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Ní Leidhin C, Erickson JP, Bynevelt M, Lam G, Lock JH, Wang G, Mankad K, Taranath A, Mason M, Lakshmanan R, Shipman P, Warne RR. (What's the story) morning glory? MRI findings in morning glory disc anomaly. Neuroradiology 2024; 66:1225-1233. [PMID: 38717474 DOI: 10.1007/s00234-024-03375-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/01/2024] [Indexed: 06/05/2024]
Abstract
PURPOSE Morning glory disc anomaly (MGDA) is a rare congenital ophthalmologic disorder. Historically it has been diagnosed fundoscopically, with little in the literature regarding its imaging findings. The purpose of this study is to further characterize the orbital and associated intracranial magnetic resonance imaging (MRI) findings of MGDA in our tertiary pediatric center. METHODS A retrospective review was performed of fundoscopically-diagnosed cases of MGDA, that had been referred for MRI. All MRI studies were scrutinized for orbital and other intracranial abnormalities known to occur in association with MGDA. RESULTS 18 of 19 cases of MGDA showed three characteristic MRI findings: funnel-shaped morphology of the posterior optic disc, abnormal soft tissue associated with the retrobulbar optic nerve, and effacement of adjacent subarachnoid spaces. The ipsilateral (intraorbital) optic nerve was larger in one patient and smaller in six. The ipsilateral optic chiasm was larger in two patients and smaller in one. CONCLUSION This study represents a comprehensive radiological-led investigation into MGDA. It describes the most frequently-encountered MRI findings in MGDA and emphasizes the importance of MRI in this cohort, i.e., in distinguishing MGDA from other posterior globe abnormalities, in assessing the visual pathway, and in screening for associated intracranial abnormalities - skull base/cerebral, vascular, and facial. It hypothesizes neurocristopathy as an underlying cause of MGDA and its associations. Caliber abnormalities of the ipsilateral optic nerve and chiasm are a frequent finding in MGDA. Optic pathway enlargement should not be labeled "glioma". (239/250).
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Affiliation(s)
- Caoilfhionn Ní Leidhin
- Department of Medical Imaging, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, WA 6009, Australia.
| | - Jonathan P Erickson
- Department of Medical Imaging, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, WA 6009, Australia
| | - Michael Bynevelt
- Department of Medical Imaging, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, WA 6009, Australia
| | - Geoffrey Lam
- Department of Ophthalmology, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, WA 6009, Australia
| | - Jane H Lock
- Department of Ophthalmology, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, WA 6009, Australia
| | - George Wang
- Department of Biostatistics, School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Kshitij Mankad
- Department of Paediatric Neuroradiology, Great Ormond Street Hospital for Children, London, England, UK
| | - Ajay Taranath
- Department of Medical Imaging, Women's and Children's Hospital, Adelaide, SA, Australia
| | - Michael Mason
- Department of Medical Imaging, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, WA 6009, Australia
| | - Rahul Lakshmanan
- Department of Medical Imaging, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, WA 6009, Australia
- Centre for Neuromuscular and Neurological Disorders (Perron Institute), University of Western Australia Medical School, Perth, WA, Australia
| | - Peter Shipman
- Department of Medical Imaging, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, WA 6009, Australia
| | - Richard R Warne
- Department of Medical Imaging, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, WA 6009, Australia
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Abstract
Optic nerve hypoplasia (ONH) is one of the most common causes of congenital visual impairment. It was first described in 1915 and represents a developmental disorder of the central nervous system. It is often associated with intracranial midline defects and is then referred to as septo-optic dysplasia (SOD). The symptoms of ONH range from minimal visual dysfunction to significant visual impairment with sensory defect nystagmus and even blindness. The ONH is often associated with further systemic, endocrinological and neurological abnormalities requiring a close interdisciplinary treatment of the patients.
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Urrets-Zavalía JA, Espósito E, Garay I, Monti R, Ruiz-Lascano A, Correa L, Serra HM, Grzybowski A. The eye and the skin in endocrine metabolic diseases. Clin Dermatol 2016; 34:151-65. [DOI: 10.1016/j.clindermatol.2015.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Oyakawa Barcelli Y, García Durruti P, Enes Romero P, Martín Frías M, Barrio Castellanos R. Morning glory syndrome associated with transsphenoidal encephalocele and panhypopituitarism. ENDOCRINOLOGIA Y NUTRICION : ORGANO DE LA SOCIEDAD ESPANOLA DE ENDOCRINOLOGIA Y NUTRICION 2014; 61:222-224. [PMID: 24418230 DOI: 10.1016/j.endonu.2013.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 11/16/2013] [Accepted: 11/20/2013] [Indexed: 06/03/2023]
Affiliation(s)
- Yoko Oyakawa Barcelli
- Unidad de diabetes pediátrica, Hospital Universitario Ramón y Cajal, Madrid, España.
| | | | - Patricia Enes Romero
- Unidad de diabetes pediátrica, Hospital Universitario Ramón y Cajal, Madrid, España
| | - María Martín Frías
- Unidad de diabetes pediátrica, Hospital Universitario Ramón y Cajal, Madrid, España
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Abstract
The optic disc represents the anterior end of the optic nerve, the most forward extension of the central nervous system (CNS). The optic disc gives a rare glimpse into the CNS. Hence, diseases of the CNS are often manifested on fundus examination. Abnormalities of the optic disc may reflect eye disease (such as glaucoma), problems in development (as in various syndromes), or CNS disease (such as increased intracranial pressure). Each optic nerve is composed of about 1.2 million axons deriving from the retinal ganglion cells of one eye. Optic atrophy is a morphological sequela reflecting the loss of many or all of these axons. Myriad diseases such as hereditary, metabolic, tumor, and increased intracranial pressure can lead to optic atrophy. Some diseases, such as optic disc drusen, intracranial masses, orbital tumors, ischemic optic neuropathies, inflammations, and infiltrations, can produce optic disc edema before leading to optic atrophy. A number of new imaging modalities, such as optical coherence tomography (OCT), quantitate the thickness of the peripapillary retinal nerve fiber layer as an indirect measure of axonal loss or swelling. OCT can therefore be used to quantitate pathology or the response to therapy in various generalized CNS conditions, such as multiple sclerosis.
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Affiliation(s)
- Alfredo A Sadun
- Departments of Ophthalmology and Neurosurgery, Doheny Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
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Metry D, Heyer G, Hess C, Garzon M, Haggstrom A, Frommelt P, Adams D, Siegel D, Hall K, Powell J, Frieden I, Drolet B. Consensus Statement on Diagnostic Criteria for PHACE Syndrome. Pediatrics 2009; 124:1447-56. [PMID: 19858157 DOI: 10.1542/peds.2009-0082] [Citation(s) in RCA: 231] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES A subgroup of patients with infantile hemangiomas have associated structural anomalies of the brain, cerebral vasculature, eyes, sternum, and/or aorta in the neurocutaneous disorder known as PHACE syndrome. The diagnosis has been broadly inclusive by using a case definition of a facial hemangioma plus >or=1 extracutaneous features, leading to numerous reports of potential associated disease features, many of uncertain significance. This consensus statement was thus developed to establish diagnostic criteria for PHACE syndrome. METHODS A multidisciplinary group of specialists with expertise in PHACE syndrome drafted initial diagnostic criteria on the basis of review of published, peer-reviewed medical literature and clinical experience. The group then convened in both executive and general sessions during the PHACE Syndrome Research Conference held in November 2008 for discussion and used a consensus method. All conflicting recommendations were subsequently reconciled via electronic communication and teleconferencing. RESULTS These criteria were stratified into 2 categories: (1) PHACE syndrome or (2) possible PHACE syndrome. Major and minor criteria were determined for the following organ systems: cerebrovascular, structural brain, cardiovascular, ocular, and ventral/midline. Definite PHACE requires the presence of a characteristic segmental hemangioma or hemangioma >5 cm on the face or scalp plus 1 major criterion or 2 minor criteria. Possible PHACE requires the presence of a hemangioma >5 cm on the face or scalp plus 1 minor criterion. The group recognized that it may be possible to have PHACE syndrome with a hemangioma affecting the neck, chest, or arm only or no cutaneous hemangioma at all. In such cases, fulfillment of additional required criteria would also lead to a possible PHACE diagnosis. CONCLUSIONS These criteria represent current knowledge and are expected to enhance future assessments of PHACE syndrome. It is understood that modifications are to be expected over time to incorporate new research findings.
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Affiliation(s)
- Denise Metry
- Department of Dermatology, Baylor College of Medicine, Houston, Texas, USA
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Metry DW, Garzon MC, Drolet BA, Frommelt P, Haggstrom A, Hall J, Hess CP, Heyer GL, Siegel D, Baselga E, Katowitz W, Levy ML, Mancini A, Maronn ML, Phung T, Pope E, Sun G, Frieden IJ. PHACE syndrome: current knowledge, future directions. Pediatr Dermatol 2009; 26:381-98. [PMID: 19689512 DOI: 10.1111/j.1525-1470.2009.00944.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
On November 7-8, 2008, physicians gathered in Houston Texas for the first-ever workshop on PHACE syndrome, an important and recently described neurocutaneous syndrome. This article represents a summary of the discussions held at that workshop, which was attended by a broad range of medical specialists.
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Affiliation(s)
- Denise W Metry
- Baylor College of Medicine, Houston, Texas 77030-2399, USA.
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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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Chaudhuri Z, Grover AK, Bageja S, Jha SN, Mohan S. Morning glory anomaly with bilateral choroidal colobomas in a patient with Goldenhar's syndrome. J Pediatr Ophthalmol Strabismus 2007; 44:187-9. [PMID: 17542443 DOI: 10.3928/0191-3913-20070301-15] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A child with Goldenhar's syndrome, bilateral choroidal colobomas, and a morning glory anomaly of the optic disk in one eye is described. Bilateral posterior segment anomalies associated with Goldenhar's syndrome are rare. An association between the morning glory anomaly and Goldenhar's syndrome has not been previously reported.
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Affiliation(s)
- Zia Chaudhuri
- Department of Ophthalmology, Sir Ganga Ram Hospital, New Delhi, India
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Trabelsi L, Mnif M, Rekik N, Kaffel N, Charfi N, Mnif J, Kchaow MS, Abid M. Anomalies de la tige pituitaire à l’IRM : aspects étiologiques à propos de 11 cas. ANNALES D'ENDOCRINOLOGIE 2006; 67:604-12. [PMID: 17194972 DOI: 10.1016/s0003-4266(06)73014-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Newer techniques of magnetic resonance imaging (MRI) describe more accurately pituitary stalk abnormalities such as infections, infiltrative lesions and tumors. In absence of all the above mentioned etiological factors, genetics defects are suspected, mainly when other malformations are equally present. We attempt to show through 11 observations the variability of pathologies involving the pituitary stalk with their respective clinical and radiological features and associated endocrine abnormalities. This is a retrospective study of 7 men (67%) and 4 women (33%), mean age of 28 year (range: 15 to 53) in whom pituitary MRI was performed for hypopituitarism, diabetes insipidus or hyperprolactinemia. Three patients had brain MRI for an extra-pituitary condition. The pituitary MRI showed a stalk section in 3 cases (27%), atrophy in 1 case and thickening in 7 cases (67%). The pituitary stalk anomaly was associated with hyperprolactinemia in 3 cases (27%), central diabetes insipidus in 4 cases (36%), growth hormone deficiency in 4 cases (36%), adrenal insufficiency in 5 cases (45%), hypogonadism in 5 cases (45%) and hypothyroidism in one case (9%). Established diagnoses were: sellar metastasis in 2 cases (18%), Langerhans' histocytosis, tuberculosis and autoimmune hypophysitis respectively in 3 cases (9%). In 6 cases (54%), no clear etiology was found. Given the multitude of pituitary stalk pathologies, a detailed etiologic inquiry must be performed in order to detect elements able to reclassify an initially idiopathic disorder.
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Affiliation(s)
- L Trabelsi
- Service d'Endocrinologie, CHU Hédi Chaker, Sfax, 3029 Tunisia.
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Sanjari MS, Falavarjani KG, Kashkouli MB. Bilateral peripapillary staphyloma, a clinicoradiological report. Br J Ophthalmol 2006; 90:1326-7. [PMID: 16980649 PMCID: PMC1857442 DOI: 10.1136/bjo.2006.096362] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2006] [Indexed: 11/03/2022]
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Metry DW, Haggstrom AN, Drolet BA, Baselga E, Chamlin S, Garzon M, Horii K, Lucky A, Mancini AJ, Newell B, Nopper A, Heyer G, Frieden IJ. A prospective study of PHACE syndrome in infantile hemangiomas: demographic features, clinical findings, and complications. Am J Med Genet A 2006; 140:975-86. [PMID: 16575892 DOI: 10.1002/ajmg.a.31189] [Citation(s) in RCA: 183] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PHACE (OMIM no. 606519) is a neurocutaneous syndrome that refers to the association of large, plaque-like, "segmental" hemangiomas of the face, with one or more of the following anomalies: posterior fossa brain malformations, arterial cerebrovascular anomalies, cardiovascular anomalies, eye anomalies, and ventral developmental defects, specifically sternal defects and/or supraumbilical raphe. The etiology and pathogenesis of PHACE is unknown, and potential risk factors for the syndrome have not been systematically studied. The purpose of this study was thus to determine (1) the incidence of PHACE and associated anomalies among a large cohort of hemangioma patients, (2) whether certain demographic, prenatal or perinatal risk factors predispose infants to this syndrome, and (3) whether the cutaneous distribution of the hemangioma can be correlated to the types of anomalies present. We undertook a prospective, cohort study of 1,096 children with hemangiomas, 25 of whom met criteria for PHACE. These 25 patients represented 20% of infants with segmental facial hemangiomas. Compared to previous reports, our PHACE patients had a higher incidence of cerebrovascular and cardiovascular anomalies. Two developed acute arterial ischemic stroke during infancy, while two with cardiovascular anomalies showed documented evidence of normalization, suggesting that both progressive and regressive vascular phenomena may occur in this syndrome. Correlation to the anatomic location of the hemangioma appears to be helpful in determining which structural abnormalities might be present. A comparison of demographic and perinatal data between our PHACE cases and the hemangioma cohort overall showed no major differences, except a trend for PHACE infants to be of slighter higher gestational age and born to slightly older mothers. Eighty-eight percent were female, a finding which has been noted in multiple other reports. Further research is needed to determine possible etiologies, optimal evaluation, and outcomes.
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Affiliation(s)
- D W Metry
- Department of Dermatology, Baylor College of Medicine, Houston, Texas, USA.
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Stefánsson E. Scientific contributions and citations. ACTA OPHTHALMOLOGICA SCANDINAVICA 2005; 83:275-7. [PMID: 15948776 DOI: 10.1111/j.1600-0420.2005.00504.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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15
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Kinoshita K, Kazukawa I, Hashimoto Y, Uchikawa H, Morita Y, Goto K, Takeda N, Minagawa M, Kohno Y. Hypothalamic Hypopituitarism Presenting with Pituitary Malformation and Morning Glory Syndrome: A Case Report. Clin Pediatr Endocrinol 2005. [DOI: 10.1297/cpe.14.s24_97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Kaori Kinoshita
- Department of Pediatrics, Graduate School of Medicine, Chiba University
| | - Itsuro Kazukawa
- Department of Pediatrics, Graduate School of Medicine, Chiba University
| | - Yuji Hashimoto
- Department of Pediatrics, Graduate School of Medicine, Chiba University
| | - Hideki Uchikawa
- Department of Pediatrics, Graduate School of Medicine, Chiba University
| | - Yoshinori Morita
- Department of Pediatrics, Graduate School of Medicine, Chiba University
| | - Kumiko Goto
- Department of Pediatrics, Graduate School of Medicine, Chiba University
| | - Nobue Takeda
- Department of Pediatrics, Graduate School of Medicine, Chiba University
| | - Masanori Minagawa
- Department of Pediatrics, Graduate School of Medicine, Chiba University
| | - Yoichi Kohno
- Department of Pediatrics, Graduate School of Medicine, Chiba University
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