Autonomic failure with persistent fever in cerebral gigantism

Sotos syndrome (cerebral gigantism): a clinical and radiological study of 14 cases from Saudi Arabia

Fourteen children (of Arab ethnic origin) with Sotos syndrome are described. They were referred to King Khalid University Hospital, Riyadh between July 1992 and June 1997. Their phenotypic characteristics were compared with established diagnostic criteria. There was a male:female ratio of 1.3:1 and a high rate of consanguinity (36%) among parents. At birth, 54% were large and about one-third showed increased height and occipitofrontal head circumference (OFHC). The neonatal histories revealed respiratory and feeding problems in 21%, followed later by delayed motor milestones and speech development in 57%. During childhood, weight, height and OFHC increased further to > 97th centile in 71%, 71% and 93%, respectively. A seizure disorder affected 43%, and 75% had mental retardation (IQ < 70). A non-specific EEG abnormality was found in half of those with seizures. Cranial CT/MRI showed ventricular dilatation in 15% and one patient had corpus callosum dysgenesis. Abdominal ultrasound revealed hydronephrosis in two patients. Radiological cephalometric measurements showed relative prognathism in cases of Sotos syndrome compared with controls (p = 0.003). The study highlights the importance of considering Sotos syndrome in children who present with psychomotor delay.

Cerebral gigantism with hydronephrosis: a case report

A case of cerebral gigantism with hydronephrosis in a 20-month-old boy is described. Hydronephrosis is believed to be an additional association of the syndrome not hitherto reported.

Thermoregulatory disorders after removal of a craniopharyngioma from the third cerebral ventricle

Aspiration and dissection of a cystic tumor from the third ventricle of a 3-year-old child resulted in several hypothalamic symptoms. One of the most persistent and troubling symptoms was marked hyperthermia which could not be traced to an infectious origin. The elevated temperature was not reduced by acetaminophen and there were abnormalities of circadian temperature cycles. In thermal stimulation tests the high body temperature was defended against induced cooling but the body temperature was raised above 40 degrees C without evoking physiological heat-loss responses and thermal discomfort. The unusual thermoregulatory status of this patient is similar to that seen in laboratory animals with hypothalamic lesions and to that observed with certain naturally occurring hypothalamic lesions in man. This dysthermia has been successfully treated with chlorpromazine.

Autonomic failure in hydrencephaly

Autonomic functions were studied in three patients with hydrencephalus and five with hydrocephalus. Autonomic failure of central origin was found in the patients with hydrencephalus; whereas, those suffering from hydrocephalus had essentially normal autonomic function. In two patients with hydrencephalus, the hypothalamus was markedly abnormal but the rest of the autonomic nervous system was histologically normal. From this it is concluded that in some patients with mental and motor retardation, autonomic failure may be of cerebral origin but that this is not a feature of patients with hydrocephalus.