1
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Metry D, Copp HL, Rialon KL, Iacobas I, Baselga E, Dobyns WB, Drolet B, Frieden IJ, Garzon M, Haggstrom A, Hanson D, Hollenbach L, Keppler-Noreuil KM, Maheshwari M, Siegel DH, Waseem S, Dias M. Delphi Consensus on Diagnostic Criteria for LUMBAR Syndrome. J Pediatr 2024; 272:114101. [PMID: 38759778 DOI: 10.1016/j.jpeds.2024.114101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 05/02/2024] [Accepted: 05/09/2024] [Indexed: 05/19/2024]
Abstract
OBJECTIVE To develop consensus on diagnostic criteria for LUMBAR syndrome, the association of segmental infantile hemangiomas that affect the Lower body with Urogenital anomalies, Ulceration, spinal cord Malformations, Bony defects, Anorectal malformations, Arterial anomalies and/or Renal anomalies. STUDY DESIGN These diagnostic criteria were developed by an expert multidisciplinary and multi-institutional team based on analysis of peer-reviewed data, followed by electronic-Delphi consensus of a panel of 61 international pediatric specialists. RESULTS After 2 Delphi rounds, a 92% or higher level of agreement was reached for each Delphi statement. 98% of panelists agreed with the diagnostic criteria, and 100% agreed the criteria would be useful in clinical practice. The diagnosis of LUMBAR requires the presence of a segmental, or patterned, infantile hemangioma of the lumbosacral, sacrococcygeal, or pelvic cutaneous regions plus one additional criterion of the urogenital, spinal, bony, anorectal, arterial, or renal organ systems. CONCLUSIONS These diagnostic criteria will enhance clinical care by improving screening, detection, and overall awareness of this poorly understood neurocutaneous disorder. The criteria can be utilized by a wide variety of pediatric subspecialists. In addition, formal criteria will improve phenotypic uniformity among LUMBAR syndrome cohorts and a patient registry, allowing investigators to assess clinical features, long-term outcomes, and results of genetic sequencing in a standardized manner. Finally, these criteria will serve as a starting point for prospective studies to establish formal screening and management guidelines.
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Affiliation(s)
- Denise Metry
- Department of Dermatology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Hillary L Copp
- Department of Urology, University of California-San Francisco, San Francisco, CA
| | - Kristy L Rialon
- Department of Surgery, Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Ionela Iacobas
- Department of Pediatrics, Cancer and Hematology Centers, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Eulalia Baselga
- Department of Dermatology, Hospital San Joan de Deu, Barcelona, Spain
| | - William B Dobyns
- Department of Genetics, University of Minnesota, Minneapolis, MN
| | - Beth Drolet
- Department of Dermatology, University of Wisconsin, Madison, WI
| | - Ilona J Frieden
- Department of Dermatology and Pediatrics, University of California, San Francisco, San Francisco, CA
| | - Maria Garzon
- Department of Dermatology and Pediatrics, Columbia University, New York, NY
| | - Anita Haggstrom
- Department of Dermatology, Indiana University, Indianapolis, IN
| | - Darrell Hanson
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX
| | - Laura Hollenbach
- Department of Gynecology, University of Arkansas, Fayetteville, AR
| | | | - Mohit Maheshwari
- Department of Radiology, Medical College of Wisconsin, Madison, WI
| | - Dawn H Siegel
- Department of Dermatology, Stanford University, Stanford, CA
| | - Shamaila Waseem
- Department of Gastroenterology, Indiana University School of Medicine, Indianapolis, IN
| | - Mark Dias
- Department of Neurosurgery, Pennsylvania State College of Medicine, Hershey, PA
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2
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Siegel DH, Frieden IJ. Are repeat neuroimaging studies needed in PHACE syndrome? Dev Med Child Neurol 2024. [PMID: 38654637 DOI: 10.1111/dmcn.15945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 04/09/2024] [Indexed: 04/26/2024]
Affiliation(s)
- Dawn H Siegel
- Stanford University School of Medicine, Dermatology, Stanford, CA, USA
| | - Ilona J Frieden
- University of California San Francisco, Dermatology and Pediatrics, San Francisco, CA, USA
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Hausman-Kedem M, Widjaja E, Vieira Neto RJ, Pope E, Lara-Corrales I, Dlamini N, Macgregor D, Pulcine E, Deveber G, Moharir M. Long-term clinical and radiological trajectories of craniocervical vasculopathy in children with PHACE syndrome. Dev Med Child Neurol 2024. [PMID: 38597798 DOI: 10.1111/dmcn.15916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 02/15/2024] [Accepted: 02/26/2024] [Indexed: 04/11/2024]
Abstract
AIM To describe the rates of stroke and craniocervical vasculopathy progression in children with posterior fossa malformations, hemangioma, arterial anomalies, coarctation of the aorta/cardiac defects, and eye abnormalities (PHACE) syndrome. METHOD A single-center, retrospective natural history study of children with PHACE syndrome. Clinical and sequential neuroimaging data were reviewed to study the characteristics and progression of vasculopathy and calculate the rates of arterial ischemic stroke (AIS) and transient ischemic stroke (TIA). Vasculopathy progression was defined as worsening or new vascular findings on follow-up magnetic resonance angiography. RESULTS Thirty-four children with cerebrovascular abnormalities at the PHACE syndrome diagnosis were studied (age range = 2 to 18 years, 85% females). Median age at the initial diagnosis was 5.5 months (interquartile range = 1-52 months); median age at the last follow-up was 8 years 6 months (range = 2-18 years). Overall, 10 (29%) patients had radiological progression of their vasculopathy, with a cumulative progression-free rate of 73% (95% confidence interval [CI] = 0.57-0.89), and a cumulative TIA-free and AIS-free rate of 87% (95% CI = 0.745-0.99). Vasculopathy was continuously progressive in six patients (18%) at the last follow-up. Three patients (9%) had TIA and all had progressive vasculopathy. One patient had presumed perinatal AIS at the initial PHACE diagnosis, while no other patient experienced an AIS during the follow-up. INTERPRETATION In children with PHACE syndrome, craniocervical vasculopathy is non-progressive and asymptomatic in the majority of cases. The risk of ischemic stroke in these children is very low. Larger and prospective studies are necessary to confirm these findings.
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Affiliation(s)
- Moran Hausman-Kedem
- Tel Aviv Sourasky Medical Center, Pediatric Neurology Institute, Dana-Dwek Children's Hospital, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elysa Widjaja
- Division of Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital, Chicago, USA
| | - Ronan J Vieira Neto
- Department of Pediatric Neurology, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Elena Pope
- Division of Dermatology, Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Irene Lara-Corrales
- Division of Dermatology, Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Nomazulu Dlamini
- Children's Stroke Program, Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Daune Macgregor
- Children's Stroke Program, Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Elizabeth Pulcine
- Children's Stroke Program, Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Gabrielle Deveber
- Children's Stroke Program, Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Mahendranath Moharir
- Children's Stroke Program, Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
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Di Nora A, Pizzo F, Testaì M, Gulizia C, Pavone P. Beard neonatal hemangioma: report of a PHACE syndrome. Acta Neurol Belg 2024; 124:727-728. [PMID: 38104298 DOI: 10.1007/s13760-023-02450-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 11/27/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Alessandra Di Nora
- Department of Clinical and Experimental Medicine, University of Catania, Via S. Sofia 78, 95123, Catania, Italy.
| | - Francesco Pizzo
- Department of Clinical and Experimental Medicine, University of Catania, Via S. Sofia 78, 95123, Catania, Italy
| | - Martina Testaì
- Department of Clinical and Experimental Medicine, University of Catania, Via S. Sofia 78, 95123, Catania, Italy
| | - Carmela Gulizia
- Department of Clinical and Experimental Medicine, University of Catania, Via S. Sofia 78, 95123, Catania, Italy
| | - Piero Pavone
- Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, AOU "Policlinico", PO "G. Rodolico", Via S. Sofia, 87, 95128, Catania, Italy
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5
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Braun M, Frieden IJ, Siegel DH, George E, Hess CP, Fox CK, Chamlin SL, Drolet BA, Metry D, Pope E, Powell J, Holland K, Ulschmid C, Liang MG, Barry KK, Ho T, Cotter C, Baselga E, Bosquez D, Jain SN, Bui JK, Lara-Corrales I, Funk T, Small A, Baghoomian W, Yan AC, Treat JR, Hogrogian GS, Huang C, Haggstrom A, List M, McCuaig CC, Barrio V, Mancini AJ, Lawley LP, Grunnet-Satcher K, Horii KA, Newell B, Nopper A, Garzon MC, Scollan ME, Mathes EF. Multicenter Study of Long-Term Outcomes and Quality of Life in PHACE Syndrome after Age 10. J Pediatr 2024; 267:113907. [PMID: 38218370 DOI: 10.1016/j.jpeds.2024.113907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/23/2023] [Accepted: 01/09/2024] [Indexed: 01/15/2024]
Abstract
OBJECTIVE To characterize long-term outcomes of PHACE syndrome. STUDY DESIGN Multicenter study with cross-sectional interviews and chart review of individuals with definite PHACE syndrome ≥10 years of age. Data from charts were collected across multiple PHACE-related topics. Data not available in charts were collected from patients directly. Likert scales were used to assess the impact of specific findings. Patient-Reported Outcomes Measurement Information System (PROMIS) scales were used to assess quality of life domains. RESULTS A total of 104/153 (68%) individuals contacted participated in the study at a median of 14 years of age (range 10-77 years). There were infantile hemangioma (IH) residua in 94.1%. Approximately one-half had received laser treatment for residual IH, and the majority (89.5%) of participants were satisfied or very satisfied with the appearance. Neurocognitive manifestations were common including headaches/migraines (72.1%), participant-reported learning differences (45.1%), and need for individualized education plans (39.4%). Cerebrovascular arteriopathy was present in 91.3%, with progression identified in 20/68 (29.4%) of those with available follow-up imaging reports. Among these, 6/68 (8.8%) developed moyamoya vasculopathy or progressive stenoocclusion, leading to isolated circulation at or above the level of the circle of Willis. Despite the prevalence of cerebrovascular arteriopathy, the proportion of those with ischemic stroke was low (2/104; 1.9%). PROMIS global health scores were lower than population norms by at least 1 SD. CONCLUSIONS PHACE syndrome is associated with long-term, mild to severe morbidities including IH residua, headaches, learning differences, and progressive arteriopathy. Primary and specialty follow-up care is critical for PHACE patients into adulthood.
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Affiliation(s)
- Mitchell Braun
- University of California San Francisco, School of Medicine, San Francisco, CA; Department of Dermatology, University of California San Francisco, San Francisco, CA
| | - Ilona J Frieden
- Department of Dermatology, University of California San Francisco, San Francisco, CA
| | - Dawn H Siegel
- Department of Dermatology, Stanford University, Palo Alto, CA
| | - Elizabeth George
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - Christopher P Hess
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - Christine K Fox
- Department of Neurology and Pediatrics, University of California San Francisco, San Francisco, CA
| | - Sarah L Chamlin
- Department of Dermatology, Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Beth A Drolet
- Department of Dermatology, University of Wisconsin Madison, Madison, WI
| | - Denise Metry
- Department of Dermatology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Elena Pope
- Division of Pediatric Dermatology, Hospital for Sick Children, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Julie Powell
- Division of Dermatology, Department of Pediatrics, Sainte-Justine University Hospital Center, University of Montreal, Montreal, Quebec, Canada
| | - Kristen Holland
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI
| | - Caden Ulschmid
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI
| | - Marilyn G Liang
- Department of Dermatology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Kelly K Barry
- Department of Dermatology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Tina Ho
- Department of Dermatology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Chantal Cotter
- Department of Dermatology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Eulalia Baselga
- Department of Dermatology, Hospital de la Sant Pau, Barcelona, Spain
| | - David Bosquez
- Department of Dermatology, Hospital de la Sant Pau, Barcelona, Spain
| | | | - Jordan K Bui
- Department of Dermatology, Stanford University, Palo Alto, CA
| | - Irene Lara-Corrales
- Division of Pediatric Dermatology, Hospital for Sick Children, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Tracy Funk
- Departments of Dermatology and Pediatrics, Oregon Health & Science University, Portland, OR
| | - Alison Small
- Departments of Dermatology and Pediatrics, Oregon Health & Science University, Portland, OR
| | - Wenelia Baghoomian
- Departments of Dermatology and Pediatrics, Oregon Health & Science University, Portland, OR
| | - Albert C Yan
- Department of Pediatrics and Dermatology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - James R Treat
- Department of Pediatrics and Dermatology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Griffin Stockton Hogrogian
- Department of Pediatrics and Dermatology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Charles Huang
- Department of Pediatrics and Dermatology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Anita Haggstrom
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN
| | - Mary List
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN
| | - Catherine C McCuaig
- Division of Dermatology, Department of Pediatrics, Sainte-Justine University Hospital Center, University of Montreal, Montreal, Quebec, Canada
| | - Victoria Barrio
- Department of Dermatology, Rady Children's Hospital, University of California San Diego, San Diego, CA
| | - Anthony J Mancini
- Department of Dermatology, Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Leslie P Lawley
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA
| | | | - Kimberly A Horii
- Division of Dermatology, Children's Mercy Hospital and Clinics, Kansas City, MO
| | - Brandon Newell
- Division of Dermatology, Children's Mercy Hospital and Clinics, Kansas City, MO
| | - Amy Nopper
- Division of Dermatology, Children's Mercy Hospital and Clinics, Kansas City, MO
| | - Maria C Garzon
- Department of Dermatology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Margaret E Scollan
- Department of Dermatology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Erin F Mathes
- Department of Dermatology, University of California San Francisco, San Francisco, CA.
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6
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Wiśniewski K, Tyfa Z, Reorowicz P, Brandel MG, Adel T, Obidowski D, Jóźwik K, Levy ML. Numerical flow experiment for assessing predictors for cerebrovascular accidents in patients with PHACES syndrome. Sci Rep 2024; 14:5161. [PMID: 38431727 PMCID: PMC10908848 DOI: 10.1038/s41598-024-55345-6] [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: 04/02/2023] [Accepted: 02/22/2024] [Indexed: 03/05/2024] Open
Abstract
There is an increased risk of cerebrovascular accidents (CVA) in individuals with PHACES, yet the precise causes are not well understood. In this analysis, we aimed to examine the role of arteriopathy in PHACES syndrome as a potential contributor to CVA. We analyzed clinical and radiological data from 282 patients with suspected PHACES syndrome. We analyzed clinical features, including the presence of infantile hemangioma and radiological features based on magnetic resonance angiography or computed tomography angiography, in individuals with PHACES syndrome according to the Garzon criteria. To analyze intravascular blood flow, we conducted a simulation based on the Fluid-Structure Interaction (FSI) method, utilizing radiological data. The collected data underwent statistical analysis. Twenty patients with PHACES syndrome were included. CVAs were noted in 6 cases. Hypoplasia (p = 0.03), severe tortuosity (p < 0.01), absence of at least one main cerebral artery (p < 0.01), and presence of persistent arteries (p = 0.01) were associated with CVAs, with severe tortuosity being the strongest predictor. The in-silico analysis showed that the combination of hypoplasia and severe tortuosity resulted in a strongly thrombogenic environment. Severe tortuosity, combined with hypoplasia, is sufficient to create a hemodynamic environment conducive to thrombus formation and should be considered high-risk for cerebrovascular accidents (CVAs) in PHACES patients.
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Affiliation(s)
- Karol Wiśniewski
- Department of Neurosurgery, University of California, San Diego-Rady Children's Hospital, San Diego, CA, 92123, USA.
- Department of Neurosurgery and Neurooncology, Medical University of Lodz, Barlicki University Hospital, Kopcińskiego 22, 90-153, Lodz, Poland.
- Institute of Turbomachinery, Lodz University of Technology, 219/223 Wolczanska Str., 90-924, Lodz, Poland.
| | - Zbigniew Tyfa
- Institute of Turbomachinery, Lodz University of Technology, 219/223 Wolczanska Str., 90-924, Lodz, Poland
| | - Piotr Reorowicz
- Institute of Turbomachinery, Lodz University of Technology, 219/223 Wolczanska Str., 90-924, Lodz, Poland
| | - Michael G Brandel
- Department of Neurosurgery, University of California, San Diego-Rady Children's Hospital, San Diego, CA, 92123, USA
| | - Thomas Adel
- Department of Neurosurgery, University of California, San Diego-Rady Children's Hospital, San Diego, CA, 92123, USA
- Medical University of Vienna, Spitalgasse 23 Str., 1090, Wien, Austria
| | - Damian Obidowski
- Institute of Turbomachinery, Lodz University of Technology, 219/223 Wolczanska Str., 90-924, Lodz, Poland
| | - Krzysztof Jóźwik
- Institute of Turbomachinery, Lodz University of Technology, 219/223 Wolczanska Str., 90-924, Lodz, Poland
| | - Michael L Levy
- Department of Neurosurgery, University of California, San Diego-Rady Children's Hospital, San Diego, CA, 92123, USA
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7
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Lamotte M, Paris C, Euvrard E, Pomero E, Schwartz C, Vené Y, Aubin F, Puzenat E. Long-term follow-up of patients with extensive segmental infantile hemangioma of the cervical or facial region: A French single-center prospective study. Arch Pediatr 2023:S0929-693X(23)00057-X. [PMID: 37188563 DOI: 10.1016/j.arcped.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 01/29/2023] [Accepted: 03/25/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Infantile hemangiomas (IHs) can be part of PHACE (posterior fossa anomalies, hemangioma, arterial anomalies, cardiac anomalies, eye anomalies) syndrome when they are segmental, extensive, and located on the face or neck. The initial assessment is codified and well known, but there are no recommendations for the follow-up of these patients. The aim of this study was to assess the long-term prevalence of different associated abnormalities. METHODS Patients with a history of large segmental IHs of the face or neck. diagnosed between 2011 and 2016 were included in the study. Each patient underwent an ophthalmological, dental, ENT (ear, nose, and throat), dermatological, neuro-pediatric, and radiological assessment at inclusion. Eight patients including five with PHACE syndrome were prospectively evaluated. RESULTS After a mean follow-up of 8.5 years, three patients presented with an angiomatous aspect of the oral mucosa, two with hearing loss, and two with otoscopic abnormalities. No patients developed ophthalmological abnormalities. The neurological examination was altered in three cases. Brain magnetic resonance imaging follow-up was unchanged in three out four patients and revealed atrophy of the cerebellar vermis in 1 patient. Neurodevelopmental disorders were found in five of the patients and learning difficulties were observed in five patients. The S1 location appears to be associated with a higher risk of neurodevelopmental disorders and cerebellar malformations, while the S3 location was associated with more progressive complications, including neurovascular, cardiovascular, and ENT abnormalities. CONCLUSION Our study reported late complications in patients with a large segmental IH of the face or neck, whether associated with PHACE syndrome or not, and we proposed an algorithm to optimize the long-term follow-up.
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Affiliation(s)
- M Lamotte
- Service de Dermatologie, Université de Franche Comté, Centre Hospitalier Universitaire, Besançon, France
| | - C Paris
- Service de Pédiatrie, Université de Franche Comté, Centre Hospitalier Universitaire, Besançon, France
| | - E Euvrard
- Service de Chirurgie maxillo-faciale, Stomatologie et Odontologie hospitalière, Université de Franche Comté, Centre Hospitalier Universitaire, Besançon, France
| | - E Pomero
- Service de Radiologie, Université de Franche Comté, Centre Hospitalier Universitaire, Besançon, France
| | - C Schwartz
- Service d'Ophtalmologie, Université de Franche Comté, Centre Hospitalier Universitaire, Besançon, France
| | - Y Vené
- Service d'ORL, Université de Franche Comté, Centre Hospitalier Universitaire, Besançon, France
| | - F Aubin
- Service de Dermatologie, Université de Franche Comté, Centre Hospitalier Universitaire, Besançon, France; Inserm UMR 1098 RIGHT, Besançon, France.
| | - E Puzenat
- Service de Dermatologie, Université de Franche Comté, Centre Hospitalier Universitaire, Besançon, France
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Davila-Williams D, Barry M, Vargas C, Vossough A, Bernard TJ, Rafay MF. Cerebral Arteriopathies of Childhood - Current Approaches. Semin Pediatr Neurol 2022; 43:101004. [PMID: 36344018 DOI: 10.1016/j.spen.2022.101004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/07/2022] [Accepted: 09/26/2022] [Indexed: 10/14/2022]
Abstract
Up to more than half of previously healthy children presenting with their first arterial ischemic stroke have a cerebral arteriopathy. Cerebral arteriopathies during childhood can be congenital, reflecting abnormal vessel development, or acquired when caused by disruption of vascular homeostasis. Distinguishing different types of cerebral arteriopathies in children can be challenging but of great clinical value as they may dictate different disease and treatment courses, and clinical and radiologic outcomes. Furthermore, children with stroke due to a specific arteriopathy exhibit distinctive features when compared to those with stroke due to other causes or a different type of arteriopathy. These features become crucial in the management of pediatric stroke by choosing appropriate diagnostic and treatment strategies. The objective of this article is to provide the reader with a comprehensive up-to-date review of the classification, symptoms, diagnosis, treatment, and outcome of cerebral arteriopathies in children.
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Affiliation(s)
| | - Megan Barry
- Section of Neurology, Department of Pediatrics, Hemophilia & Thrombosis Center, University of Colorado, Aurora, Co, USA
| | - Carolina Vargas
- Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Arastoo Vossough
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Timothy J Bernard
- Section of Neurology, Department of Pediatrics, Hemophilia & Thrombosis Center, University of Colorado, Aurora, Co, USA
| | - Mubeen F Rafay
- Children's Hospital Winnipeg, Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Children's Hospital Research Institute of Manitoba, Manitoba, Canada.
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9
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Mayer JLR, Intzes S, Oza VS, Blei F. How we approach hemangiomas in infants. Pediatr Blood Cancer 2022; 69 Suppl 3:e29077. [PMID: 34151510 DOI: 10.1002/pbc.29077] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 04/09/2021] [Indexed: 12/28/2022]
Abstract
Pediatric oncologists are increasingly involved in the management of benign vascular tumors and their associated life-threatening complications. Hemangiomas are the most common referring diagnosis to multidisciplinary vascular anomalies clinics. However, as contemporary research has revealed, hemangiomas are not a single, easily defined entity but rather a diverse set of related vascular tumors, each having a unique natural history, growth pattern, and response to therapy. This manuscript seeks to illustrate how we evaluate and manage these complex tumors, their complications, and associated syndromes, while remaining ever vigilant for malignant hemangioma mimickers such as soft tissue sarcomas and congenital leukemia.
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Affiliation(s)
- Jennifer L R Mayer
- Vascular Anomalies and Birthmarks Program, Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Stefanos Intzes
- Pediatric Hematology/Oncology, Providence Sacred Heart Children's Hospital, Spokane, Washington, USA
| | - Vikash S Oza
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York, USA
| | - Francine Blei
- Hemangioma and Vascular/Lymphatic Malformations Program, New York University Langone Health, New York, New York, USA
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10
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Letertre O, Boccara O, Prey S, Pedespan JM, Boralevi F, Léauté-Labrèze C. Segmental facial infantile haemangiomas in the era of propranolol: evaluation at 6 years of age. J Eur Acad Dermatol Venereol 2022; 36:610-614. [PMID: 35000215 DOI: 10.1111/jdv.17907] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/23/2021] [Accepted: 12/07/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND The long-term evolution of children with segmental facial infantile haemangioma (SFIH) treated with propranolol remains unstudied. OBJECTIVES The objective of this study was to evaluate the neurodevelopmental features of children with SFIH treated with propranolol at 6 years of age. METHODS This retrospective case series study was conducted from January 2008 to June 2020 using data from medical files, patient examinations and appointments spanning 6 years. To be included, patients should present SFIH and have previously received propranolol. A complete physical examination, magnetic resonance imaging (MRI) of the head, echocardiography and ophthalmologic examination should have been performed. Neurodevelopmental features were divided into cognition, audition, vision, orality, motor skills and the occurrence of new symptoms. RESULTS Thirty children with SFIH were included. Of these, 11 presented criteria of PHACES. Evaluation of neurodevelopmental features of the children at 6 years of age showed learning difficulties in one case but grade skipping in three cases. There were six cases of unilateral hearing loss that had not been diagnosed at birth, two of oral difficulties and one of minor hypotonia. Early headache was primarily reported as the main new outcome. All children were treated with propranolol, with three following oral steroid therapy. No severe adverse effects were reported. The median length of treatment with propranolol was 16 months, and the median age at treatment cessation was 21 months. Analysis based on segment implication showed the median length of treatment to vary from 12 months (if S3 was spared) to 25 months (if at least S3 was involved). Vascular laser therapy was used in 16 patients (53.3%) and surgery in four. CONCLUSION In this case series, children with SFIH, including patients with PHACES criteria, presented a good tolerance of propranolol, as well as encouraged neurodevelopmental data. Segmental implication appears to have a significant impact on treatment duration and associated complications.
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Affiliation(s)
- O Letertre
- Department of Pediatric Dermatology, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
| | - O Boccara
- Department of Pediatric Dermatology, Hôpital Necker, APHP Paris, Paris, France
| | - S Prey
- Department of Pediatric Dermatology, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
| | - J-M Pedespan
- Department of Pediatric Neurology, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
| | - F Boralevi
- Department of Pediatric Dermatology, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
| | - C Léauté-Labrèze
- Department of Pediatric Dermatology, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
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11
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Jones VA, Patel PM, Valikodath T, Ashack KA. Dermatologic manifestations of pediatric cardiovascular diseases: Skin as a reflection of the heart. Pediatr Dermatol 2021; 38:1461-1474. [PMID: 34725847 DOI: 10.1111/pde.14841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cutaneous disease can often be an initial clue of an underlying cardiovascular disease. Many congenital conditions (ie, Noonan syndrome with multiple lentigines, Carney complex, and Fabry disease) and acquired conditions may present initially with specific cutaneous features that should prompt clinicians to conduct a full cardiac workup. Given the extensive number of conditions with both cardiovascular and cutaneous findings, this review will focus on diseases with cardiocutaneous pathology with hopes of raising clinician awareness of these associations to decrease morbidity and mortality, as several of these diseases often result in fatal outcomes.
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Affiliation(s)
- Virginia A Jones
- Department of Dermatology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Payal M Patel
- Department of Dermatology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Tom Valikodath
- Cincinnati Children's Hospital Medical Center Heart Institute, Cincinnati, Ohio, USA
| | - Kurt A Ashack
- Dermatology Associates of West Michigan, Grand Rapids, Michigan, USA
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12
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Initial Diagnostic Evaluation of the Child With Suspected Arterial Ischemic Stroke. Top Magn Reson Imaging 2021; 30:211-223. [PMID: 34613944 DOI: 10.1097/rmr.0000000000000276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
ABSTRACT Numerous factors make the initial diagnostic evaluation of children with suspected arterial ischemic stroke (AIS) a relatively unsettling challenge, even for the experienced stroke specialist. The low frequency of pediatric AIS, diversity of unique age-oriented stroke phenotypes, and unconventional approaches required for diagnosis and treatment all contribute difficulty to the process. This review aims to outline important features that differentiate pediatric AIS from adult AIS and provide practical strategies that will assist the stroke specialist with diagnostic decision making in the initial phase of care.
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13
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Soumya VC, Ramachandran D, Sekar S, Sreedharan SE, Sylaja PN. PHACE Syndrome Presenting as Transient Ischemic Attack. Neurol India 2021; 69:766-767. [PMID: 34169890 DOI: 10.4103/0028-3886.319227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- V C Soumya
- Department of Neurology, Comprehensive Stroke Care Program, Sree ChitraTirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Dileep Ramachandran
- Department of Neurology, Comprehensive Stroke Care Program, Sree ChitraTirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Sabarish Sekar
- Department of Imaging Sciences and Interventional Radiology, Sree ChitraTirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Sapna E Sreedharan
- Department of Neurology, Comprehensive Stroke Care Program, Sree ChitraTirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - P N Sylaja
- Department of Neurology, Comprehensive Stroke Care Program, Sree ChitraTirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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14
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Hypoxic-ischemic injury causes functional and structural neurovascular degeneration in the juvenile mouse retina. Sci Rep 2021; 11:12670. [PMID: 34135369 PMCID: PMC8209038 DOI: 10.1038/s41598-021-90447-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 05/04/2021] [Indexed: 12/11/2022] Open
Abstract
Ischemic stroke is a major cause of long-term disabilities, including vision loss. Neuronal and blood vessel maturation can affect the susceptibility of and outcome after ischemic stroke. Although we recently reported that exposure of neonatal mice to hypoxia–ischemia (HI) severely compromises the integrity of the retinal neurovasculature, it is not known whether juvenile mice are similarly impacted. Here we examined the effect of HI injury in juvenile mice on retinal structure and function, in particular the susceptibility of retinal neurons and blood vessels to HI damage. Our studies demonstrated that the retina suffered from functional and structural injuries, including reduced b-wave, thinning of the inner retinal layers, macroglial remodeling, and deterioration of the vasculature. The degeneration of the retinal vasculature associated with HI resulted in a significant decrease in the numbers of pericytes and endothelial cells as well as an increase in capillary loss. Taken together, these findings suggest a need for juveniles suffering from ischemic stroke to be monitored for changes in retinal functional and structural integrity. Thus, there is an emergent need for developing therapeutic approaches to prevent and reverse retinal neurovascular dysfunction with exposure to ischemic stroke.
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15
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PHACES Syndrome and Associated Anomalies: Risk Associated With Small and Large Facial Hemangiomas. AJR Am J Roentgenol 2021; 217:507-514. [PMID: 34036811 DOI: 10.2214/ajr.20.23488] [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] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. PHACES syndrome includes posterior fossa malformations, hemangioma, arterial anomalies, coarctation of the aorta and cardiac defects, eye abnormalities, and sternal defect with or without supraumbilical raphe. Usually, brain imaging is performed when facial hemangiomas are larger than 5 cm. Data on associated anomalies regardless of hemangioma size are sparse. The objective of this study was to determine, first, the prevalence of PHACES-like associated anomalies in a large sample of infants with all sizes of segmental facial or periorbital focal infantile hemangioma and, second, whether the cutaneous localization of the hemangioma correlates with the type of anomalies present. MATERIALS AND METHODS. The records of all patients of a vascular anomalies practice who had a diagnosis of segmental facial or periorbital focal infantile hemangioma and who had clinical photographs and brain MRI available were reviewed. The clinical photographs were reviewed to determine the localization by segment and lateralization. MRI was reviewed by two experienced pediatric radiologists. If present, cardiovascular anomalies, sternal defects, and eye anomalies were recorded. The criteria for definite and possible PHACES were used. RESULTS. The study included 122 children (90 girls, 32 boys; mean age, 16.6 months). Forty-five (36.9%) children had a facial infantile hemangioma larger than 5 cm. Twenty-two patients (18.0%) had PHACES or possible PHACES syndrome. Cerebrovascular structural anomalies were seen in 14 of 22 and brain anomalies in 6 of 22 patients with PHACES syndrome but in none and one of the patients in the group without PHACES (p < .001). Cardiovascular anomalies were seen in six patients and ocular anomalies in eight patients. All but one of them had PHACES syndrome. CONCLUSION. Clinical concern about associated extracutaneous anomalies is warranted for all children with facial segmental or periorbital focal infantile hemangiomas, including those with small hemangiomas. Further studies are needed to correlate cerebrovascular anomalies with the clinical evolution of hemangiomas and their effects on cerebral perfusion.
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16
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Dorschel KB, Wanebo JE. Genetic and Proteomic Contributions to the Pathophysiology of Moyamoya Angiopathy and Related Vascular Diseases. Appl Clin Genet 2021; 14:145-171. [PMID: 33776470 PMCID: PMC7987310 DOI: 10.2147/tacg.s252736] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 12/26/2020] [Indexed: 12/13/2022] Open
Abstract
RATIONALE This literature review describes the pathophysiological mechanisms of the current classes of proteins, cells, genes, and signaling pathways relevant to moyamoya angiopathy (MA), along with future research directions and implementation of current knowledge in clinical practice. OBJECTIVE This article is intended for physicians diagnosing, treating, and researching MA. METHODS AND RESULTS References were identified using a PubMed/Medline systematic computerized search of the medical literature from January 1, 1957, through August 4, 2020, conducted by the authors, using the key words and various combinations of the key words "moyamoya disease," "moyamoya syndrome," "biomarker," "proteome," "genetics," "stroke," "angiogenesis," "cerebral arteriopathy," "pathophysiology," and "etiology." Relevant articles and supplemental basic science articles published in English were included. Intimal hyperplasia, medial thinning, irregular elastic lamina, and creation of moyamoya vessels are the end pathologies of many distinct molecular and genetic processes. Currently, 8 primary classes of proteins are implicated in the pathophysiology of MA: gene-mutation products, enzymes, growth factors, transcription factors, adhesion molecules, inflammatory/coagulation peptides, immune-related factors, and novel biomarker candidate proteins. We anticipate that this article will need to be updated in 5 years. CONCLUSION It is increasingly apparent that MA encompasses a variety of distinct pathophysiologic conditions. Continued research into biomarkers, genetics, and signaling pathways associated with MA will improve and refine our understanding of moyamoya's complex pathophysiology. Future efforts will benefit from multicenter studies, family-based analyses, comparative trials, and close collaboration between the clinical setting and laboratory research.
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Affiliation(s)
- Kirsten B Dorschel
- Heidelberg University Medical School, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - John E Wanebo
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
- Department of Neuroscience, HonorHealth Research Institute, Scottsdale, AZ, USA
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17
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Escarza BS, Cruz-Beltran S, Lessans G, Austin TM, Lam HV. Are pediatric patients with PHACE association at high risk for anesthetic complications? Paediatr Anaesth 2021; 31:239-241. [PMID: 33078456 DOI: 10.1111/pan.14043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/09/2020] [Accepted: 10/10/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Brett S Escarza
- Anesthesiology Consultants Exchange, P.C., Chattanooga, TN, USA
| | | | - Greg Lessans
- Department of Anesthesiology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Thomas M Austin
- Department of Anesthesiology, Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - Humphrey V Lam
- Department of Anesthesiology, Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
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18
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Dayasiri K, Thadchanamoorthy V. PHACE Syndrome Presenting With Retinal Degeneration, Cortical Dysplasia, Microphthalmia, and Atrial Septal Defect in a South Asian Boy. Cureus 2021; 13:e12928. [PMID: 33654609 PMCID: PMC7907719 DOI: 10.7759/cureus.12928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
PHACE syndrome is a rare disorder of vasculogenesis that occurs during the first trimester of pregnancy. The disorder commonly presents with posterior fossa brain anomalies and coarctation of aorta/arterial anomalies and is predominantly seen in female patients. Herein, we report a male child with PHACE syndrome who had several less common features such as cortical dysplasia, retinal degeneration, and microphthalmia. The diagnosis of PHACE syndrome was confirmed based on revised diagnostic criteria and by the presence of one major criterion and two minor criteria in addition to >5 cm haemangioma. Further, the reported child had atrial septal defect as the only cardiac abnormality, and this has been rarely described in patients with PHACE syndrome.
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19
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Mamlouk MD, Vossough A, Caschera L, Maheshwari M, Hess CP. Arterial Spin-Labeling Perfusion for PHACE Syndrome. AJNR Am J Neuroradiol 2021; 42:173-177. [PMID: 33214180 DOI: 10.3174/ajnr.a6871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/19/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND PURPOSE Arterial stroke is a rare-but-reported complication in patients with posterior fossa brain malformations, hemangiomas, arterial anomalies, coarctation of the aorta and cardiac defects, and eye abnormalities (PHACE) syndrome. Currently, stroke risk is inferred by the severity of arterial anomalies identified on MRA, though no evidenced-based data exist. The purpose of our study was to determine whether arterial spin-labeling MR imaging perfusion can detect alterations in CBF in patients with PHACE syndrome. MATERIALS AND METHODS Records were reviewed from 3 institutions for all patients with PHACE syndrome who underwent arterial spin-labeling from 2000 to 2019. CBF was qualitatively investigated with arterial spin-labeling to determine whether there was decreased or normal perfusion. Arterial anomalies were characterized on MRA imaging, and parenchymal brain findings were evaluated on conventional MR imaging sequences. RESULTS Forty-one patients with PHACE syndrome had arterial spin-labeling imaging. There were 30 females and 11 males (age range, 7 days to 15 years). Of the 41 patients, 10 (24%) had decreased CBF signal corresponding to a major arterial territory. Ten of 10 patients had decreased CBF signal in the anterior circulation, 2/10 had decreased anterior and posterior circulation CBF signal, 2/10 had decreased bilateral anterior circulation CBF signal, and 1/10 had globally decreased CBF signal. Forty of 41 (97.5%) patients had at least 1 arteriopathy, and in those with decreased CBF signal, the arteriopathy corresponded to the CBF signal alteration in 10/10 patients. CONCLUSIONS Arterial spin-labeling can potentially characterize hemodynamic changes in patients with PHACE syndrome.
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Affiliation(s)
- M D Mamlouk
- From the Department of Radiology (M.D.M.), The Permanente Medical Group, Kaiser Permanente Medical Center, Santa Clara, Santa Clara, California
- Department of Radiology and Biomedical Imaging (M.D.M., C.P.H.), University of California, San Francisco, San Francisco, California
| | - A Vossough
- Department of Radiology (A.V., L.C.), Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - L Caschera
- Department of Radiology (A.V., L.C.), Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Radiology (L.C.), La Fondazione Institute for Research, Hospitalization and Health Care Ca' Granda Ospedale Maggiore di Milano Policlinico, Milan, Italy
| | - M Maheshwari
- Department of Radiology (M.M.), Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - C P Hess
- Department of Radiology and Biomedical Imaging (M.D.M., C.P.H.), University of California, San Francisco, San Francisco, California
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20
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Olsen GM, Hansen LM, Stefanko NS, Mathes E, Puttgen KB, Tollefson MM, Lauren C, Mancini AJ, McCuaig CC, Frieden IJ, Adams D, Baselga E, Chamlin S, Gupta D, Frommelt P, Garzon MC, Horii K, Klajn J, Maheshwari M, Newell B, Nguyen HL, Nopper A, Powell J, Siegel DH, Drolet BA. Evaluating the Safety of Oral Propranolol Therapy in Patients With PHACE Syndrome. JAMA Dermatol 2020; 156:186-190. [PMID: 31825455 DOI: 10.1001/jamadermatol.2019.3839] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Oral propranolol is widely considered to be first-line therapy for complicated infantile hemangioma, but its use in patients with PHACE (posterior fossa malformations, hemangioma, arterial anomalies, cardiac defects, eye anomalies) syndrome has been debated owing to concerns that the cardiovascular effects of the drug may increase the risk for arterial ischemic stroke. Objective To assess the incidence of adverse events among patients with PHACE syndrome receiving oral propranolol for infantile hemangioma. Design, Setting, and Participants This multicenter retrospective cohort study assessed the incidence of adverse events among 76 patients with PHACE syndrome receiving oral propranolol for infantile hemangioma at 11 tertiary care, academic pediatric dermatology practices. Medical records from January 1, 2010, through April 25, 2017, were reviewed. Exposures Patients received oral propranolol, 0.3 mg/kg/dose or more. Main Outcomes and Measures The main outcome was the rate and severity of adverse events occurring throughout the course of treatment with oral propranolol, as documented in the medical records. Adverse events were graded from 1 to 5 using a scale derived from the Common Terminology Criteria for Adverse Events and were considered to be serious if they were grade 3 or higher. Results A total of 76 patients (59 girls and 17 boys; median age at propranolol initiation, 56 days [range, 0-396 days]) met the inclusion criteria. There were no reports of serious adverse events (ie, stroke, transient ischemic attack, or cardiovascular events) during treatment with oral propranolol. A total of 46 nonserious adverse events were reported among 29 patients (38.2%); the most commonly reported nonserious adverse events were sleep disturbances and minor gastrointestinal tract and respiratory tract symptoms. In a comparison with 726 infants who received oral propranolol for hemangioma but did not meet criteria for PHACE syndrome, there was no significant difference in the rate of serious adverse events experienced during treatment (0 of 76 patients with PHACE syndrome and 3 of 726 patients without PHACE syndrome [0.4%]). Conclusions and Relevance This study found that oral propranolol was used to treat infantile hemangioma in 76 patients with PHACE syndrome and that no serious adverse events were experienced. These data provide support for the safety of oral propranolol in this patient population.
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Affiliation(s)
- Gerilyn M Olsen
- Department of Dermatology, Medical College of Wisconsin, Milwaukee
| | - Leanna M Hansen
- Department of Dermatology, Medical College of Wisconsin, Milwaukee
| | | | - Erin Mathes
- Department of Dermatology, University of California, San Francisco
| | - Katherine B Puttgen
- Department of Dermatology, John Hopkins University School of Medicine, Baltimore, Maryland.,Department of Dermatology, Intermountain Healthcare, Salt Lake City, Utah
| | | | - Christine Lauren
- Department of Dermatology, Columbia University, New York, New York
| | - Anthony J Mancini
- Department of Pediatrics, Northwestern University and Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Dermatology, Northwestern University and Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Catherine C McCuaig
- Division of Pediatric Dermatology, Department of Pediatrics, Sainte-Justine University Hospital Centre, University of Montreal, Montreal, Quebec, Canada
| | - Ilona J Frieden
- Department of Dermatology, University of California, San Francisco
| | - Denise Adams
- Department of Hematology, Boston Children's Hospital, Boston, Massachusetts
| | - Eulalia Baselga
- Pediatric Dermatology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Sarah Chamlin
- Department of Pediatrics, Northwestern University and Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Dermatology, Northwestern University and Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Deepti Gupta
- Division of Dermatology, Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington
| | - Peter Frommelt
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee
| | - Maria C Garzon
- Department of Dermatology, Columbia University, New York, New York
| | - Kimberly Horii
- Division of Dermatology, Children's Mercy Hospital, Kansas City, Missouri
| | - Justyna Klajn
- Department of Hematology, Boston Children's Hospital, Boston, Massachusetts
| | - Mohit Maheshwari
- Department of Radiology, Medical College of Wisconsin, Milwaukee
| | - Brandon Newell
- Division of Dermatology, Children's Mercy Hospital, Kansas City, Missouri
| | - Henry L Nguyen
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Amy Nopper
- Division of Dermatology, Children's Mercy Hospital, Kansas City, Missouri
| | - Julie Powell
- Division of Pediatric Dermatology, Department of Pediatrics, Sainte-Justine University Hospital Centre, University of Montreal, Montreal, Quebec, Canada
| | - Dawn H Siegel
- Department of Dermatology, Medical College of Wisconsin, Milwaukee
| | - Beth A Drolet
- Department of Dermatology, Medical College of Wisconsin, Milwaukee.,Department of Dermatology, University of Wisconsin-Madison School of Medicine and Public Health, Madison
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Abstract
Infantile hemangiomas (IHs) are the most common benign tumors of infancy. They typically appear after birth and undergo a period of rapid growth, followed by a gradual period of involution. Although the majority of IHs do not requirement treatment, oral propranolol is the first-line therapy for lesions that are at risk for life-threatening complications, functional impairment, ulceration, or permanent disfigurement. Rarely, IHs can be associated with structural anomalies. Congenital hemangiomas (CHs) are a distinct clinical entity, caused by a point mutation in GNAQ or GNA11. These lesions are typically present at birth and display a wide spectrum of clinical presentations. CHs can be distinguished from IHs by their unique histologic and radiographic features. Given the high-flow vascularity of CHs, surgical excision may be indicated due to the high risk of bleeding.
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Affiliation(s)
- Gerilyn M Olsen
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, United States
| | - Allison Nackers
- Department of Dermatology, University of Wisconsin Madison, 1 S Park St, 7th floor, Madison, WI 53715, United States
| | - Beth A Drolet
- Department of Dermatology, University of Wisconsin Madison, 1 S Park St, 7th floor, Madison, WI 53715, United States.
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22
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Eisenmenger LB, Rivera-Rivera LA, Johnson KM, Drolet BA. Utilisation of advanced MRI techniques to understand neurovascular complications of PHACE syndrome: a case of arterial stenosis and dissection. BMJ Case Rep 2020; 13:13/9/e235992. [PMID: 32928832 PMCID: PMC7490943 DOI: 10.1136/bcr-2020-235992] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PHACE syndrome is a rare disorder with posterior fossa brain malformations, segmental infantile haemangiomas, arterial anomalies, cardiac defects and eye anomalies. Cerebral and cervical arterial abnormalities occur commonly in these patients, predisposing subjects with PHACE syndrome to neurovascular complications including migraine-like headaches, moyamoya vasculopathy, arterial dissection and arterial ischaemia stroke. We leveraged institutional MRI protocols developed for adult neurovascular disease to better elucidate the pathogenesis of the arterial alternations observed in PHACE. Using high-resolution vessel wall and 4D flow MRI, we demonstrated enhancement, focal dissection and altered blood flow in a 7-year-old girl with PHACE syndrome. This is the first-time vessel wall imaging has been used to detail the known arterial changes in PHACE, and these findings may indicate that progressive vascular narrowing and vessel wall changes/inflammation are a factor in chronic headaches and other arterial complications seen in subjects with PHACE syndrome.
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Affiliation(s)
| | | | - Kevin M Johnson
- Radiology, University of Wisconsin, Madison, Wisconsin, USA.,Medical Physics, University of Wisconsin, Madison, Wisconsin, USA
| | - Beth A Drolet
- Dermatology, University of Wisconsin, Madison, Wisconsin, USA
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23
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Abstract
PURPOSE OF REVIEW There is a growing understanding of complications and anomalies associated with infantile hemangiomas. The current review will discuss recent clinical advances in syndromes associated with segmental hemangiomas, including PHACE and LUMBAR syndrome. In addition, the importance of recognizing visceral hemangiomatosis is highlighted. RECENT FINDINGS Ongoing longitudinal studies of PHACE and LUMBAR syndromes associated with segmental infantile hemangiomas have led to improved diagnosis and recommendations for screening for associated anomalies. Characterization of a growing spectrum of associated anomalies as well as better classification of at-risk patients will improve diagnosis and outcomes. In addition, visceral hemangiomatosis recognition and understanding of the potential association with consumptive hypothyroidism will improve initiation of appropriate screening. SUMMARY Clinicians should be aware of infantile hemangiomas associated with potential syndromic complications and recognize the need to initiate appropriate work-up. Segmental hemangiomas of the head and neck region may indicate a risk of PHACE syndrome and associated developmental anomalies. Although LUMBAR syndrome is the association of lower body segmental hemangioma with developmental anomalies. Visceral hemangiomas most commonly affect the liver and may be associated with complications such as consumptive hypothyroidism and heart failure.
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24
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Aygünes U, Dogan MT, Keceli AM. PHACE Syndrome in a Child with Structural Malformations of the Brain. J Pediatr Genet 2020; 10:315-318. [PMID: 34849278 DOI: 10.1055/s-0040-1714066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/27/2020] [Indexed: 10/23/2022]
Abstract
PHACE syndrome is an acronym that describes a neurocutaneous condition, consisting of posterior fossa malformations that coexist with large facial hemangiomas, eye anomalies, and cardiac/aortic defects. The prognosis of the disease has not been clearly identified. There appears to be a risk of stroke in children with arterial anomalies. Radiological examinations play a considerable role in determining the degree of intracranial, cardiac involvement and the probable complications. In this article, we reported a 4-month-old boy with PHACE syndrome that has been diagnosed through a large segmental infantile hemangioma involving the eye and over the left half of the face in brain magnetic resonance imaging and magnetic resonance angiography findings. One month after starting propranolol therapy, there was a noticeable reduction in the size of the lesions. Almost complete resolution of the hemangioma was seen after a 6 months of propranolol therapy.
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Affiliation(s)
- Utku Aygünes
- Department of Pediatric Hematology and Oncology, Konya Training and Research Hospital, Konya, Turkey
| | - Melih Timucin Dogan
- Department of Pediatric Cardiology, Konya Training and Research Hospital, Konya, Turkey
| | - Avni Merter Keceli
- Department of Pediatric Radiology, Konya Training and Research Hospital, Konya, Turkey
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Disse SC, Toelle SP, Schroeder S, Theiler M, Weibel L, Broser P, Langner C, Siegel D, Brockmann K, Schoenfelder I, Meyer S. Epidemiology, Clinical Features, and Use of Early Supportive Measures in PHACE Syndrome: A European Multinational Observational Study. Neuroepidemiology 2020; 54:383-391. [PMID: 32610335 DOI: 10.1159/000508187] [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: 11/14/2019] [Accepted: 04/14/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND PHACE syndrome is a rare inborn condition characterized by large facial hemangiomas and variable malformations of the arterial system, heart, central nervous system, and eyes. According to Orphanet estimates, the prevalence is <1.0 per million. Data from Europe are limited to small case series, and there are no population-based data available. OBJECTIVES We conducted the present study to provide population-based estimates of the disease prevalence of PHACE syndrome in children in Germany, Switzerland, and Austria. We compared these first systematic data on PHACE syndrome from Europe to published data from the PHACE Syndrome International Clinical Registry and Genetic Repository (USA). Clinical features in our cohort with PHACE syndrome were assessed in detail, including the need for early supportive measures. METHODS We used a population-based approach by means of a previously well-established network of child neurologists from Germany, Switzerland, and Austria ("ESNEK") to identify potential patients. The patients' guardians and child neurologists were asked to fill in questionnaires developed in collaboration with the International PHACE Registry. RESULTS We identified 19 patients with PHACE syndrome. Estimated prevalence rates were 6.5 per million in Switzerland, 0.59 per million in Germany, and 0.65 per million in Austria. A subset of 10 patients from Germany and Switzerland participated in our study, providing detailed clinical assessment (median age: 2.5 years; 9 females, 1 male). Cerebrovascular involvement was frequent (80%). Facial hemangioma extent correlated significantly with the number of organs involved (p = 0.011). In 9 out of 10 patients, facial hemangiomas were treated successfully with oral propranolol. Baseline demographic data as well as the rate of cerebrovascular and cardiovascular anomalies were in line with those from the US International PHACE Registry and other published PHACE cohorts. CONCLUSIONS Our study provides population-based estimates for PHACE syndrome in 3 German-speaking countries. The data from Switzerland indicate that PHACE syndrome may be more prevalent than demonstrated by previous reports. Underreporting of PHACE syndrome in Germany and Austria likely accounts for the differences in prevalence rates. The clinical observation of a potential association between the size of facial hemangioma and extent of organ involvement warrants further investigation.
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Affiliation(s)
- Sigrid Claudia Disse
- Department of Neuropediatrics, Children's Hospital at University Medical Center Homburg, Homburg, Germany, .,Children's Hospital Weiden, Kliniken Nordoberpfalz AG, Weiden, Germany,
| | - Sandra P Toelle
- Department of Neuropediatrics, University Children's Hospital Zurich, Zurich, Switzerland
| | - Simone Schroeder
- Interdisciplinary Pediatric Center for Children with Developmental Disabilities and Severe Chronic Disorders, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Martin Theiler
- Pediatric Skin Center, Department of Dermatology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Lisa Weibel
- Pediatric Skin Center, Department of Dermatology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Philip Broser
- Center for Pediatric Neurology, Development and Rehabilitation, Ostschweizer Kinderspital, St. Gallen, Switzerland
| | | | - Dawn Siegel
- Department of Dermatology and Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Knut Brockmann
- Interdisciplinary Pediatric Center for Children with Developmental Disabilities and Severe Chronic Disorders, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Göttingen, Germany
| | | | - Sascha Meyer
- Department of Neuropediatrics, Children's Hospital at University Medical Center Homburg, Homburg, Germany
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Habib M, Manilha R, Khan N. Management of PHACES syndrome: Risk of stroke and its prevention from a neurosurgical perspective. Eur J Paediatr Neurol 2020; 26:39-45. [PMID: 32276757 DOI: 10.1016/j.ejpn.2020.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 03/10/2020] [Accepted: 03/14/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES A multidisciplinary approach for PHACES is essential. A meticulous diagnostic and treatment protocol for PHACES patients with cerebrovascular anomalies within the intermediate and high risk strata for ischemic stroke is presented. We also differentiate the vasculopathy associated with PHACES syndrome from moyamoya angiopathy. METHODS Medical records and radiological imaging were reviewed. After initial magnetic resonance imaging/angiography (MRI/MRA), H215O-PET scan (baseline and Acetazolamide challenge) was performed in three patients and 6-vessel cerebral angiography was performed in two patients. Two patients with significant intracranial cerebrovascular anomalies underwent cerebral revascularization. RESULTS Each patient presented with a facial hemangioma at birth and additional cerebrovascular anomalies ranging from hypoplasia to steno-occlusive changes of intracranial cerebral arteries. Additional involvement of the cardiovascular system was observed in two patients. Additional to MRI/MRA, a H215O-PET helped stratify the three patients into intermediate (n=1) and high risk groups (n=2). The high-risk group patients underwent individualized cerebral revascularization for future stroke prevention. The patient in intermediate risk group will be followed. Cerebrovascular angiopathy seen in all patients was typical for PHACES without moyamoya and was not progressive at follow-up. CONCLUSIONS Patients within the intermediate and high-risk strata for ischemic stroke must undergo a 6-vessel cerebral angiography and further hemodynamic evaluation to indicate need for cerebral revascularization to prevent ischemic stroke. Non-progressive vasculopathy associated with PHACES can itself be hemodynamically relevant for neurosurgical intervention. This vasculopathy is distinct from moyamoya angiopathy, which can occur in conjunction with PHACES, resulting in concurrent progressive vasculopathy that would otherwise be absent.
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Affiliation(s)
- Mikaeel Habib
- Moyamoya Center, Division of Pediatric Neurosurgery, University Children's Hospital, Zürich, Switzerland
| | - Rui Manilha
- Moyamoya Center, Division of Pediatric Neurosurgery, University Children's Hospital, Zürich, Switzerland
| | - Nadia Khan
- Moyamoya Center, Division of Pediatric Neurosurgery, University Children's Hospital, Zürich, Switzerland.
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Narayanan S, Schmithorst V, Panigrahy A. Arterial Spin Labeling in Pediatric Neuroimaging. Semin Pediatr Neurol 2020; 33:100799. [PMID: 32331614 DOI: 10.1016/j.spen.2020.100799] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Perfusion imaging using arterial spin labeling noninvasively evaluates cerebral blood flow utilizing arterial blood water as endogenous tracer. It does not require the need of radiotracer or intravenous contrast and offers unique complimentary information in the imaging of pediatric brain. Common clinical applications include neonatal hypoxic ischemic encephalopathy, pediatric stroke and vascular malformations, epilepsy and brain tumors. Future applications may include evaluation of silent ischemia in sickle cell patients, monitor changes in intracranial pressure in hydrocephalus, provide additional insights in nonaccidental trauma and chronic traumatic brain injury (TBI) and in functional Magnetic resonance imaging (MRI). The purpose of this review article is to evaluate the technical considerations including pitfalls, physiological variations, clinical applications and future directions of arterial spin labeling imaging.
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Affiliation(s)
- Srikala Narayanan
- Children's Hospital of Pittsburgh of UPMC, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA.
| | - Vincent Schmithorst
- Children's Hospital of Pittsburgh of UPMC, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Ashok Panigrahy
- John F. Caffey Endowed Chair in Pediatric Radiology, Children's Hospital of Pittsburgh of UPMC, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA
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28
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Abstract
Vascular tumors in pediatric patients are an important entity for the clinician to recognize and correctly diagnose. They may present at birth or develop at any point during infancy, childhood, or adolescence. Most are benign, but even benign lesions may have significant morbidity without proper intervention. Malignant vascular tumors are also rarely seen in the pediatric population, and may be associated with various syndromes.
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Affiliation(s)
- Harriet Bagnal Hinen
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, SC, United States
| | - Cameron C Trenor
- Division of Hematology/Oncology, Vascular Anomalies Center, Boston Children's Hospital, Boston, MA, United States
| | - Lara Wine Lee
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, SC, United States
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Abstract
Hemangiomas are common benign vascular tumors that often present in childhood. Diagnosis is based on clinical history, physical examination, and, when unclear, assisted with ultrasound or MRI. While the majority are small, nonproblematic, and can be managed conservatively, some hemangiomas may be associated with underlying syndromes or concerning for visceral involvement. Symptomatic lesions may develop ulceration, bleeding, vision disturbances, functional limitations, or disfigurement. The ideal treatment for a symptomatic hemangioma is often multimodal and may vary depending on the size, location, and proximity to critical structures. Medical treatments include topical beta blockers, oral propranolol, or steroid injections. Surgical resection and laser therapies may be necessary to optimize long term outcomes.
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Affiliation(s)
- Austin DeHart
- Otolaryngology, Head and Neck Surgery, Arkansas Children's Hospital at the University of Arkansas for Medical Science, Little Rock, Arkansas, 72202, USA
| | - Gresham Richter
- Otolaryngology, Head and Neck Surgery, Arkansas Children's Hospital at the University of Arkansas for Medical Science, Little Rock, Arkansas, 72202, USA
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30
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Siegel DH. PHACE syndrome: Infantile hemangiomas associated with multiple congenital anomalies: Clues to the cause. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2019; 178:407-413. [PMID: 30580483 DOI: 10.1002/ajmg.c.31659] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/25/2018] [Accepted: 10/29/2018] [Indexed: 12/22/2022]
Abstract
Infantile hemangiomas (IH) are the most common vascular tumor of infancy with an estimated 80,000 annual diagnoses in the United States. The genetic mechanisms underlying IH and the related multi-organ birth defect syndromes, PHACE (an acronym for Posterior fossa brain malformations, segmental facial Hemangiomas, Arterial anomalies, Cardiac defects, Eye anomalies, and sternal clefting or supraumbilical raphe) and LUMBAR (an acronym for Lower body hemangiomas, Urogenital anomalies, Myelopathy, Bone deformities, Anorectal malformations/Arterial anomalies, Renal anomalies) remain unsolved. With advances in next generation sequencing (NGS), genomic alterations have been identified in a wide range of vascular anomaly syndromes. We hypothesize that PHACE is a genetic disorder, caused by somatic mutations, likely in cancer genetic pathways. Identification of the genetic etiology will lead to improved diagnosis in PHACE syndrome and development of targeted therapies for IH and related congenital anomalies.
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Affiliation(s)
- Dawn H Siegel
- Department of Dermatology and Pediatrics, Medical College of Wisconsin, Milwaukee, WI
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31
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Schmid F, Reipschlaeger M, Leenen A, Hoeger P. Risk of associated cerebrovascular anomalies in children with segmental facial haemangiomas. Br J Dermatol 2019; 181:1334-1335. [DOI: 10.1111/bjd.18246] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- F. Schmid
- Department of Paediatrics Catholic Children's Hospital Wilhelmstift Hamburg Germany
| | - M. Reipschlaeger
- Department of Paediatrics Catholic Children's Hospital Wilhelmstift Hamburg Germany
| | - A. Leenen
- Department of Paediatric Radiology Catholic Children's Hospital Wilhelmstift Hamburg Germany
| | - P.H. Hoeger
- Department of Paediatrics Catholic Children's Hospital Wilhelmstift Hamburg Germany
- Department of Paediatric Dermatology Catholic Children's Hospital Wilhelmstift Hamburg Germany
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32
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Stefanko NS, Cossio ML, Powell J, Blei F, Davies OMT, Frieden IJ, Garzon MC, Lauren CT, Maheshwari M, McCuaig CC, Metry D, Salman S, Drolet BA, Siegel DH. Natural history of PHACE syndrome: A survey of adults with PHACE. Pediatr Dermatol 2019; 36:618-622. [PMID: 31222913 DOI: 10.1111/pde.13871] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Awareness of PHACE syndrome has increased; however, little information exists regarding its natural history, especially in patients over the age of 18. We aim to describe the natural history of PHACE to enhance clinical management and counseling of patients. METHODS A cohort of patients ≥ 18 years was identified through the PHACE Syndrome Registry and a Vascular Anomalies Clinic Database. A cross-sectional survey was designed after a review of the literature by PHACE experts (IF, JP, DS). Questions were selected by consensus, and the survey was conducted using the Qualtrics platform and via in-person interviews. A 75% response rate was found. RESULTS Eighteen adults-17 females and one transgender male-completed the survey. Respondents ranged in age from 18 to 59, with 24 being the mean age. Eighty-nine percent reported experiencing headaches, and 17% reported experiencing acute but transient symptoms mimicking acute ischemic stroke, later diagnosed as atypical migraines. Thirty-three percent reported hearing loss, and 67% endorsed dental issues. One patient experienced two arterial dissections. Three-fourths who attempted conception were successful, and none of their children had clinical features of PHACE. Because results were based on a retrospective survey, data captured were prone to recall bias and not objective. Results were limited by a small sample size. CONCLUSIONS Health care providers should be aware of a possible increased risk of neurovascular complications, including atypical migraines mimicking transient ischemic attacks and arterial dissection, in adults with PHACE. Heritability has not been demonstrated, and future studies are needed to assess the risk of infertility.
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Affiliation(s)
| | - Maria-Laura Cossio
- Sainte-Justine University Hospital Center, Montreal, Québec, Canada.,Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Julie Powell
- Sainte-Justine University Hospital Center, Montreal, Québec, Canada.,University of Montreal, Montreal, Québec, Canada
| | - Francine Blei
- Lennox Hill Hospital of Northwell Health, New York, New York
| | | | - Ilona J Frieden
- University of California, San Francisco, San Francisco, California
| | | | | | | | | | | | | | - Beth A Drolet
- Department of Dermatology, Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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33
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Moyamoya angiopathy in PHACE syndrome not associated with RNF213 variants. Childs Nerv Syst 2019; 35:1231-1237. [PMID: 31037424 DOI: 10.1007/s00381-019-04145-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 04/02/2019] [Indexed: 10/26/2022]
Abstract
Moyamoya angiopathy is a rare vasculopathy with stenosis and/or occlusion of bilateral intracranial parts of internal carotid arteries and/or proximal parts of middle and anterior cerebral arteries. PHACE syndrome is characterized by large segmental hemangiomas in the cervical-facial region. Both conditions are known to be associated in rare cases. Recently, it was discussed in the literature that RNF213 variants could be etiologically involved in this association. Here, we describe a childhood case with this rare co-occurrence in which we did not identify any rare RNF213 variant. The clinical and genetic backgrounds are discussed.
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34
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Sekioka A, Fukumoto K, Horikoshi Y, Nii M, Urushihara N. PHACE syndrome with unnoticeable skin lesion and rare anomaly of coronary artery. Pediatr Int 2019; 61:524-526. [PMID: 31090165 DOI: 10.1111/ped.13841] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 01/06/2019] [Accepted: 03/14/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Akinori Sekioka
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Koji Fukumoto
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Yasuo Horikoshi
- Department of Hematology and Oncology, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Masaki Nii
- Department of Cardiology, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Naoto Urushihara
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
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35
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Chokr J, Taslakian B, Maroun G, Choudhary G. PHACES syndrome with ectopia cordis and hemihypertrophy. Proc (Bayl Univ Med Cent) 2019; 32:237-239. [DOI: 10.1080/08998280.2018.1548263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/04/2018] [Accepted: 11/05/2018] [Indexed: 10/27/2022] Open
Affiliation(s)
- Jad Chokr
- Department of Radiology, Clemenceau Medical Center, Johns Hopkins International, Beirut, Lebanon
| | - Bedros Taslakian
- Department of Radiology, New York University School of Medicine, New York, New York
| | - Gilbert Maroun
- Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Gagandeep Choudhary
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
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36
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Krowchuk DP, Frieden IJ, Mancini AJ, Darrow DH, Blei F, Greene AK, Annam A, Baker CN, Frommelt PC, Hodak A, Pate BM, Pelletier JL, Sandrock D, Weinberg ST, Whelan MA. Clinical Practice Guideline for the Management of Infantile Hemangiomas. Pediatrics 2019; 143:peds.2018-3475. [PMID: 30584062 DOI: 10.1542/peds.2018-3475] [Citation(s) in RCA: 207] [Impact Index Per Article: 41.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Infantile hemangiomas (IHs) occur in as many as 5% of infants, making them the most common benign tumor of infancy. Most IHs are small, innocuous, self-resolving, and require no treatment. However, because of their size or location, a significant minority of IHs are potentially problematic. These include IHs that may cause permanent scarring and disfigurement (eg, facial IHs), hepatic or airway IHs, and IHs with the potential for functional impairment (eg, periorbital IHs), ulceration (that may cause pain or scarring), and associated underlying abnormalities (eg, intracranial and aortic arch vascular abnormalities accompanying a large facial IH). This clinical practice guideline for the management of IHs emphasizes several key concepts. It defines those IHs that are potentially higher risk and should prompt concern, and emphasizes increased vigilance, consideration of active treatment and, when appropriate, specialty consultation. It discusses the specific growth characteristics of IHs, that is, that the most rapid and significant growth occurs between 1 and 3 months of age and that growth is completed by 5 months of age in most cases. Because many IHs leave behind permanent skin changes, there is a window of opportunity to treat higher-risk IHs and optimize outcomes. Early intervention and/or referral (ideally by 1 month of age) is recommended for infants who have potentially problematic IHs. When systemic treatment is indicated, propranolol is the drug of choice at a dose of 2 to 3 mg/kg per day. Treatment typically is continued for at least 6 months and often is maintained until 12 months of age (occasionally longer). Topical timolol may be used to treat select small, thin, superficial IHs. Surgery and/or laser treatment are most useful for the treatment of residual skin changes after involution and, less commonly, may be considered earlier to treat some IHs.
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Affiliation(s)
- Daniel P Krowchuk
- Departments of Pediatrics and Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina;
| | - Ilona J Frieden
- Departments of Dermatology and Pediatrics, School of Medicine, University of California, San Francisco, San Francisco, California
| | - Anthony J Mancini
- Departments of Pediatrics and Dermatology, Feinberg School of Medicine, Northwestern University and Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - David H Darrow
- Departments of Otolaryngology and Pediatrics, Eastern Virginia Medical School and Children's Hospital of the King's Daughters, Norfolk, Virginia
| | - Francine Blei
- Donald and Barbara Zucker School of Medicine, Northwell Health, New York City, New York
| | - Arin K Greene
- Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Aparna Annam
- Department of Radiology, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Cynthia N Baker
- Department of Pediatrics, Kaiser Permanente Medical Center, Los Angeles, California
| | - Peter C Frommelt
- Department of Pediatrics, Cardiology, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Amy Hodak
- American Board of Pediatrics, Chapel Hill, North Carolina
| | - Brian M Pate
- Department of Pediatrics, University of Kansas School of Medicine-Wichita, Wichita, Kansas
| | | | - Deborah Sandrock
- St Christopher's Hospital for Children and College of Medicine, Drexel University, Philadelphia, Pennsylvania
| | - Stuart T Weinberg
- Departments of Biomedical Informatics and Pediatrics, School of Medicine, Vanderbilt University, Nashville, Tennessee; and
| | - Mary Anne Whelan
- College of Physicians and Surgeons, Columbia University, New York City, New York
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Cerebral Vasculopathy in Coarctation of Aorta-a Rare Association. J Stroke Cerebrovasc Dis 2018; 27:3393-3394. [DOI: 10.1016/j.jstrokecerebrovasdis.2018.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 06/11/2018] [Accepted: 06/24/2018] [Indexed: 11/30/2022] Open
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38
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Padia R, Bly R, Bull C, Geddis AE, Perkins J. Medical Management of Vascular Anomalies. CURRENT TREATMENT OPTIONS IN PEDIATRICS 2018; 4:221-236. [PMID: 30505648 PMCID: PMC6261360 DOI: 10.1007/s40746-018-0130-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW This chapter will summarize the most recent literature regarding the current state of medical treatment for vascular anomalies. RECENT FINDINGS Research into the biology of these anomalies has strengthened our understanding of each anomaly and has helped to pave the way for more tailored treatment options involving molecular and/or genetic targets. SUMMARY While there is still a role for surgical intervention, medical therapies that target the etiology of vascular anomalies may represent an alternative or adjunctive approach in the management of these lesions.
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Affiliation(s)
- Reema Padia
- Division of Pediatric Otolaryngology, Department of Surgery, Seattle Children's Hospital and Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, United States
| | - Randall Bly
- Division of Pediatric Otolaryngology, Department of Surgery, Seattle Children's Hospital and Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, United States
| | - Catherine Bull
- Division of Pediatric Otolaryngology, Department of Surgery, Seattle Children's Hospital and Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, United States
| | - Amy E. Geddis
- Cancer and Blood Disorders Clinic, Seattle Children's Hospital, Seattle, Washington, United States
| | - Jonathan Perkins
- Division of Pediatric Otolaryngology, Department of Surgery, Seattle Children's Hospital and Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, United States
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39
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Droitcourt C, Kerbrat S, Rault C, Botrel MA, Happe A, Garlantezec R, Guillot B, Schleich JM, Oger E, Dupuy A. Safety of Oral Propranolol for Infantile Hemangioma. Pediatrics 2018; 141:peds.2017-3783. [PMID: 29844139 DOI: 10.1542/peds.2017-3783] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The safety of oral propranolol for infantile hemangioma has not yet been studied at population level since the pediatric use marketing authorization was obtained in Europe. METHODS A survey of a nationwide, claim-based observational cohort of children <3 years old, with at least 1 delivery of oral propranolol between July 2014 and June 2016, was performed by using the database of the French National Health Insurance system. Standardized morbidity ratios (SMRs) were calculated by using, from the same database, a representative random sample of nonexposed subjects. The main outcomes were hospitalizations for cardiovascular (conduction disorders, bradycardia, and hypotension), respiratory (bronchial hyperactivity and bronchospasm), or metabolic events (hypoglycemia and hyperkalaemia), identified through the hospitalization diagnostic codes of the International Classification of Diseases, 10th Revision. The main analysis was conducted separately on "healthy" children (N = 1484), that is, free from of any prespecified underlying disease and on children with 1 of these underlying diseases (N = 269). RESULTS In all, 1753 patients <3 years of age had at least 2 deliveries of oral propranolol. In the healthy population, we observed 2 cardiovascular events (SMR = 2.8 [0-6.7]), 51 respiratory events (SMR = 1.7 [1.2-2.1]), and 3 metabolic events (SMR = 5.1 [0-10.9]). In the population with an underlying disease (mainly congenital heart disease), we observed 11 cardiovascular events leading to an SMR of 6.0 (2.5-9.6). SMRs were not significantly raised for respiratory or metabolic events in this "nonhealthy" population. CONCLUSIONS In this study on a large continuous nationwide claims database, we confirm the safety profile of oral propranolol in healthy children to be good.
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Affiliation(s)
- Catherine Droitcourt
- University of Rennes, Rennes, France; .,Departments of Dermatology.,Institut National de la Santé et de la Recherche Médicale, Centre d'Investigation Clinique 1414, Rennes, France.,University of Rennes, EA 7449 REPERES Pharmacoepidemiology and Health Services Research, Rennes, France
| | - Sandrine Kerbrat
- University of Rennes, EA 7449 REPERES Pharmacoepidemiology and Health Services Research, Rennes, France
| | - Caroline Rault
- University of Rennes, EA 7449 REPERES Pharmacoepidemiology and Health Services Research, Rennes, France
| | - Marie-Anne Botrel
- University of Rennes, EA 7449 REPERES Pharmacoepidemiology and Health Services Research, Rennes, France
| | - André Happe
- University of Rennes, EA 7449 REPERES Pharmacoepidemiology and Health Services Research, Rennes, France
| | - Ronan Garlantezec
- University of Rennes, Rennes, France.,Public Health.,Institut de Recherche en Santé, Environnement et Travail, Unité Mixte de Recherche 1085, Rennes, France; and
| | - Bernard Guillot
- Department of Dermatology, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | | | - Emmanuel Oger
- University of Rennes, Rennes, France.,University of Rennes, EA 7449 REPERES Pharmacoepidemiology and Health Services Research, Rennes, France.,Centre of Pharmacovigilance, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Alain Dupuy
- University of Rennes, Rennes, France.,Departments of Dermatology.,University of Rennes, EA 7449 REPERES Pharmacoepidemiology and Health Services Research, Rennes, France
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40
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Rotter A, Samorano LP, Rivitti-Machado MC, Oliveira ZNP, Gontijo B. PHACE syndrome: clinical manifestations, diagnostic criteria, and management. An Bras Dermatol 2018; 93:405-411. [PMID: 29924216 PMCID: PMC6001075 DOI: 10.1590/abd1806-4841.20187693] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 01/07/2018] [Indexed: 11/25/2022] Open
Abstract
Infantile hemangioma can be linked to other organ malformations. In 1996, PHACE syndrome was first defined as the association of large and segmental infantile hemangioma, usually on the face, head, or cervical region, with malformations of the posterior fossa of the brain, arterial anomalies of the central nervous system, coarctation of the aorta, cardiac defects, and ocular abnormalities. Over 300 cases of PHACE syndrome have been reported, and it is cconsidered one of the most common neurocutaneous vascular disorders in childhood. Knowledge of the features and locations of lesions that imply a greater risk of systemic involvement is crucial for the diagnosis and proper management of PHACE syndrome patients. This review highlights the diagnostic criteria for PHACE syndrome, the imaging workup for extracutaneous involvement, the treatment of infantile hemangioma, and the importance of a multidisciplinary approach in the management of these patients.
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Affiliation(s)
- Anita Rotter
- Dermatology Department, Hospital das Clínicas, Faculdade de
Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Luciana Paula Samorano
- Dermatology Department, Hospital das Clínicas, Faculdade de
Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Maria Cecília Rivitti-Machado
- Dermatology Department, Hospital das Clínicas, Faculdade de
Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Zilda Najjar Prado Oliveira
- Dermatology Department, Hospital das Clínicas, Faculdade de
Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Bernardo Gontijo
- Dermatology Unit. Hospital das Clínicas, Universidade
Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
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Petrauskas LA, Vaitaitis VJ, Mundinger G, Sheahan C, Poole J, Kanotra SP. Open resection and laryngotracheal reconstruction in a case of subglottic hemangioma in PHACE syndrome. Int J Pediatr Otorhinolaryngol 2018; 108:186-189. [PMID: 29605352 DOI: 10.1016/j.ijporl.2018.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/04/2018] [Accepted: 03/05/2018] [Indexed: 11/30/2022]
Abstract
We describe a 1 month old infant with PHACE syndrome who underwent successful management of subglottic hemangioma by open resection and laryngotracheal reconstruction using a thyroid ala graft. Propranolol is typically the treatment of choice for subglottic hemangiomas however, recent reports have suggested adverse complications with the use of propranolol in children with PHACE syndrome. The child had cerebral and cervical vascular anomalies associated with her PHACE syndrome making her at an increased risk of stroke with the use of propranolol.
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Affiliation(s)
| | - Vilija J Vaitaitis
- Department of Otolaryngology, Louisiana State University Health Sciences Center and Children's Hospital New Orleans, New Orleans, LA, USA
| | - Gerhard Mundinger
- Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center and Children's Hospital New Orleans, New Orleans, LA, USA
| | - Claudie Sheahan
- Division of Vascular Surgery, Louisiana State University Health Sciences Center and Children's Hospital New Orleans, New Orleans, LA, USA
| | - Jeffrey Poole
- Department of Dermatology, Louisiana State University Health Sciences Center and Children's Hospital New Orleans, New Orleans, LA, USA
| | - Sohit Paul Kanotra
- Department of Otolaryngology, Louisiana State University Health Sciences Center and Children's Hospital New Orleans, New Orleans, LA, USA.
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42
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Grzesik P, Wu JK. Current perspectives on the optimal management of infantile hemangioma. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2017; 8:107-116. [PMID: 29388636 PMCID: PMC5774589 DOI: 10.2147/phmt.s115528] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Infantile hemangiomas (IHs) are the most common benign tumor of infancy. As our understanding of their pathobiology has evolved, treatment has become more focused and tailored to specifically treat IH while minimizing adverse effects. Propranolol has gained FDA approval as the first medical therapy for a traditionally surgical disease. This review provides readers with an overview of IH, treatment modalities, and addresses specific considerations in IH disease management.
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Affiliation(s)
- Peter Grzesik
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - June K Wu
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY, USA
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43
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Peng SH, Yang KY, Chen SY, Ji Y. [Research progresses in the pathogenesis, diagnosis and treatment of infantile hemangioma with PHACE syndrome]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2017; 19:1291-1296. [PMID: 29237532 PMCID: PMC7389804 DOI: 10.7499/j.issn.1008-8830.2017.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 10/27/2017] [Indexed: 06/07/2023]
Abstract
Infant hemangioma, the most common benign tumor in children, is characterized by rapid proliferation, followed by slower spontaneous involution. However, some patients with facial segmental hemangioma are associated with PHACE syndrome. PHACE syndrome is characterized by vascular nerve and vascular cutaneous lesions of multiple systemic systems, often resulting in structural and functional impairments. Recent studies have demonstrated that the possible pathogeneses of PHACE syndrome mainly include hypoxia, abnormality of mesodermal vascular endothelial cells, genetic abnormality, and abnormality of interstitial mesenchymal stem cells. The current medications for hemangioma with PHACE syndrome include beta blockers, glucocorticoids, and mTOR inhibitors. This review article mainly describes the pathogenesis, diagnoses and treatments of PHACE syndrome, in order to provide directions for diagnosis and treatment of this disorder.
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Affiliation(s)
- Su-Hua Peng
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu 610041, China.
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Tortora D, Severino M, Accogli A, Martinetti C, Vercellino N, Capra V, Rossi A, Pavanello M. Moyamoya Vasculopathy in PHACE Syndrome: Six New Cases and Review of the Literature. World Neurosurg 2017; 108:291-302. [DOI: 10.1016/j.wneu.2017.08.176] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 08/26/2017] [Accepted: 08/28/2017] [Indexed: 11/26/2022]
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45
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Lee YJ, Yeon GM, Kong SG. PHACE Syndrome with Large Facial Segmental Hemangioma and Cerebellar Hypoplasia. CLINICAL PEDIATRIC HEMATOLOGY-ONCOLOGY 2017. [DOI: 10.15264/cpho.2017.24.2.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Young Joon Lee
- Department of Pediatrics, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Gyu Min Yeon
- Department of Pediatrics, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Seom Gim Kong
- Department of Pediatrics, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
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46
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Mamlouk MD, Nicholson AD, Cooke DL, Hess CP. Tips and tricks to optimize MRI protocols for cutaneous vascular anomalies. Clin Imaging 2017. [DOI: 10.1016/j.clinimag.2017.05.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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47
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Delgado N, Carroll JJ, Meyers PM. Concomitant carotid aplasia and basilar artery occlusion in a child with PHACES syndrome. BMJ Case Rep 2017; 2017:bcr-2017-221055. [PMID: 28814594 DOI: 10.1136/bcr-2017-221055] [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] [Indexed: 11/04/2022] Open
Abstract
We report a case of an 8-year-old girl with posterior fossa abnormalities, haemangioma, arterial lesions, cardiac abnormalities or coarctation of the aorta and eye abnormalities syndrome with right carotid aplasia and complete basilar occlusion. The patient initially presented at 2.5 weeks of age with a growing right facial haemangioma involving segments 1, 3 and 4. Initial MRI at 2.5 weeks of age revealed an extraconal right orbital haemangioma without posterior fossa abnormalities and MR angiography (MRA) 3 weeks later showed right internal carotid aplasia. A follow-up MRA and cerebral angiography at 8 years of age revealed a complete occlusion of the basilar artery that was not appreciated on previous imaging. Neurological function remains normal, meeting all age-appropriate milestones.
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Affiliation(s)
- Noel Delgado
- Columbia University College of Physicians and Surgeons, New York, USA
| | - Jason J Carroll
- Department of Radiology, Columbia University College of Physicians and Surgeons, New York, USA
| | - Philip M Meyers
- Department of Radiology, Columbia University College of Physicians and Surgeons, New York, USA
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48
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Schilter KF, Steiner JE, Demos W, Maheshwari M, Prokop JW, Worthey E, Drolet BA, Siegel DH. RNF213 variants in a child with PHACE syndrome and moyamoya vasculopathy. Am J Med Genet A 2017; 173:2557-2561. [PMID: 28686325 DOI: 10.1002/ajmg.a.38258] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/22/2017] [Accepted: 03/24/2017] [Indexed: 11/06/2022]
Abstract
Segmental infantile hemangiomas (IH) can be associated with congenital anomalies in a regional distribution. PHACE refers to large cervicofacial segmental IH in association with congenital anomalies of the aortic arch and medium-sized arteries of the head and neck, as well as structural anomalies of the posterior fossa and eye. A subset of PHACE patients have arterial anomalies that progress to moyamoya vasculopathy (MMV). MMV is defined as stenosis of the supraclinoid segment of the internal carotid arteries and/or their major branches, with subsequent development of a compensatory collateral vessel network. We describe a patient with MMV and segmental IH on the back and lower body who meets diagnostic criteria for PHACE based on a posterior segment eye anomaly and cerebral arterial anomalies. Whole exome sequencing demonstrated two inherited heterozygous variants in RNF213. Variants in RNF213 are associated with increased susceptibility to MMV. Our findings suggest that RNF213 variants may play a role in the development of MMV in patients with hemangioma syndromes associated with congenital cerebral arterial anomalies.
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Affiliation(s)
- Kala F Schilter
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jack E Steiner
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Wendy Demos
- Department of Human and Molecular Genetics Center, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mohit Maheshwari
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jeremy W Prokop
- HudsonAlpha Institute for Biotechnology, Huntsville, Alabama
| | | | - Beth A Drolet
- Departments of Dermatology and Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Dawn H Siegel
- Departments of Dermatology and Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
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Abstract
With a prevalence of 4·5%, infantile haemangiomas are the most common benign tumours of infancy, arising in the first few weeks of life and exhibiting a characteristic sequence of growth and spontaneous involution. Most infantile haemangiomas do not require therapy. However, to identify at-risk haemangiomas, close follow-up is crucial in the first weeks of life; 80% of all haemangiomas reach their final size by 3 months of age. The main indications for treatment are life-threatening infantile haemangioma (causing heart failure or respiratory distress), tumours posing functional risks (eg, visual obstruction, amblyopia, or feeding difficulties), ulceration, and severe anatomic distortion, especially on the face. Oral propranolol is now the first-line treatment, which should be administered as early as possible to avoid potential complications. Haemangioma shrinkage is rapidly observed with oral propranolol, but a minimum of 6 months of therapy is recommended.
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Affiliation(s)
| | - John I Harper
- Department of Paediatric Dermatology, Institute of Child Health and Great Ormond Street Hospital, London, UK
| | - Peter H Hoeger
- Departments of Paediatrics and Paediatric Dermatology, Catholic Children's Hospital Wilhelmstift, Hamburg, Germany
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50
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McVey MJ, Farlinger CM, Van Arsdell G, Armstrong D, Holtby H. Anesthesia for Complex Cardiovascular Surgery in a Patient With PHACES Syndrome and Review of the Literature. J Cardiothorac Vasc Anesth 2017; 31:1042-1047. [DOI: 10.1053/j.jvca.2016.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Indexed: 12/19/2022]
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