - Magdalena A Wirth
- Department of Ophthalmology & Visual Sciences, University of British Columbia, Vancouver, Canada.,Department of Ophthalmology, University Hospital Zurich, Zürich, Switzerland
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3
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Ponnatapura J. Morning glory syndrome with Moyamoya disease: A rare association with role of imaging. Indian J Radiol Imaging 2021; 28:165-168. [PMID: 30050238 PMCID: PMC6038211 DOI: 10.4103/ijri.ijri_219_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Morning glory disc anomaly (MGDA) is a congenital optic nerve anomaly characterized by a funnel-shaped excavation of the posterior globe that incorporates the optic disc. Most cases are isolated and not associated with systemic anomalies. Systemic anomalies include midline cranial facial defects, hypertelorism, agenesis of the corpus callosum, cleft lip and palate, basal encephalocele, congenital forebrain abnormalities, and renal anomalies. We report a case of 4-year-old male child who presented with reduced visual acuity on left eye with poor fixation. The left eye demonstrated 6-diopter esotropia. Examination of fundus revealed features of MGDA. The child was further subjected to magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) of brain to rule out other associated anomalies. It demonstrated narrowing at the distal part of internal carotid artery on both sides, left more than right with prominence of lenticulostriate and leptomeningeal vessels. MRI also revealed funnel-shaped excavation of the posterior globe on the left side consistent with MGDA. Ascertaining the accurate diagnosis of MGDA guides appropriate ophthalmic management and should also prompt a search for associated intracranial abnormalities. Although the diagnosis of MGDA is typically made clinically, imaging may feed supplementary value in establishing the diagnosis and reveal the extent and character of associated ocular abnormalities, and cross-sectional imaging permits for evaluation of the globe in the setting of associated opacities of the refractive media, including persistent hyperplastic primary vitreous, which may alleviate the capacity to make this diagnosis on the basis of the fundoscopy examination alone.
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Affiliation(s)
- Janardhana Ponnatapura
- Department of Radio-Diagnosis, Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka, India
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4
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Barh A, Mukherjee B, Ambika S. Optic nerve sheath fenestration for visual rehabilitation in moyamoya disease. Saudi J Ophthalmol 2021; 34:223-226. [PMID: 34085022 PMCID: PMC8081073 DOI: 10.4103/1319-4534.310410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 04/21/2020] [Accepted: 06/04/2020] [Indexed: 11/04/2022] Open
Abstract
A 13-year-old female presented with decrease in vision in both eyes with headache and vomiting for 15 days. Her visual acuity was perception of light with inaccurate projection in the right eye and counting fingers close to face in the left eye. Pupils were nonreactive. Fundus showed bilateral disc edema. Magnetic resonance angiography showed an attenuated caliber of the left internal carotid artery with occlusion of the left middle cerebral artery with collaterals, characteristic of moyamoya disease. The patient underwent right optic nerve sheath fenestration, following which her vision improved to 6/36 in the right and 6/24 in the left eye. Moyamoya disease is an occlusive disease of the cerebral vasculature most commonly seen in the Japanese. Children usually present with ischemic events. In the literature, visual symptoms secondary to raised intracranial tension in moyamoya disease are not well described. Ophthalmologists should be aware of this disease and the treatment options for salvaging vision.
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Affiliation(s)
- Atanu Barh
- Department of Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Chennai, Tamil Nadu, India
| | - Bipasha Mukherjee
- Department of Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Chennai, Tamil Nadu, India
| | - S Ambika
- Department of Neuro-Ophthalmology, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India
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A rare triad of morning glory disc anomaly, moyamoya vasculopathy, and transsphenoidal cephalocele: pathophysiological considerations and surgical management. Neurol Sci 2021; 42:5433-5439. [PMID: 33825116 PMCID: PMC8642253 DOI: 10.1007/s10072-021-05221-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 03/23/2021] [Indexed: 11/04/2022]
Abstract
Morning glory disc anomaly is a congenital abnormality of the optic disc and peripapillary retina reported as an isolated condition or associated with various anomalies, including basal encephaloceles and moyamoya vasculopathy. However, the co-occurrence of these three entities is extremely rare and the pathogenesis is still poorly understood. Moreover, data on the surgical management and long-term follow-up of the intracranial anomalies are scarce. Here, we describe the case of a 11-year-old boy with morning glory disc anomaly, transsphenoidal cephalocele, and moyamoya vasculopathy, who underwent bilateral indirect revascularization with encephalo-duro-myo-arterio-pericranio-synangiosis at the age of 2 years, and endoscopic repair of the transsphenoidal cephalocele at the age of 6 years. A rare missense variant (c.1081T>C,p.Tyr361His) was found in OFD1, a gene responsible for a X-linked ciliopathy, the oral-facial-digital syndrome type 1 (OFD1; OMIM 311200). This case expands the complex phenotype of OFD1 syndrome and suggests a possible involvement of OFD1 gene and Shh pathway in the pathogenesis of these anomalies.
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Rootman MS, Dotan G, Konen O. Neuroimaging in Children with Ophthalmological Complaints: A Review. J Neuroimaging 2021; 31:446-458. [PMID: 33615595 DOI: 10.1111/jon.12842] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 01/22/2021] [Accepted: 01/23/2021] [Indexed: 11/27/2022] Open
Abstract
Pediatric patients are commonly referred to imaging following abnormal ophthalmological examinations. Common indications include papilledema, altered vision, strabismus, nystagmus, anisocoria, proptosis, coloboma, and leukocoria. Magnetic resonance imaging (MRI) of the brain and orbits (with or without contrast material administration) is typically the imaging modality of choice. However, a cranial CT scan is sometimes initially performed, particularly when MRI is not readily available. Familiarity with the various ophthalmological conditions may assist the radiologist in formulating differential diagnoses and proper MRI protocols afterward. Although MRI of the brain and orbits usually suffices, further refinements are sometimes warranted to enable suitable assessment and accurate diagnosis. For example, the assessment of children with sudden onset anisocoria associated with Horner syndrome will require imaging of the entire oculosympathetic pathway, including the brain, orbits, neck, and chest. Dedicated orbital scans should cover the area between the hard palate and approximately 1 cm above the orbits in the axial plane and extend from the lens to the midpons in the coronal plane. Fat-suppressed T2-weighted fast spin echo sequences should enable proper assessment of the globes, optic nerves, and perioptic subarachnoid spaces. Contrast material should be given judiciously, ideally according to clinical circumstances and precontrast scans. In this review, we discuss the major indications for imaging following abnormal ophthalmological examinations.
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Affiliation(s)
- Mika Shapira Rootman
- Department of Radiology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University
| | - Gad Dotan
- Ophthalmology Unit, Schneider Children's Medical center of Israel, Petac Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University
| | - Osnat Konen
- Department of Radiology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University
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Ruggiero J, Zocchi J, Gallo S, Pietrobon G, De Bernardi F, Bignami M, Locatelli D, Castelnuovo P. Congenital Anterior Skull Base Encephaloceles: Long-Term Outcomes After Transnasal Endoscopic Reconstruction. World Neurosurg 2020; 143:e324-e333. [PMID: 32712408 DOI: 10.1016/j.wneu.2020.07.128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/17/2020] [Accepted: 07/18/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Congenital intranasal encephaloceles (ECs) are rare malformations of the pediatric age, complex to diagnose and treat, above all if associated with genetic syndromes or concomitant dysmorphisms. The aims of the study were to report our experience in managing nasal ECS in children, to evaluate the efficacy and safety of the transnasal endoscopic repair, and to analyze in an overall way the surgical long-term outcomes. Moreover, we sought to contribute to the debate on pathogenesis of ECs, investigating possible related risk factors described in the literature. METHODS A retrospective analysis was performed of pediatric nasal ECs managed with a transnasal endoscopic approach at a tertiary referral center through clinical follow-up and telephone survey. RESULTS Twenty-three patients with nasal ECs fitted the criteria of the study. Mean age at surgery was 5 years (69 months) and the mean follow-up was 59 months. The clinical presentation is described in detail, with particular emphasis on syndromic cases. Of 23 patients, 17 had an isolated EC, and in 4 patients, a malformation syndrome was associated. EC recurred in 2/23 patients (8.7%) after surgical correction, necessitating a revision procedure. No perioperative complications or long-term sequelae were noted in the entire population. CONCLUSIONS Endonasal endoscopic management of congenital ECs is feasible in children, although regular long-term follow-up is essential. Furthermore, the surgical approach does not seem to affect patients' development and quality of life, although more studies and validated questionnaires are needed. No recurrent risk factors were observed able to justify a certain etiologic relation.
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Affiliation(s)
- Jessica Ruggiero
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Jacopo Zocchi
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy; Department of Otolaryngology-Head and Neck Surgery, Regina Elena National Cancer Institute IRCCS, Rome, Italy.
| | - Stefania Gallo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy; Head and Neck Surgery and Forensic Dissection Research Center, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Giacomo Pietrobon
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy; Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Francesca De Bernardi
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Maurizio Bignami
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy; Head and Neck Surgery and Forensic Dissection Research Center, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Davide Locatelli
- Head and Neck Surgery and Forensic Dissection Research Center, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy; Head and Neck Surgery and Forensic Dissection Research Center, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
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Wang YY, Zhou KY, Ye Y, Song F, Yu J, Chen JC, Yao K. Moyamoya Disease Associated With Morning Glory Disc Anomaly and Other Ophthalmic Findings: A Mini-Review. Front Neurol 2020; 11:338. [PMID: 32499749 PMCID: PMC7242724 DOI: 10.3389/fneur.2020.00338] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/07/2020] [Indexed: 12/01/2022] Open
Abstract
Moyamoya disease (MMD) is a chronic cerebrovascular disease that frequently results in intracranial ischemia or hemorrhage. Its concurrence with varying ophthalmic findings is relatively rare yet may lead to irreversible blindness. We performed a search and review of the literature to characterize the relevance of MMD (excluding moyamoya syndrome) and ophthalmic findings. As a result, a total of 38 articles identified from PubMed and Web of Science were included in this mini-review. Patients with MMD sometimes present with decreased visual acuity or visual field defects before the onset of symptomatic cerebrovascular dysfunction. The most predominant ophthalmic condition in MMD patients is the morning glory disc anomaly (MGDA). Deficiency during neuroectodermal genesis and subsequent mesodermal changes may be responsible for the association between these two diseases. Thus, it may be beneficial for patients with MGDA to receive cerebral vascular examinations as the precaution against life-threatening intracranial angiopathy. Other ophthalmic findings reported in cases of MMD include retinal vascular occlusion, optic disc pallor, cortical blindness, etc. For most of the patients with MMD, retinal examinations would be recommended to prevent potential loss of vision. It is essential for both neurologists and ophthalmologists to be aware of the correlation between cerebrovascular diseases such as MMD and ocular manifestations to achieve a comprehensive diagnosis.
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Affiliation(s)
- Yue-Ye Wang
- Eye Center, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Ke-Yao Zhou
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yang Ye
- Eye Center, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Fan Song
- Eye Center, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Jin Yu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jin-Cao Chen
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ke Yao
- Eye Center, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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Solomou A, Spiliopoulos KC, Vasilagkos G, Vagionis A, Zampakis P. Internal carotid artery origin of the anterior cerebral artery: A rare anatomic intracranial arterial variation in a child with morning glory disc anomaly and moyamoya vascular pattern; case report and review of literature. Brain Circ 2020; 6:133-138. [PMID: 33033785 PMCID: PMC7511914 DOI: 10.4103/bc.bc_10_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/15/2020] [Accepted: 06/03/2020] [Indexed: 11/19/2022] Open
Abstract
Morning glory disc anomaly (MGDA) characterizes a congenital dysgenetic disorder of the optic disc, coexisting with arterial intracranial abnormalities, including Moyamoya vascular disease, a significantly rare disease in the European populations. We report a 2.5-year-old female child from Greece previously diagnosed with MGDA, who presented with right-hand paresis, accompanied by focal epileptic spasms, followed by an episode of brief absence seizure, as well as some arm clonic spasms. Magnetic resonance angiography scan revealed the presence of an anomalous origin of the anterior cerebral artery (ACA) from the internal carotid artery (ICA) along with vascular abnormalities, compatible with Moyamoya pattern. To the very best of our knowledge, this is the first reported case of anomalous origin of ACA from the supraclinoid ICA accompanied by severe occlusive intracranial disease (moyamoya-like pattern) in a patient with known MGDA, highlighting the embryonic character of the vascular manifestations in MGDA. It also verifies the association of Moyamoya pattern with MGDA, thus linking vascular dysgenesis as a possible cause of MGDA.
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Affiliation(s)
- Aikaterini Solomou
- MRI Unit, Department of Radiology, University Hospital of Patras, Patras, Greece
| | | | - Georgios Vasilagkos
- MRI Unit, Department of Radiology, University Hospital of Patras, Patras, Greece
| | - Athanasios Vagionis
- MRI Unit, Department of Radiology, University Hospital of Patras, Patras, Greece
| | - Petros Zampakis
- MRI Unit, Department of Radiology, University Hospital of Patras, Patras, Greece
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Sathyan S, Chackochan M. Morning glory disc anomaly and facial hemangiomas in a girl with moyamoya syndrome. Indian J Ophthalmol 2018; 66:1644-1646. [PMID: 30355892 PMCID: PMC6213674 DOI: 10.4103/ijo.ijo_538_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Moyamoya disease (MMD) is a chronic progressive, occlusive cerebrovascular disease in the circle of Willis and the feeding arteries. Morning glory disc anomaly (MGDA) is characterized by an abnormal excavated optic disc with radial emergence of blood vessels from the rim of the disc. We describe a case of moyamoya syndrome (MMS), a rare entity among Indian ethnicity, associated with MGDA and regressed facial capillary hemangiomas, which are relatively less reported presentations of MMD. This report emphasizes on the role of neuroimaging in MGDA, so as to facilitate early detection and management of life-threatening intracranial pathologies such as MMS.
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Affiliation(s)
- Sanitha Sathyan
- Department of Ophthalmology, Little Flower Hospital and Research Centre, Angamaly, Kerala, India
| | - Mariea Chackochan
- Department of Ophthalmology, Little Flower Hospital and Research Centre, Angamaly, Kerala, India
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Kraemer M, Huynh QB, Wieczorek D, Balliu B, Mikat B, Boehringer S. Distinctive facial features in idiopathic Moyamoya disease in Caucasians: a first systematic analysis. PeerJ 2018; 6:e4740. [PMID: 29977664 PMCID: PMC6029584 DOI: 10.7717/peerj.4740] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 04/19/2018] [Indexed: 12/02/2022] Open
Abstract
Background Craniofacial dysmorphic features are morphological changes of the face and skull which are associated with syndromic conditions. Moyamoya angiopathy is a rare cerebral vasculopathy that can be divided into Moyamoya syndrome, which is associated or secondary to other diseases, and into idiopathic Moyamoya disease. Facial dysmorphism has been described in rare genetic syndromes with associated Moyamoya syndrome. However, a direct relationship between idiopathic Moyamoya disease with dysmorphic facial changes is not known yet. Methods Landmarks were manually placed on frontal photographs of the face of 45 patients with bilateral Moyamoya disease and 50 matched controls. After procrustes alignment of landmarks a multivariate, penalized logistic regression (elastic-net) was performed on geometric features derived from landmark data to classify patients against controls. Classifiers were visualized in importance plots that colorcode importance of geometric locations for the classification decision. Results The classification accuracy for discriminating the total patient group from controls was 82.3% (P-value = 6.3×10−11, binomial test, a-priori chance 50.2%) for an elastic-net classifier. Importance plots show that differences around the eyes and forehead were responsible for the discrimination. Subgroup analysis corrected for body mass index confirmed a similar result. Discussion Results suggest that there is a resemblance in faces of Caucasian patients with idiopathic Moyamoya disease and that there is a difference to matched controls. Replication of findings is necessary as it is difficult to control all residual confounding in study designs such as ours. If our results would be replicated in a larger cohort, this would be helpful for pathophysiological interpretation and early detection of the disease.
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Affiliation(s)
- Markus Kraemer
- Department of Neurology, Alfried Krupp Hospital Essen, Essen, Germany.,Department of Neurology, University Clinic of Duesseldorf, Duesseldorf, Germany
| | - Quoc Bao Huynh
- Department of Neurology, Alfried Krupp Hospital Essen, Essen, Germany
| | - Dagmar Wieczorek
- Institute of Human Genetics, University of Duesseldorf, Duesseldorf, Germany.,Institute of Human Genetics, University of Essen, Essen, Germany
| | - Brunilda Balliu
- Institute of Genetics, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Barbara Mikat
- Institute of Human Genetics, University of Essen, Essen, Germany
| | - Stefan Boehringer
- Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Nederlands
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Sajja A, Tsering D, Mooser AC, DeFreitas TA, Carpenter J, Magge SN. Patient With Severe Moyamoya Disease Who Presents With Acute Cortical Blindness. Stroke 2017; 48:e126-e129. [PMID: 28411258 DOI: 10.1161/strokeaha.116.015548] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 03/09/2017] [Accepted: 03/14/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Aparna Sajja
- From the Department of Neurology (J.C.), Department of Neurological Surgery (S.N.M.), and Department of Pediatrics (J.C., S.N.M.), George Washington University School of Medicine and Health Sciences, Washington, DC (A.S.); Division of Neurosurgery (D.T., S.N.M.), Division of Anesthesiology (T.A.D.), and Department of Neurology (J.C.), Children's National Health System, Washington, DC; and Department of Surgery, St. Louis University, MO (A.C.M.)
| | - Deki Tsering
- From the Department of Neurology (J.C.), Department of Neurological Surgery (S.N.M.), and Department of Pediatrics (J.C., S.N.M.), George Washington University School of Medicine and Health Sciences, Washington, DC (A.S.); Division of Neurosurgery (D.T., S.N.M.), Division of Anesthesiology (T.A.D.), and Department of Neurology (J.C.), Children's National Health System, Washington, DC; and Department of Surgery, St. Louis University, MO (A.C.M.)
| | - Annie C Mooser
- From the Department of Neurology (J.C.), Department of Neurological Surgery (S.N.M.), and Department of Pediatrics (J.C., S.N.M.), George Washington University School of Medicine and Health Sciences, Washington, DC (A.S.); Division of Neurosurgery (D.T., S.N.M.), Division of Anesthesiology (T.A.D.), and Department of Neurology (J.C.), Children's National Health System, Washington, DC; and Department of Surgery, St. Louis University, MO (A.C.M.)
| | - Tiffani A DeFreitas
- From the Department of Neurology (J.C.), Department of Neurological Surgery (S.N.M.), and Department of Pediatrics (J.C., S.N.M.), George Washington University School of Medicine and Health Sciences, Washington, DC (A.S.); Division of Neurosurgery (D.T., S.N.M.), Division of Anesthesiology (T.A.D.), and Department of Neurology (J.C.), Children's National Health System, Washington, DC; and Department of Surgery, St. Louis University, MO (A.C.M.)
| | - Jessica Carpenter
- From the Department of Neurology (J.C.), Department of Neurological Surgery (S.N.M.), and Department of Pediatrics (J.C., S.N.M.), George Washington University School of Medicine and Health Sciences, Washington, DC (A.S.); Division of Neurosurgery (D.T., S.N.M.), Division of Anesthesiology (T.A.D.), and Department of Neurology (J.C.), Children's National Health System, Washington, DC; and Department of Surgery, St. Louis University, MO (A.C.M.)
| | - Suresh N Magge
- From the Department of Neurology (J.C.), Department of Neurological Surgery (S.N.M.), and Department of Pediatrics (J.C., S.N.M.), George Washington University School of Medicine and Health Sciences, Washington, DC (A.S.); Division of Neurosurgery (D.T., S.N.M.), Division of Anesthesiology (T.A.D.), and Department of Neurology (J.C.), Children's National Health System, Washington, DC; and Department of Surgery, St. Louis University, MO (A.C.M.).
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13
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John D, Muthusamy K, Bandla B, Sudhakar SV, Thomas M. Ocular Features and Visual Outcome in Children with Moyamoya Disease and Moyamoya Syndrome: A Case Series. J Clin Diagn Res 2016; 10:NR01-4. [PMID: 27437259 DOI: 10.7860/jcdr/2016/19153.7744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 03/15/2016] [Indexed: 11/24/2022]
Abstract
Moya Moya Disease (MMD) is characterised by idiopathic vasculopathy affecting the terminal internal carotid arteries resulting in the formation of extensive collaterals at the base of the brain, leptomeninges and parenchymal regions with resultant infarcts and bleeds. Four children presented with clinico-radiological features suggestive of Moyamoya disease/syndrome. This includes global developmental delay, recurrent seizures, transient ischaemic attacks and impaired vision. The first patient had vision of 6/15 in both eyes with bilateral optic disc pallor. Second case also had bilateral optic disc pallor with arteriolar attenuation, but had vision of perception of light only in both eyes. The third child had vision of 6/60 with alternate divergent squint and clinical features suggestive of Neurofibromatosis 1 (NF 1). Fourth patient presented with poor fixation in both eyes with bilateral total cataract. He underwent bilateral cataract surgery with intraocular lens implantation and vision improved to 2/60 with good fixation. We also describe their medical and neurosurgical interventions in this report.
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Affiliation(s)
- Deepa John
- Associate Surgeon, Department of Ophthalmology, Christian Medical College , Vellore, Tamil Nadu, India
| | - Karthik Muthusamy
- Associate Professor, Dept of Neurology, Christian Medical College , Vellore, Tamil Nadu, India
| | - Bhavagna Bandla
- Resident, Department of Ophthalmology, Christian Medical College , Vellore, Tamil Nadu, India
| | - Sniya Valsa Sudhakar
- Physician, Department of Radiodagnosis, Christian Medical College , Vellore, Tamil Nadu, India
| | - Maya Thomas
- Professor, Department of Neurology, Christian Medical College , Vellore, Tamil Nadu, India
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14
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Reddy B, Kelawala DN, Shah T, Patel AB, Patil DB, Parikh PV, Patel N, Parmar N, Mohapatra AB, Singh KM, Menon R, Pandya D, Jakhesara SJ, Koringa PG, Rao MV, Joshi CG. Identification of putative SNPs in progressive retinal atrophy affected Canis lupus familiaris using exome sequencing. Mamm Genome 2015; 26:638-49. [PMID: 26515695 DOI: 10.1007/s00335-015-9607-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 10/08/2015] [Indexed: 11/30/2022]
Abstract
Progressive retinal atrophy (PRA) is one of the major causes of retinal photoreceptor cell degeneration in canines. The inheritance pattern of PRA is autosomal recessive and genetically heterogeneous. Here, using targeted sequencing technology, we have performed exome sequencing of 10 PRA-affected (Spitz=7, Cocker Spaniel=1, Lhasa Aphso=1 and Spitz-Labrador cross breed=1) and 6 normal (Spitz=5, Cocker Spaniel=1) dogs. The high-throughput sequencing using 454-Roche Titanium sequencer generated about 2.16 Giga bases of raw data. Initially, we have successfully identified 25,619 single nucleotide polymorphisms (SNPs) that passed the stringent SNP calling parameters. Further, we performed association study on the cohort, and the highly significant (0.001) associations were short-listed and investigated in-depth. Out of the 171 significant SNPs, 113 were previously unreported. Interestingly, six among them were non-synonymous coding (NSC) SNPs, which includes CPPED1 A>G (p.M307V), PITRM1 T>G (p.S715A), APP G>A (p.T266M), RNF213 A>G (p.V1482A), C>A (p.V1456L), and SLC46A3 G>A (p.R168Q). On the other hand, 35 out of 113 unreported SNPs were falling in regulatory regions such as 3'-UTR, 5'-UTR, etc. In-depth bioinformatics analysis revealed that majority of NSC SNPs have damaging effect and alter protein stability. This study highlighted the genetic markers associated with PRA, which will help to develop genetic assay-based screening in effective breeding.
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Affiliation(s)
- Bhaskar Reddy
- Ome Research Facility, Department of Animal Biotechnology, Anand Agricultural University, Anand, Gujarat, 388001, India.,Department of Zoology, Genetic Diagnostic Centre, University School of Sciences, Gujarat University, Ahmedabad, Gujarat, 380009, India
| | - Divyesh N Kelawala
- Department of Veterinary Surgery & Radiology, College of Veterinary Science & Animal Husbandry, Anand Agricultural University, Anand, Gujarat, 388001, India
| | - Tejas Shah
- Ome Research Facility, Department of Animal Biotechnology, Anand Agricultural University, Anand, Gujarat, 388001, India
| | - Anand B Patel
- Ome Research Facility, Department of Animal Biotechnology, Anand Agricultural University, Anand, Gujarat, 388001, India
| | - Deepak B Patil
- Department of Veterinary Surgery & Radiology, College of Veterinary Science & Animal Husbandry, Anand Agricultural University, Anand, Gujarat, 388001, India
| | - Pinesh V Parikh
- Department of Veterinary Surgery & Radiology, College of Veterinary Science & Animal Husbandry, Anand Agricultural University, Anand, Gujarat, 388001, India
| | - Namrata Patel
- Ome Research Facility, Department of Animal Biotechnology, Anand Agricultural University, Anand, Gujarat, 388001, India
| | - Nidhi Parmar
- Ome Research Facility, Department of Animal Biotechnology, Anand Agricultural University, Anand, Gujarat, 388001, India
| | - Amit B Mohapatra
- Ome Research Facility, Department of Animal Biotechnology, Anand Agricultural University, Anand, Gujarat, 388001, India
| | - Krishna M Singh
- Datar Genetics Ltd, F-8, D Road, Ambad, Nasik, Maharashtra, 422010, India
| | - Ramesh Menon
- Ome Research Facility, Department of Animal Biotechnology, Anand Agricultural University, Anand, Gujarat, 388001, India
| | - Dipal Pandya
- Ome Research Facility, Department of Animal Biotechnology, Anand Agricultural University, Anand, Gujarat, 388001, India
| | - Subhash J Jakhesara
- Ome Research Facility, Department of Animal Biotechnology, Anand Agricultural University, Anand, Gujarat, 388001, India
| | - Prakash G Koringa
- Ome Research Facility, Department of Animal Biotechnology, Anand Agricultural University, Anand, Gujarat, 388001, India
| | - Mandava V Rao
- Department of Zoology, Genetic Diagnostic Centre, University School of Sciences, Gujarat University, Ahmedabad, Gujarat, 380009, India
| | - Chaitanya G Joshi
- Ome Research Facility, Department of Animal Biotechnology, Anand Agricultural University, Anand, Gujarat, 388001, India.
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15
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Albrecht P, Blasberg C, Lukas S, Ringelstein M, Müller AK, Harmel J, Kadas EM, Finis D, Guthoff R, Aktas O, Hartung HP, Paul F, Brandt AU, Berlit P, Methner A, Kraemer M. Retinal pathology in idiopathic moyamoya angiopathy detected by optical coherence tomography. Neurology 2015; 85:521-7. [DOI: 10.1212/wnl.0000000000001832] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 04/15/2015] [Indexed: 11/15/2022] Open
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16
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Papavasileiou E, Sobrin L, Papaliodis GN. Ocular ischemic syndrome presenting as retinal vasculitis in a patient with moyamoya syndrome. Retin Cases Brief Rep 2015; 9:170-172. [PMID: 25799075 DOI: 10.1097/icb.0000000000000129] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To report a case of ocular ischemic syndrome presenting as retinal vasculitis in a patient with Moyamoya syndrome. METHODS A retrospective chart review was conducted to record clinical data including fluorescein angiography, optical coherence tomography, and serologic testing. A review of the literature from 1969 to 2014 of ocular involvement in Moyamoya syndrome was performed. RESULTS A 51-year-old woman with long history of bilateral retinal vasculitis and refractory cystoid macular edema was eventually diagnosed with Moyamoya syndrome after sustaining a perioperative cerebrovascular accident. Moyamoya syndrome has been associated in the literature with ocular ischemic syndrome, presenting with narrowed retinal arteries, dilated veins, and midperipheral retinal hemorrhages, but retinal vasculitis with cystoid macular edema has not been reported. CONCLUSION Moyamoya-related ocular ischemic syndrome can present as retinal vascular leakage and macular edema. Ophthalmologists should be cognizant that signs of the disease may be first observed in the eye before manifestations in the cerebrovascular system.
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Affiliation(s)
- Evangelia Papavasileiou
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
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17
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Ganesh A. Cavitary anomalies of the optic disc: Different entities or part of a single spectrum of disease? Oman J Ophthalmol 2014; 7:53-4. [PMID: 25136226 PMCID: PMC4134545 DOI: 10.4103/0974-620x.137137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Anuradha Ganesh
- Department of Ophthalmology, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
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18
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Ellika S, Robson CD, Heidary G, Paldino MJ. Morning glory disc anomaly: characteristic MR imaging findings. AJNR Am J Neuroradiol 2013; 34:2010-4. [PMID: 23660287 DOI: 10.3174/ajnr.a3542] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
SUMMARY Establishing the diagnosis of morning glory disc anomaly is crucial to appropriate patient treatment. Although typically made clinically, the diagnosis is not always straightforward, especially in circumstances where physical examination is limited. The goal of this study was to define the spectrum and frequency of orbital findings in a series of patients with funduscopically-confirmed morning glory disc anomaly by using MR imaging. MR imaging demonstrated 3 findings in all patients: 1) funnel-shaped morphologic pattern of the posterior optic disc with elevation of the adjacent retinal surface; 2) abnormal tissue associated with the distal intraorbital segment of the ipsilateral optic nerve, with effacement of the regional subarachnoid spaces; and 3) discontinuity of the uveoscleral coat. These findings were not observed in any of the unaffected globes of the study patients. In summary, these consistent and characteristic findings of morning glory disc anomaly should allow for accurate differentiation from other ocular anomalies and have the potential to guide appropriate management of this patient population.
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19
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Kumar M A, Ganesh B A. CRAO in Moyamoya Disease. J Clin Diagn Res 2013; 7:545-7. [PMID: 23634418 DOI: 10.7860/jcdr/2013/4579.2819] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 12/02/2012] [Indexed: 11/24/2022]
Abstract
Moyo Moya Disease (MMD) is a rare, progressively stenotic condition of the intracranial arteries with various cerebrovascular manifestations. Ocular manifestations are seen very rarely and there are only few case reports of ocular perfusion anomalies. Central Retinal Artery Occlusion (CRAO) can be caused by atherosclerosis related thrombosis, carotid embolism, cardiac embolism, thrombophilic disorders, giant cell arteritis, etc. We are reporting a 26 years old patient with CRAO in the right eye, who was found to have the typical features of MMD on cerebral angiography. CRAO with MMD is a rare occurrence.
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Affiliation(s)
- Ashok Kumar M
- Professor, Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute , Puducherry, India
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20
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Bang GM, Kirmani S, Patton A, Pulido JS, Brodsky MC. "Ocular moyamoya" syndrome in a patient with features of microcephalic osteodysplastic primordial dwarfism type II. J AAPOS 2013; 17:100-2. [PMID: 23337351 DOI: 10.1016/j.jaapos.2012.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 09/19/2012] [Accepted: 09/22/2012] [Indexed: 10/27/2022]
Abstract
Primordial dwarfism refers to severely impaired growth beginning early in fetal life. There are many genetic causes of primordial dwarfism, including disorders classified as microcephalic osteodysplastic primordial dwarfism. Microcephalic osteodysplastic primordial dwarfism type II is an autosomal-recessive disease characterized by small stature, bone and dental anomalies, and characteristic facies. Affected patients have a high risk of stroke secondary to progressive cerebral vascular anomalies, which often are classified as moyamoya disease. We present the case of a boy with features suggestive of MOPD II with unilateral moyamoya cerebrovascular changes and correlative moyamoya collaterals involving the iris of the ipsilateral eye.
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Affiliation(s)
- Genie M Bang
- Department of Ophthalmology, Mayo Clinic, Rochester, MN 55905, USA
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21
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22
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Abstract
BACKGROUND Transsphenoidal encephaloceles are rare cystic herniations of meninges, cerebrospinal fluid, and/or brain matter resulting from incomplete closure of the cranial base and may be associated with midfacial, central nervous system, and endocrine anomalies. Although some centers choose not to operate because of risks, the authors document their staged operative approach to avoid recurrent meningitis, progressive neurologic decline, and other symptoms. METHODS Patients with symptomatic transsphenoidal encephaloceles who underwent staged treatment with intracranial and transpalatal cyst correction, facial bipartition, and cleft palate repair were studied (n = 4). Outcome measures included perioperative complications, recurrence, interdacyron distance comparison, and speech and developmental assessments. RESULTS The authors' staged correction of transsphenoidal encephaloceles as detailed in this article proved successful in all four patients, with no recurrence of meningitis, no cerebrospinal fluid leakage, alleviation of headaches, aesthetic improvement, and no encephalocele relapse. Skeletal correction by computed tomographic scan showed correction of interdacyron distance with a mean 22-mm reduction (56 percent). After the initial procedure of encephalocele correction, speech scores fell from 2.2 (borderline incompetent) to 7.9 (incompetent) but improved after the cleft palate repair and speech therapy to 1.4 (borderline competent). Follow-up developmental tests showed normal global evaluations in memory and attention skills in all but one patient (who had persistent deficiencies consistent with preoperative evaluations). CONCLUSION A staged operative treatment for symptomatic transsphenoidal encephaloceles offers functional and morphologic correction.
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23
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Abstract
The morning glory disc anomaly has distinctive clinical characteristics and is important to diagnose correctly so that associated central nervous system and vascular abnormalities are promptly identified and treated. This review covers the ophthalmic findings, clinical features, and histopathologic findings in patients with this rare developmental abnormality. The most common systemic associations are described and reviewed.
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Affiliation(s)
- Brian J Lee
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
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24
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Pituitary stalk duplication in association with moya moya disease and bilateral morning glory disc anomaly - broadening the clinical spectrum of midline defects. J Neurol 2008; 255:885-90. [PMID: 18350354 DOI: 10.1007/s00415-008-0799-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2007] [Revised: 09/24/2007] [Accepted: 10/29/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Duplication of the pituitary stalk, morning glory disc anomaly and moya moya are rare malformations. The combination of these findings may be syndromic and may have an underlying genetic etiology. METHODS Case report and review of the literature of neurological, ophthalmological, and neuroradiological findings including ophthalmic examination, MRI and MRA. CASE REPORT A 2 year-old girl presented with reduced visual acuity and roving eye movements since birth. Ophthalmological workup revealed bilateral morning glory disc anomaly. MRI showed duplication of the pituitary stalk and caudal displacement of the floor of the third ventricle. MRA showed narrowing of the supraclinoid internal carotid arteries with focal narrowing of the proximal middle cerebral arteries consistent with early moya moya disease. CONCLUSIONS Review of the literature of pituitary gland duplication and of the combination of morning glory disc anomaly and moya moya disease revealed only one previously reported case. However, the spectrum of this possibly syndromic presentation may be much broader and include various types of anterior midline defects and may have a common underlying genetic cause.
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25
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Abstract
Developmental anomalies of the optic nerve are an important and growing cause of lifelong visual handicap and they are often associated with systemic abnormalities. This review focuses on the ocular and systemic aspects of developmental anomalies arising from defects of fetal fissure closure and retinal ganglion cell development, and covers some other optic-disc anomalies that have systemic significance.
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Affiliation(s)
- D Taylor
- Institute of Child Health, Visual Sciences Unit, London, UK.
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26
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Chen CS, Lee AW, Kelman S, Wityk R. Anterior ischemic optic neuropathy in moyamoya disease: a first case report. Eur J Neurol 2007; 14:823-5. [PMID: 17594343 DOI: 10.1111/j.1468-1331.2007.01819.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Neuro-ophthalmological manifestations in moyamoya disease are usually the result of cerebrovascular involvement of the visual pathways. We report a case of ischemic optic neuropathy due to ocular hypoperfusion as a result of moyamoya disease, despite a prior internal to external carotid artery bypass with normal hemisphere perfusion. The blood supply of the optic nerve, a proposed pathogenesis of an anterior ischemic optic neuropathy and complications of the ocular ischemic syndrome are discussed.
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Affiliation(s)
- C S Chen
- Department of Neuro Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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27
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Lenhart PD, Lambert SR, Newman NJ, Biousse V, Atkinson DS, Traboulsi EI, Hutchinson AK. Intracranial vascular anomalies in patients with morning glory disk anomaly. Am J Ophthalmol 2006; 142:644-50. [PMID: 17011858 DOI: 10.1016/j.ajo.2006.05.040] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2005] [Revised: 05/08/2006] [Accepted: 05/17/2006] [Indexed: 02/04/2023]
Abstract
PURPOSE An association between morning glory disk anomaly (MGDA) and intracranial vascular anomalies including Moyamoya disease has been recognized. We evaluated a series of patients with MGDA to ascertain the frequency of cerebrovascular anomalies. DESIGN Retrospective observational case series. METHODS We reviewed the neurologic histories and neuroimaging studies of twenty patients with MGDA at two institutions between 1982 and 2004. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) of the brain was performed on all patients who had not undergone neuroimaging. MRI/MRA studies done for 40 pediatric patients without MGDA were also evaluated for cerebrovascular anomalies. The prevalence of anomalies in the two groups was compared by Fisher exact test. RESULTS Nine of 20 patients (45%) with MGDA had cerebrovascular anomalies. Anomalies ranged from agenesis of the A1 segment of the anterior cerebral artery to bilateral stenosis of the internal carotid arteries with moyamoya disease. Three patients underwent revascularization procedures. Ten of 40 patients (25%) in the control group had any intracranial vascular anomaly, whereas only two of 40 (5%) had an abnormality of the anterior circulation, the most common finding in the MGDA group. CONCLUSION We recommend that all patients with MGDA undergo MRI/MRA or computerized tomographic angiography to detect vascular and structural brain anomalies. It may be unclear whether cerebrovascular anomalies represent isolated congenital anomalies or findings of progressive occlusive cerebrovascular disease. Follow-up imaging should be considered in patients with cerebrovascular anomalies and is clearly indicated if neurologic signs or symptoms are present.
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Affiliation(s)
- Phoebe D Lenhart
- Department of Pediatric Ophthalmology, Emory Eye Center, Atlanta, GA 30322, USA
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28
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Teng E, Heller J, Lazareff J, Kawamoto H, Wasson K, Garri JI, Bradley JP. Caution in Treating Transsphenoidal Encephalocele with Concomitant Moyamoya Disease. J Craniofac Surg 2006; 17:1004-9. [PMID: 17003634 DOI: 10.1097/01.scs.0000224988.40280.4a] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
A basal encephalocele is a rare congenital malformation involving a cranial bone defect and cystic-like herniation through the defect. Moyamoya is a rare cerebrovascular disease of unclear etiology involving occlusion of the distal internal carotids and formation of collateral vascular networks. Both diseases have been correlated with optic disc anomalies, hypopituitarism, and midfacial defects. We present a case of a 2-year-old boy with a midline facial cleft who underwent surgical correction of a basal encephalocele. His moyamoya disease may have contributed to a vascular complication. There is growing evidence indicating an overlap in disease profiles for these two rare diseases. In addition, molecular evidence indicates elevated levels of fibroblast growth factor and transforming growth factor in both diseases, suggesting common molecular pathways.
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Affiliation(s)
- Edward Teng
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, Los Angeles, California 90095-6960, USA.
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29
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Murphy MA, Perlman EM, Rogg JM, Easton JD, Easton DJ, Schuman JS. Reversible Carotid Artery Narrowing in Morning Glory Disc Anomaly. J Neuroophthalmol 2005; 25:198-201. [PMID: 16148627 DOI: 10.1097/01.wno.0000177300.44845.a4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 14-year-old boy with morning glory disc anomaly (MGDA) and normal visual and neurologic function displayed marked carotid artery narrowing on magnetic resonance angiography (MRA). This narrowing disappeared on a follow-up MRA six months later. Optic coherence tomography and scanning laser polarimetry disclosed a normal retinal nerve fiber layer in the eye with MGDA. MGDA has been reported in association with irreversible carotid artery stenosis leading to moya moya disease. This case suggests that mild cases of MGDA may be associated with reversible carotid artery narrowing owing to vasospasm.
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Affiliation(s)
- Marjorie A Murphy
- Department of Ophthalmology, Rhode Island Hospital, Brown Medical School, Providence, Rhode Island 02903, USA.
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30
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Ghanem RC, Nicoletti AGB, Cunha LP, Monteiro MLR. [Congenital anomalies of the optic disc associated with moyamoya disease: case report]. ARQUIVOS DE NEURO-PSIQUIATRIA 2005; 63:345-7. [PMID: 16100989 DOI: 10.1590/s0004-282x2005000200029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Congenital anomalies of the optic disc can be associated with intracranial vascular abnormalities. We report a 9-year old boy with morning glory disc anomaly in one eye and optic disc and infrapapilar choroidal coloboma in the other. His past medical history was remarkable for a transient ischemic attack. A magnetic resonance angiogram of the brain was consistent with moyamoya disease. This case illustrates the important association between optic disc abnormalities and moyamoya disease. Funduscopic examination of suspicious cases can be helpful in establishing the clinical diagnosis. Early identification of the intracranial vascular anomalies may be of help in preventing severe neurological complications.
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Affiliation(s)
- Ramon Coral Ghanem
- Divisão de Oftalmologia do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo SP, Brasil.
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31
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Sabti K, Hajj BA, Hwang JM, Traboulsi EI, Reid J. Congenital third nerve palsy, moyamoya disease and optic nerve head staphyloma. Br J Ophthalmol 2005; 89:778-9. [PMID: 15923525 PMCID: PMC1772674 DOI: 10.1136/bjo.2004.059246] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Quah BL, Hamilton J, Blaser S, Héon E, Tehrani NN. Morning glory disc anomaly, midline cranial defects and abnormal carotid circulation: an association worth looking for. Pediatr Radiol 2005; 35:525-8. [PMID: 15480611 DOI: 10.1007/s00247-004-1345-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2004] [Revised: 08/23/2004] [Accepted: 09/02/2004] [Indexed: 10/26/2022]
Abstract
We report on a 4-year-old boy who presented to the ophthalmology department for assessment of convergent strabismus. Ophthalmic examination showed a left morning glory optic disc anomaly and retinal detachment. Plain films obtained for investigation of short stature prior to ophthalmic examination revealed delayed bone age. Ophthalmological findings prompted CT and MRI imaging and angiographic investigations. Midline cranial defects and abnormal carotid circulation were identified. These findings may be associated with morning glory optic disc anomaly, and their association is often under-recognized. It is important that clinicians and radiologists be aware of this spectrum of disorders, as the vascular abnormalities may predispose the patient to transient ischemic attacks and strokes. Growth delay may result from hypopituitarism.
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Affiliation(s)
- Boon Long Quah
- Singapore National Eye Centre, Department of Ophthalmology, Kandang Kerbau Women's and Children's Hospital, Singapore
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Harissi-Dagher M, Sebag M, Dagher JH, Moumdjian R. Chorioretinal atrophy in a patient with moyamoya disease. Case report. J Neurosurg 2004; 101:843-5. [PMID: 15540924 DOI: 10.3171/jns.2004.101.5.0843] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Moyamoya disease is characterized by constrictions of segments of the internal carotid arteries (ICAs) and a resultant abnormal anastomotic network. In the literature, visual disturbances from cerebrovascular accidents in patients with moyamoya disease have been described, but very few reports of intraocular pathological conditions have been published. The authors describe a patient with moyamoya disease who presented with chorioretinal atrophy; an association between these two diseases has not previously been reported in the literature. Findings of a clinical ophthalmological evaluation and angiographic series are presented. During the fundic examination, evidence of chorioretinal atrophy was found in this patient. Choroidal vascular insufficiency was revealed by intravenous fluorescein angiography and occlusion of the ICAs proximal to the origin of the posterior communicating arteries by selective carotid and vertebral arteriography. The vertebrobasilar system provided anastomotic connections via the posterior communicating arteries. This is the first case report of chorioretinal atrophy associated with moyamoya disease. It is believed that the vasoocclusive effects of moyamoya disease may predispose the patient to atrophic changes in the peripheral retina. The development of an anastomotic network precludes the progression of this fundic anomaly.
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Affiliation(s)
- Mona Harissi-Dagher
- Department of Ophthalmology, University of Montreal Hospital Centres, Notre Dame Hospital, Quebec, Canada
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34
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Taşkintuna I, Oz O, Teke MY, Koçak H, Firat E. Morning glory syndrome: association with moyamoya disease, midline cranial defects, central nervous system anomalies, and persistent hyaloid artery remnant. Retina 2003; 23:400-2. [PMID: 12824843 DOI: 10.1097/00006982-200306000-00018] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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35
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Optic disc coloboma (the morning glory syndrome) and optic nerve coloboma associated with transsphenoidal meningoencephalocele. ACTA ACUST UNITED AC 2003. [DOI: 10.1016/s1571-4675(03)00008-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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36
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Abstract
Stroke is the second most common cause of death worldwide, exceeded only by heart disease. Epidemiologic studies have greatly enhanced our understanding of the factors that increase stroke risk. There have also been many recent developments in the understanding of the various etiologies of stroke as well as specific new treatments. The characteristic sudden onset and rapid tissue damage make stroke particularly challenging to treat. The most promising therapy for acute ischemic stroke is the use of a thrombolytic agent. This has been the focus of recent large trials and remains a challenging treatment for cerebral ischemic stroke as well as for retinal artery occlusion. Because neuro-ophthalmic symptoms and signs such as vision loss and diplopia are common in patients with stroke, patients are often seen by ophthalmologists prior to their primary care physicians or neurologists. The ophthalmologist should be aware of some of the new diagnostic and therapeutic issues in the management of patients with acute ischemic stroke. This review emphasizes some of the controversial topics published during the past few years.
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Affiliation(s)
- R A Egan
- Departments of Ophthalmology and Neurology, Oregon Health Sciences University, Portland, Oregon, USA.
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Abstract
Ocular colobomata present diagnostic and therapeutic challenges in patients of all ages, but especially in young children. The "typical" coloboma, caused by defective closure of the fetal fissure, is located in the inferonasal quadrant, and it may affect any part of the globe traversed by the fissure from the iris to the optic nerve. Ocular colobomata are often associated with microphthalmia, and they may be idiopathic or associated with various syndromes. Types and severity of complications vary depending on the location and size of the colobomata. This article reviews the pathogeneses, categorization, genetic bases, differential diagnoses and management of ocular coloboma.
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Affiliation(s)
- B C Onwochei
- Family Practice Departments of Schenectady Family Health Services and St. Clare's Hospital, Schenectady, NY, USA
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