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Cecchetto G, Milanese L, Giordano R, Viero A, Suma V, Manara R. Looking at the missing brain: hydranencephaly case series and literature review. Pediatr Neurol 2013; 48:152-8. [PMID: 23337012 DOI: 10.1016/j.pediatrneurol.2012.10.009] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Accepted: 10/10/2012] [Indexed: 11/29/2022]
Abstract
Hydranencephaly is a severe congenital condition where most of the cerebral hemispheres are replaced by a membranous sac. Despite the growing amount of case reports, most pathogenic, phenotypic, and prognostic aspects of hydranencephaly remain controversial. By matching the recent literature data with the findings of our own series (four cases: two fetuses at the twelfth gestational week, a 32-year-old man, and a 14-year-old female), we attempted to date back the insult leading to hydranencephaly to understand its pathogenesis and to explain the basis of its protean phenotype. The variable detection of cerebral remnants seems to mirror the developmental pathway of cerebral arteries. Moreover, fetal and postnatal neuroimaging data and histopathologic findings point toward an early bilateral internal carotid artery occlusion, mostly occurring between the eighth and twelfth gestational weeks, as the main pathogenic mechanism of hydranencephaly.
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Affiliation(s)
- Giovanni Cecchetto
- Department of Molecular Medicine, Section of Legal Medicine, University of Padova, Padua, Italy
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Negi M, Kobayashi D, Kumagai J, Kuroiwa T, Shiraishi J, Takemura T, Irahara K, Hayashi M, Eishi Y. An autopsy case of congenital hydrocephalus and severe thinning of the cerebral cortex in a 4-year-old boy. Neuropathology 2010; 30:559-63. [PMID: 20667020 DOI: 10.1111/j.1440-1789.2010.01138.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Mariko Negi
- Department of Human Pathology, Graduate School, Tokyo Medical and Dental UniversityDepartments of PathologyPediatrics, Japan Red Cross Medical CenterDepartment of Clinical Neuropathology, Tokyo Metropolitan Institute for Neuroscience, TokyoLaboratory of Clinical Medicine, Namegata District General Hospital, Ibaraki, Japan
| | - Daisuke Kobayashi
- Department of Human Pathology, Graduate School, Tokyo Medical and Dental UniversityDepartments of PathologyPediatrics, Japan Red Cross Medical CenterDepartment of Clinical Neuropathology, Tokyo Metropolitan Institute for Neuroscience, TokyoLaboratory of Clinical Medicine, Namegata District General Hospital, Ibaraki, Japan
| | - Jiro Kumagai
- Department of Human Pathology, Graduate School, Tokyo Medical and Dental UniversityDepartments of PathologyPediatrics, Japan Red Cross Medical CenterDepartment of Clinical Neuropathology, Tokyo Metropolitan Institute for Neuroscience, TokyoLaboratory of Clinical Medicine, Namegata District General Hospital, Ibaraki, Japan
| | - Toshihiko Kuroiwa
- Department of Human Pathology, Graduate School, Tokyo Medical and Dental UniversityDepartments of PathologyPediatrics, Japan Red Cross Medical CenterDepartment of Clinical Neuropathology, Tokyo Metropolitan Institute for Neuroscience, TokyoLaboratory of Clinical Medicine, Namegata District General Hospital, Ibaraki, Japan
| | - Junichi Shiraishi
- Department of Human Pathology, Graduate School, Tokyo Medical and Dental UniversityDepartments of PathologyPediatrics, Japan Red Cross Medical CenterDepartment of Clinical Neuropathology, Tokyo Metropolitan Institute for Neuroscience, TokyoLaboratory of Clinical Medicine, Namegata District General Hospital, Ibaraki, Japan
| | - Tamiko Takemura
- Department of Human Pathology, Graduate School, Tokyo Medical and Dental UniversityDepartments of PathologyPediatrics, Japan Red Cross Medical CenterDepartment of Clinical Neuropathology, Tokyo Metropolitan Institute for Neuroscience, TokyoLaboratory of Clinical Medicine, Namegata District General Hospital, Ibaraki, Japan
| | - Kaori Irahara
- Department of Human Pathology, Graduate School, Tokyo Medical and Dental UniversityDepartments of PathologyPediatrics, Japan Red Cross Medical CenterDepartment of Clinical Neuropathology, Tokyo Metropolitan Institute for Neuroscience, TokyoLaboratory of Clinical Medicine, Namegata District General Hospital, Ibaraki, Japan
| | - Masaharu Hayashi
- Department of Human Pathology, Graduate School, Tokyo Medical and Dental UniversityDepartments of PathologyPediatrics, Japan Red Cross Medical CenterDepartment of Clinical Neuropathology, Tokyo Metropolitan Institute for Neuroscience, TokyoLaboratory of Clinical Medicine, Namegata District General Hospital, Ibaraki, Japan
| | - Yoshinobu Eishi
- Department of Human Pathology, Graduate School, Tokyo Medical and Dental UniversityDepartments of PathologyPediatrics, Japan Red Cross Medical CenterDepartment of Clinical Neuropathology, Tokyo Metropolitan Institute for Neuroscience, TokyoLaboratory of Clinical Medicine, Namegata District General Hospital, Ibaraki, Japan
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Abstract
Hydranencephaly is a rare and fatal central nervous system disorder where all or nearly all of the bilateral cerebral hemispheres are absent. The extensive hollow cerebrum is replaced with cerebrospinal fluid. Clinically, the differential diagnoses of hydranencephaly include severe hydrocephalus and alobar holoprosencephaly. Nearly all cases are sporadic, involving approximately 1 in 5000 continuing pregnancies. The exact main cause is still unknown, but hydranencephaly is usually found to develop secondarily to the occlusion of cerebral arteries above the supraclinoid level. We present the case of a 1-month-old male infant with hydranencephaly initially thought to be severely hydrocephalus via routine antenatal intrauterine sonography performed at 35 weeks of gestation. Hydranencephaly was confirmed by brain sonography, brain magnetic resonance imaging and magnetic resonance angiography postnatally. We discuss several imaging features that are helpful in distinguishing hydranencephaly from extreme hydrocephaly. Different theories that have been recently proposed regarding the origin of hydranencephaly are reviewed.
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