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Hernández-Hernández A, Uribe-Pacheco R, Guinto-Nishimura GY, Álvarez-Castro A, Castro-Soto F, Villanueva-Castro E, Del Pino-Camposeco J, Rodríguez-Hernández LA, Gómez JAP, Arriada-Mendicoa N. Predictors of poor functional outcomes in adults with type I Chiari Malformation: Clinical and surgical factors assessed with the Chicago Chiari Outcome Scale over long-term follow-up. Clin Neurol Neurosurg 2024; 243:108392. [PMID: 38945118 DOI: 10.1016/j.clineuro.2024.108392] [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: 05/08/2024] [Revised: 06/09/2024] [Accepted: 06/12/2024] [Indexed: 07/02/2024]
Abstract
OBJECTIVE This study aimed to identify clinical and surgical features associated with poor long-term postoperative outcomes in patients diagnosed with Type I Chiari Malformation (CMI) treated with posterior fossa decompression with duroplasty (PFDD), with or without tonsillar coagulation. METHODS This retrospective, single-center study included 107 adult patients with CMI surgically treated between 2010 and 2021. The surgical technique involved a midline suboccipital craniectomy, C1 laminectomy, durotomy, arachnoid dissection, duroplasty, and tonsillar coagulation until 2014, after which tonsillar coagulation was discontinued. Postoperative outcomes were assessed using the Chicago Chiari Outcome Scale (CCOS) at a median follow-up of 35 months. Clinical, surgical, and neuroimaging data were analyzed using the Wilcoxon signed-rank test, Cox regression analysis, and Kaplan-Meier survival curves to identify predictors of poor functional outcomes. RESULTS Of the 107 patients (mean age 43.9 years, SD 13), 81 (75.5 %) showed functional improvement, 25 (23.4 %) remained unchanged, and 1 (0.9 %) experienced worsened outcomes. Cephalalgia, bilateral motor weakness, and bilateral paresthesia were the most frequent initial symptoms. Tonsillar coagulation was performed in 31 cases (28.9 %) but was clinically associated with higher rates of unfavorable outcomes. The Wilcoxon signed-rank test indicated that long-term follow-up CCOS was significantly higher than postoperative CCOS (Z = -7.678, p < 0.000). Multivariate Cox analysis identified preoperative bilateral motor weakness (HR 6.1, 95 % CI 1.9-18.9; p = 0.002), hydrocephalus (HR 3.01, 95 % CI 1.3-6.9; p = 0.008), and unilateral motor weakness (HR 2.99, 95 % CI 1.1-8.2; p = 0.033) as significant predictors of poor outcomes on a long-term follow-up. CONCLUSION This study highlights the high rate of functional improvement in CMI patients following PFDD. Preoperative motor weakness and hydrocephalus were significant predictors of poor long-term outcomes. Tonsillar coagulation did not demonstrate a clear clinical benefit and may be associated with worse outcomes. Our findings suggest that careful preoperative assessment and selection of surgical techniques are crucial for optimizing patient outcomes.
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Affiliation(s)
- Alan Hernández-Hernández
- Neurosurgery Department, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - Rodrigo Uribe-Pacheco
- Neurosurgery Department, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico.
| | | | - Alfonso Álvarez-Castro
- Neurosurgery Department, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico.
| | - Fernando Castro-Soto
- Neurosurgery Department, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - Eliezer Villanueva-Castro
- Neurosurgery Department, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico.
| | - Jorge Del Pino-Camposeco
- Spine Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | | | - Juan Antonio Ponce Gómez
- Spine Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico.
| | - Nicasio Arriada-Mendicoa
- Spine Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico.
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Tomai XH, Nguyen HT, Nguyen Thi TT, Nguyen TA, Nguyen TV. Prenatal diagnosis of non-typical Chiari malformation type I associated with de novo Nuclear Factor I A gene mutation: a case report. J Med Case Rep 2024; 18:90. [PMID: 38347602 PMCID: PMC10863238 DOI: 10.1186/s13256-024-04361-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/03/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Chiari malformation is one of the most common Central nervous system (CNS) abnormalities that can be detected in routine fetal scanning. Chiari malformation type I (CMI) is a congenital defect characterized by a displacement of the cerebellar tonsils through the foramen magnum. The etiology of CMI has not been well established and suggested having multifactorial contributions, especially genetic deletion. Clinical characteristics of this anomaly may express in different symptoms from neurological dysfunction and/or skeletal abnormalities in the later age, but it is rarely reported in pregnancy. CASE PRESENTATION We present a case in which the Chiari malformation type I was diagnosed with comorbidities of facial anomalies (flatting forehead and micrognathia) and muscular-skeletal dysmorphologies (clenched hands and clubfeet) at the 24+6 weeks of gestation in a 29-year-old Vietnamese pregnant woman. The couple refused an amniocentesis, and the pregnancy was followed up every 4 weeks until a spontaneous delivery occurred at 38 weeks. The newborn had a severe asphyxia and seizures at birth required to have an emergency resuscitation at delivery. He is currently being treated in the intensive neonatal care unit. He carries the novel heterozygous NFIA gene mutation confirmed after birth. No further postnatal malformation detected. CONCLUSION CMI may only represent with facial abnormalities and muscle-skeletal malformations at the early stage of pregnancy, which may also alert an adverse outcome. A novel heterozygous NFIA gene mutation identified after birth helps to confirm prenatal diagnosis of CMI and to provide an appropriate consultation.
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Affiliation(s)
- Xuan-Hong Tomai
- University of Alberta, Alberta, Canada
- University of Nam Can Tho, Can Tho, Vietnam
| | - Huu-Trung Nguyen
- University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam. *
- University Medical Center, Branch 2, Ho Chi Minh City, Vietnam. *
| | | | - Tuan-Anh Nguyen
- University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
- University Medical Center, Branch 2, Ho Chi Minh City, Vietnam
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Bogdanov EI, Heiss JD. Evaluation and Treatment of Patients with Small Posterior Cranial Fossa and Chiari Malformation, Types 0 and 1. Adv Tech Stand Neurosurg 2024; 50:307-334. [PMID: 38592536 DOI: 10.1007/978-3-031-53578-9_11] [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] [Indexed: 04/10/2024]
Abstract
The diagnosis of Chiari I malformation is straightforward in patients with typical signs and symptoms of Chiari I malformation and magnetic resonance imaging (MRI) confirming ≥5 mm of cerebellar tonsillar ectopia, with or without a syrinx. However, in many cases, Chiari I malformation is discovered incidentally on MRI to evaluate global headache, cervical radiculopathy, or other conditions. In those cases, the clinician must consider if cerebellar tonsillar ectopia is related to the presenting symptoms. Surgical decompression of the cerebellar tonsils and foramen magnum in patients with symptomatic Chiari I malformation effectively relieves suboccipital headache, reduces syrinx distension, and arrests syringomyelia progression. Neurosurgeons must avoid operative treatments decompressing incidental tonsillar ectopia, not causing symptoms. Such procedures unnecessarily place patients at risk of operative complications and tissue injuries related to surgical exploration. This chapter reviews the typical signs and symptoms of Chiari I malformation and its variant, Chiari 0 malformation, which has <5 mm of cerebellar tonsillar ectopia and is often associated with syringomyelia. Chiari I and Chiari 0 malformations are associated with incomplete occipital bone development, reduced volume and height of the posterior fossa, tonsillar ectopia, and compression of the neural elements and cerebrospinal fluid (CSF) pathways at the foramen magnum. Linear, angular, cross-sectional area, and volume measurements of the posterior fossa, craniocervical junction, and upper cervical spine identify morphometric abnormalities in Chiari I and Chiari 0 malformation patients. Chiari 0 patients respond like Chiari I patients to foramen magnum decompression and should not be excluded from surgical treatment because their tonsillar ectopia is <5 mm. The authors recommend the adoption of diagnostic criteria for Chiari 0 malformation without syringomyelia. This chapter provides updated information and guidance to the physicians managing Chiari I and Chiari 0 malformation patients and neuroscientists interested in Chiari malformations.
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Affiliation(s)
- Enver I Bogdanov
- Department of Neurology and Rehabilitation, Kazan State Medical University, Kazan, Russia
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - John D Heiss
- Department of Neurology and Rehabilitation, Kazan State Medical University, Kazan, Russia.
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
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Mekbib KY, Muñoz W, Allington G, McGee S, Mehta NH, Shofi JP, Fortes C, Le HT, Nelson-Williams C, Nanda P, Dennis E, Kundishora AJ, Khanna A, Smith H, Ocken J, Greenberg ABW, Wu R, Moreno-De-Luca A, DeSpenza T, Zhao S, Marlier A, Jin SC, Alper SL, Butler WE, Kahle KT. Human genetics and molecular genomics of Chiari malformation type 1. Trends Mol Med 2023; 29:1059-1075. [PMID: 37802664 DOI: 10.1016/j.molmed.2023.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 10/08/2023]
Abstract
Chiari malformation type 1 (CM1) is the most common structural brain disorder involving the craniocervical junction, characterized by caudal displacement of the cerebellar tonsils below the foramen magnum into the spinal canal. Despite the heterogeneity of CM1, its poorly understood patho-etiology has led to a 'one-size-fits-all' surgical approach, with predictably high rates of morbidity and treatment failure. In this review we present multiplex CM1 families, associated Mendelian syndromes, and candidate genes from recent whole exome sequencing (WES) and other genetic studies that suggest a significant genetic contribution from inherited and de novo germline variants impacting transcription regulation, craniovertebral osteogenesis, and embryonic developmental signaling. We suggest that more extensive WES may identify clinically relevant, genetically defined CM1 subtypes distinguished by unique neuroradiographic and neurophysiological endophenotypes.
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Affiliation(s)
- Kedous Y Mekbib
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA; Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA; Harvard Center for Hydrocephalus and Neurodevelopmental Disorders, Massachusetts General Hospital, Boston, MA, USA
| | - William Muñoz
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA; Harvard Center for Hydrocephalus and Neurodevelopmental Disorders, Massachusetts General Hospital, Boston, MA, USA
| | - Garrett Allington
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | | | - Neel H Mehta
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - John P Shofi
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Carla Fortes
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Hao Thi Le
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | | | - Pranav Nanda
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Evan Dennis
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Adam J Kundishora
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Arjun Khanna
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Hannah Smith
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Jack Ocken
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Ana B W Greenberg
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Rui Wu
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Andres Moreno-De-Luca
- Department of Radiology, Autism and Developmental Medicine Institute, Genomic Medicine Institute, Geisinger, Danville, PA, USA
| | - Tyrone DeSpenza
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Shujuan Zhao
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Sheng Chih Jin
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA; Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Seth L Alper
- Division of Nephrology and Vascular Biology Research Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - William E Butler
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Kristopher T Kahle
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA; Harvard Center for Hydrocephalus and Neurodevelopmental Disorders, Massachusetts General Hospital, Boston, MA, USA; Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA, USA; Broad Institute of MIT and Harvard, Cambridge, MA, USA.
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Toader C, Ples H, Covache-Busuioc RA, Costin HP, Bratu BG, Dumitrascu DI, Glavan LA, Ciurea AV. Decoding Chiari Malformation and Syringomyelia: From Epidemiology and Genetics to Advanced Diagnosis and Management Strategies. Brain Sci 2023; 13:1658. [PMID: 38137106 PMCID: PMC10741770 DOI: 10.3390/brainsci13121658] [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: 11/06/2023] [Accepted: 11/24/2023] [Indexed: 12/24/2023] Open
Abstract
Chiari Malformation and Syringomyelia are neurosurgical entities that have been the subject of extensive research and clinical interest. Globally prevalent, these disorders vary demographically and have witnessed evolving temporal trends. Chiari Malformation impacts the normal cerebrospinal fluid flow, consequently affecting overall health. Key observations from canine studies offer pivotal insights into the pathogenesis of Syringomyelia and its extrapolation to human manifestations. Genetics plays a pivotal role; contemporary knowledge identifies specific genes, illuminating avenues for future exploration. Clinically, these disorders present distinct phenotypes. Diagnostically, while traditional methods have stood the test of time, innovative neurophysiological techniques are revolutionizing early detection and management. Neuroradiology, a cornerstone in diagnosis, follows defined criteria. Advanced imaging techniques are amplifying diagnostic precision. In therapeutic realms, surgery remains primary. For Chiari 1 Malformation, surgical outcomes vary based on the presence of Syringomyelia. Isolated Syringomyelia demands a unique surgical approach, the effectiveness of which is continually being optimized. Post-operative long-term prognosis and quality of life measures are crucial in assessing intervention success. In conclusion, this review amalgamates existing knowledge, paving the way for future research and enhanced clinical strategies in the management of Chiari Malformation and Syringomyelia.
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Affiliation(s)
- Corneliu Toader
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (L.A.G.); (A.V.C.)
- Department of Vascular Neurosurgery, National Institute of Neurology and Neurovascular Diseases, 077160 Bucharest, Romania
| | - Horia Ples
- Department of Neurosurgery, Centre for Cognitive Research in Neuropsychiatric Pathology 6 (NeuroPsy-Cog), 300736 Timișoara, Romania
- Department of Neurosurgery, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Razvan-Adrian Covache-Busuioc
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (L.A.G.); (A.V.C.)
| | - Horia Petre Costin
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (L.A.G.); (A.V.C.)
| | - Bogdan-Gabriel Bratu
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (L.A.G.); (A.V.C.)
| | - David-Ioan Dumitrascu
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (L.A.G.); (A.V.C.)
| | - Luca Andrei Glavan
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (L.A.G.); (A.V.C.)
| | - Alexandru Vlad Ciurea
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (L.A.G.); (A.V.C.)
- Neurosurgery Department, Sanador Clinical Hospital, 010991 Bucharest, Romania
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García M, Amayra I, Pérez M, Salgueiro M, Martínez O, López-Paz JF, Allen PA. Cognition in Chiari Malformation Type I: an Update of a Systematic Review. Neuropsychol Rev 2023:10.1007/s11065-023-09622-2. [PMID: 37798373 DOI: 10.1007/s11065-023-09622-2] [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: 03/31/2023] [Accepted: 09/26/2023] [Indexed: 10/07/2023]
Abstract
Chiari malformation has been classified as a group of posterior cranial fossa disorders characterized by hindbrain herniation. Chiari malformation type I (CM-I) is the most common subtype, ranging from asymptomatic patients to those with severe disorders. Research about clinical manifestations or medical treatments is still growing, but cognitive functioning has been less explored. The aim of this systematic review is to update the literature search about cognitive deficits in CM-I patients. A literature search was performed through the following electronic databases: MEDLINE, PsychINFO, Pubmed, Cochrane Library, Scopus, and Web of Science. The date last searched was February 1, 2023. The inclusion criteria were as follows: (a) include pediatric or adult participants with a CM-I diagnosis, (b) include cognitive or neuropsychological assessment with standardized tests, (c) be published in English or Spanish, and (d) be empirical studies. Articles that did not report empirical data, textbooks and conference abstracts were excluded. After the screening, twenty-eight articles were included in this systematic review. From those, twenty-one articles were focused on adult samples and seven included pediatric patients. There is a great heterogeneity in the recruited samples, followed methodology and administered neurocognitive protocols. Cognitive functioning appears to be affected in CM-I patients, at least some aspects of attention, executive functions, visuospatial abilities, episodic memory, or processing speed. However, these results require careful interpretation due to the methodological limitations of the studies. Although it is difficult to draw a clear profile of cognitive deficits related to CM-I, the literature suggests that cognitive dysfunction may be a symptom of CM-I. This suggest that clinicians should include cognitive assessment in their diagnostic procedures used for CM-I. In summary, further research is needed to determine a well-defined cognitive profile related to CM-I, favoring a multidisciplinary approach of this disorder.
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Affiliation(s)
- Maitane García
- Department of Psychology, Faculty of Health Sciences, Neuro-E-Motion Research Team, University of Deusto, Bilbao, Spain.
| | - Imanol Amayra
- Department of Psychology, Faculty of Health Sciences, Neuro-E-Motion Research Team, University of Deusto, Bilbao, Spain
| | - Manuel Pérez
- Department of Psychology, Faculty of Health Sciences, Neuro-E-Motion Research Team, University of Deusto, Bilbao, Spain
- Faculty of Health Sciences, Isabel I University, Burgos, Spain
| | - Monika Salgueiro
- Department of Clinical and Health Psychology, and Research Methodology, Faculty of Psychology, University of the Basque Country, Donostia, Spain
| | - Oscar Martínez
- Department of Psychology, Faculty of Health Sciences, Neuro-E-Motion Research Team, University of Deusto, Bilbao, Spain
| | - Juan Francisco López-Paz
- Department of Psychology, Faculty of Health Sciences, Neuro-E-Motion Research Team, University of Deusto, Bilbao, Spain
| | - Philip A Allen
- Conquer Chiari Research Center, Department of Psychology, University of Akron, Akron, OH, USA
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Brockmeyer DL, Cheshier SH, Stevens J, Facelli JC, Rowe K, Heiss JD, Musolf A, Viskochil DH, Allen-Brady KL, Cannon-Albright LA. A likely HOXC4 predisposition variant for Chiari malformations. J Neurosurg 2023; 139:266-274. [PMID: 36433874 PMCID: PMC10193467 DOI: 10.3171/2022.10.jns22956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 10/12/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Inherited variants predisposing patients to type 1 or 1.5 Chiari malformation (CM) have been hypothesized but have proven difficult to confirm. The authors used a unique high-risk pedigree population resource and approach to identify rare candidate variants that likely predispose individuals to CM and protein structure prediction tools to identify pathogenicity mechanisms. METHODS By using the Utah Population Database, the authors identified pedigrees with significantly increased numbers of members with CM diagnosis. From a separate DNA biorepository of 451 samples from CM patients and families, 32 CM patients belonging to 1 or more of 24 high-risk Chiari pedigrees were identified. Two high-risk pedigrees had 3 CM-affected relatives, and 22 pedigrees had 2 CM-affected relatives. To identify rare candidate predisposition gene variants, whole-exome sequence data from these 32 CM patients belonging to 24 CM-affected related pairs from high-risk pedigrees were analyzed. The I-TASSER package for protein structure prediction was used to predict the structures of both the wild-type and mutant proteins found here. RESULTS Sequence analysis of the 24 affected relative pairs identified 38 rare candidate Chiari predisposition gene variants that were shared by at least 1 CM-affected pair from a high-risk pedigree. The authors found a candidate variant in HOXC4 that was shared by 2 CM-affected patients in 2 independent pedigrees. All 4 of these CM cases, 2 in each pedigree, exhibited a specific craniocervical bony phenotype defined by a clivoaxial angle less than 125°. The protein structure prediction results suggested that the mutation considered here may reduce the binding affinity of HOXC4 to DNA. CONCLUSIONS Analysis of unique and powerful Utah genetic resources allowed identification of 38 strong candidate CM predisposition gene variants. These variants should be pursued in independent populations. One of the candidates, a rare HOXC4 variant, was identified in 2 high-risk CM pedigrees, with this variant possibly predisposing patients to a Chiari phenotype with craniocervical kyphosis.
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Affiliation(s)
- Douglas L. Brockmeyer
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Utah, Salt Lake City, Utah
- Intermountain Healthcare, Salt Lake City, Utah
| | - Samuel H. Cheshier
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Utah, Salt Lake City, Utah
- Intermountain Healthcare, Salt Lake City, Utah
- Huntsman Cancer Institute, Salt Lake City, Utah
| | - Jeff Stevens
- Genetic Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | | | - Kerry Rowe
- Intermountain Healthcare, Salt Lake City, Utah
| | - John D. Heiss
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; and
| | - Anthony Musolf
- Statistical Genetics Section, Computational and Statistical Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - David H. Viskochil
- Intermountain Healthcare, Salt Lake City, Utah
- Pediatrics, University of Utah, Salt Lake City, Utah
| | - Kristina L. Allen-Brady
- Genetic Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Lisa A. Cannon-Albright
- Huntsman Cancer Institute, Salt Lake City, Utah
- Genetic Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
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Higuchi N, Nakamura T, Yoshioka F, Sanefuji M, Matsuo M. Two differential cavities in syringomyelia of pediatric Chiari I malformation presenting with unilateral foot drop. Brain Dev 2023; 45:191-195. [PMID: 36529612 DOI: 10.1016/j.braindev.2022.11.007] [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] [Received: 10/08/2022] [Revised: 11/21/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Patients with Chiari I malformation (CM1) may have chronic symptoms of syringomyelia, including numbness and weakness of the upper limbs, typically during young adulthood. Acute or subacute presentation of unilateral foot drop has been rarely reported as a first symptom of CM1-associated syringomyelia exclusively in childhood or adolescence. Why these patients do not show any symptoms of the upper limbs although holocord syringomyelia is always observed on magnetic resonance imaging (MRI) is unclear. CASE PRESENTATION A four-year-old girl presented rapidly with isolated left foot drop. Conventional MRI revealed holocord syringomyelia associated with CM1. Three-dimensional constructive interference in steady state (3D-CISS) imaging further demonstrated that the syringomyelia was comprised of two differential cavities that communicated with each other via a small pore: a centrally positioned upper cavity and a left-deviated lower one. Surgical decompression of the foramen magnum resolved the symptom with radiological improvement of the two cavities. CONCLUSION In contrast to a centrally enlarged syrinx that is often asymptomatic, a paracentrally extended syrinx usually produces segmental signs related to its levels. Thus, the left foot drop in this case would have been due to the ipsilaterally deviated lower cavity that was distinguished from the central upper cavity by 3D-CISS imaging. Further reports using this imaging technique are needed to verify the hypothetic pathology.
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Affiliation(s)
- Naoya Higuchi
- Department of Pediatrics, National Hospital Organization Ureshino Medical Center, Ureshino, Saga, Japan
| | - Takuji Nakamura
- Department of Pediatrics, Faculty of Medicine, Saga University, Saga, Japan
| | - Fumitaka Yoshioka
- Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Masafumi Sanefuji
- Department of Pediatrics, Faculty of Medicine, Saga University, Saga, Japan.
| | - Muneaki Matsuo
- Department of Pediatrics, Faculty of Medicine, Saga University, Saga, Japan
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Leon E, Nde C, Ray RS, Preciado D, Zohn IE. ALDH1A2-related disorder: A new genetic syndrome due to alteration of the retinoic acid pathway. Am J Med Genet A 2023; 191:90-99. [PMID: 36263470 PMCID: PMC9805811 DOI: 10.1002/ajmg.a.62991] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/15/2022] [Accepted: 08/01/2022] [Indexed: 01/03/2023]
Abstract
Aldehyde Dehydrogenase 1, Family Member A2 (ALDH1A2) is essential for the synthesis of retinoic acid from vitamin A. Studies in model organisms demonstrate a critical role for ALDH1A2 in embryonic development, yet few pathogenic variants are linked to congenital anomalies in humans. We present three siblings with multiple congenital anomaly syndrome linked to biallelic sequence variants in ALDH1A2. The major congenital malformations affecting these children include tetralogy of Fallot, absent thymus, diaphragmatic eventration, and talipes equinovarus. Upper airway anomalies, hypocalcemia, and dysmorphic features are newly reported in this manuscript. In vitro functional validation of variants indicated that substitutions reduced the expression of the enzyme. Our clinical and functional data adds to a recent report of biallelic ALDH1A2 pathogenic variants in two families with a similar constellation of congenital malformations. These findings provide further evidence for an autosomal recessive ALDH1A2-deficient recognizable malformation syndrome involving the diaphragm, cardiac and musculoskeletal systems.
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Affiliation(s)
- Eyby Leon
- Rare Disease Institute, Children's National Hospital, Washington, DC, USA
| | - Claris Nde
- Center for Genetic Medicine, Children's National Hospital, Washington, DC, USA
| | - Randall S. Ray
- Rare Disease Institute, Children's National Hospital, Washington, DC, USA
| | - Diego Preciado
- Division of Pediatric Otolaryngology, Children's National Hospital, Washington, DC, USA
| | - Irene E. Zohn
- Center for Genetic Medicine, Children's National Hospital, Washington, DC, USA
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10
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Elucidating the Genetic Basis of Chiari I Malformation. Neurosurg Clin N Am 2023; 34:55-60. [DOI: 10.1016/j.nec.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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11
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Martínez-Gil N, Mellibovsky L, Gonzalez DML, Patiño JD, Cozar M, Rabionet R, Grinberg D, Balcells S. On the association between Chiari malformation type 1, bone mineral density and bone related genes. Bone Rep 2022; 16:101181. [PMID: 35313637 PMCID: PMC8933671 DOI: 10.1016/j.bonr.2022.101181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 03/04/2022] [Accepted: 03/08/2022] [Indexed: 11/26/2022] Open
Abstract
Background Chiari malformation type 1 (C1M) is a neurological disease characterized by herniation of the cerebellar tonsils below the foramen magnum. Cranial bone constriction is suspected to be its main cause. To date, genes related to bone development (e.g. DKK1 or COL1A2) have been associated with C1M, while some bone diseases (e.g. Paget) have been found to cosegregate with C1M. Nevertheless, the association between bone mineral density (BMD) and C1M has not been investigated, yet. Here, we systematically investigate the association between C1M and BMD, and between bone related genes and C1M. Methods We have recruited a small cohort of C1M patients (12 unrelated patients) in whom we have performed targeted sequencing of an in-house bone-related gene panel and BMD determination through non-invasive DXA. Results In the search for association between the bone related genes and C1M we have found variants in more than one C1M patient in WNT16, CRTAP, MYO7A and NOTCH2. These genes have been either associated with craniofacial development in different ways, or previously associated with C1M (MYO7A). Regarding the potential link between BMD and C1M, we have found three osteoporotic patients and one patient who had high BMD, very close to the HBM phenotype values, although most patients had normal BMD. Conclusions Variants in bone related genes have been repeatedly found in some C1M cases. The relationship of bone genes with C1M deserves further study, to get a clearer estimate of their contribution to its etiology. No direct correlation between BMD and C1M was observed. We used an in-house bone gene panel to investigate a small cohort of C1M patients. Variants in WNT16, CRTAP, MYO7A and NOTCH2 were found in more than one C1M patient. No clear relationship was found between C1M and BMD in this small C1M cohort.
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12
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Parihar M, Bendelac-Kapon L, Gur M, Abbou T, Belorkar A, Achanta S, Kinberg K, Vadigepalli R, Fainsod A. Retinoic Acid Fluctuation Activates an Uneven, Direction-Dependent Network-Wide Robustness Response in Early Embryogenesis. Front Cell Dev Biol 2021; 9:747969. [PMID: 34746144 PMCID: PMC8564372 DOI: 10.3389/fcell.2021.747969] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/23/2021] [Indexed: 01/15/2023] Open
Abstract
Robustness is a feature of regulatory pathways to ensure signal consistency in light of environmental changes or genetic polymorphisms. The retinoic acid (RA) pathway, is a central developmental and tissue homeostasis regulatory signal, strongly dependent on nutritional sources of retinoids and affected by environmental chemicals. This pathway is characterized by multiple proteins or enzymes capable of performing each step and their integration into a self-regulating network. We studied RA network robustness by transient physiological RA signaling disturbances followed by kinetic transcriptomic analysis of the recovery during embryogenesis. The RA metabolic network was identified as the main regulated module to achieve signaling robustness using an unbiased pattern analysis. We describe the network-wide responses to RA signal manipulation and found the feedback autoregulation to be sensitive to the direction of the RA perturbation: RA knockdown exhibited an upper response limit, whereas RA addition had a minimal feedback-activation threshold. Surprisingly, our robustness response analysis suggests that the RA metabolic network regulation exhibits a multi-objective optimization, known as Pareto optimization, characterized by trade-offs between competing functionalities. We observe that efficient robustness to increasing RA is accompanied by worsening robustness to reduced RA levels and vice versa. This direction-dependent trade-off in the network-wide feedback response, results in an uneven robustness capacity of the RA network during early embryogenesis, likely a significant contributor to the manifestation of developmental defects.
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Affiliation(s)
- Madhur Parihar
- Daniel Baugh Institute for Functional Genomics and Computational Biology, Department of Pathology, Anatomy, and Cell Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Liat Bendelac-Kapon
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Jerusalem, Israel
| | - Michal Gur
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Jerusalem, Israel
| | - Tali Abbou
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Jerusalem, Israel
| | - Abha Belorkar
- Daniel Baugh Institute for Functional Genomics and Computational Biology, Department of Pathology, Anatomy, and Cell Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Sirisha Achanta
- Daniel Baugh Institute for Functional Genomics and Computational Biology, Department of Pathology, Anatomy, and Cell Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Keren Kinberg
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Jerusalem, Israel
| | - Rajanikanth Vadigepalli
- Daniel Baugh Institute for Functional Genomics and Computational Biology, Department of Pathology, Anatomy, and Cell Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Abraham Fainsod
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Jerusalem, Israel
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13
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Shuman WH, DiRisio A, Carrasquilla A, Lamb CD, Quinones A, Pionteck A, Yang Y, Kurt M, Shrivastava RK. Is there a morphometric cause of Chiari malformation type I? Analysis of existing literature. Neurosurg Rev 2021; 45:263-273. [PMID: 34254195 DOI: 10.1007/s10143-021-01592-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/10/2021] [Accepted: 06/17/2021] [Indexed: 02/07/2023]
Abstract
Although many etiologies have been proposed for Chiari malformation type I (CM-I), there currently is no singular known cause of CM-I pathogenesis. Advances in imaging have greatly progressed the study of CM-I. This study reviews the literature to determine if an anatomical cause for CM-I could be proposed from morphometric studies in adult CM-I patients. After conducting a literature search using relevant search terms, two authors screened abstracts for relevance. Full-length articles of primary morphometric studies published in peer-reviewed journals were included. Detailed information regarding methodology and symptomatology, craniocervical instability, syringomyelia, operative effects, and genetics were extracted. Forty-six studies met inclusion criteria, averaging 93.2 CM-I patients and 41.4 healthy controls in size. To obtain measurements, 40 studies utilized MRI and 10 utilized CT imaging, whereas 41 analyzed parameters within the posterior fossa and 20 analyzed parameters of the craniovertebral junction. The most commonly measured parameters included clivus length (n = 30), tonsillar position or descent (n = 28), McRae line length (n = 26), and supraocciput length (n = 26). While certain structural anomalies including reduced clivus length have been implicated in CM-I, there is a lack of consensus on how several other morphometric parameters may or may not contribute to its development. Heterogeneity in presentation with respect to the extent of tonsillar descent suggests alternate methods utilizing morphometric measurements that may help to identify CM-I patients and may benefit future research to better understand underlying pathophysiology and sequelae such as syringomyelia.
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Affiliation(s)
- William H Shuman
- Department of Neurosurgery, Icahn School of Medicine At Mount Sinai, 1468 Madison Avenue, New York, NY, 10029, USA.
| | - Aislyn DiRisio
- Department of Neurosurgery, Icahn School of Medicine At Mount Sinai, 1468 Madison Avenue, New York, NY, 10029, USA
| | - Alejandro Carrasquilla
- Department of Neurosurgery, Icahn School of Medicine At Mount Sinai, 1468 Madison Avenue, New York, NY, 10029, USA
| | - Colin D Lamb
- Department of Neurosurgery, Icahn School of Medicine At Mount Sinai, 1468 Madison Avenue, New York, NY, 10029, USA
| | - Addison Quinones
- Department of Neurosurgery, Icahn School of Medicine At Mount Sinai, 1468 Madison Avenue, New York, NY, 10029, USA
| | - Aymeric Pionteck
- Department of Mechanical Engineering, Stevens Institute of Technology, Hoboken, NJ, USA
| | - Yang Yang
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine At Mount Sinai, New York, NY, USA
| | - Mehmet Kurt
- Department of Mechanical Engineering, Stevens Institute of Technology, Hoboken, NJ, USA
| | - Raj K Shrivastava
- Department of Neurosurgery, Icahn School of Medicine At Mount Sinai, 1468 Madison Avenue, New York, NY, 10029, USA
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14
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Han S, Gao J, Li Z, Wang X, Li Y. One-Year Outcomes of Chiari Type 1 Malformation and Syringomyelia Treated With Posterior Fossa Decompression. Clin Spine Surg 2021; 34:E248-E255. [PMID: 33605611 DOI: 10.1097/bsd.0000000000001136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 12/22/2020] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN This was a retrospective cohort study. OBJECTIVE The objective of this study was to evaluate posterior fossa structural differences between Chiari type 1 malformation with and without syringomyelia, and assess data of the improvement of syringomyelia after different surgical options. SUMMARY OF BACKGROUND DATA Syringomyelia is among the most common concomitant complications of Chiari malformation (CM). However, posterior fossa decompression cannot definitely make the syringomyelia disappear even in the long term. Also, there are no universal criteria defining improvement in syrinx. MATERIALS AND METHODS All admitted CM patients at our institution from 2013 to 2018 with a 1-year follow-up were analyzed. Patients without syringomyelia were compared with those who had syringomyelia. Patients were divided into 3 groups according to the procedures performed: posterior fossa decompression versus posterior fossa decompression with duralplasty (PFDD) versus PFDD plus obex unblocking. Divergent prognosis of syringomyelia was defined as a 3-category ordinal variable. A multivariable ordinal regression model was used to estimate the relationship between patient variables and increased odds for better resolution of syringomyelia. RESULTS No significant linear difference in bony structure was found between syringomyelia and nonsyringomyelia patients. Among syringomyelia patients, the regression analysis demonstrated that patients with shorter posterior fossa height ( P =0.032), lower Pavlov ratio ( P =0.029), and obex unblocking (vs. PFDD, P <0.001; vs. posterior fossa decompression, P =0.037) were more likely to gain a better resolution of syringomyelia. CONCLUSIONS Syringomyelia of CM patients may not simply originate from single linear anatomic variation. Patients with shorter posterior fossa height and lower Pavlov ratio received better syringomyelia resolution. Also, unblocking the obex received better syringomyelia resolution compared with duraplasty alone and bony decompression alone with the avoidance of increased postoperative complications and worse clinical outcomes.
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Affiliation(s)
| | | | | | | | - Yongning Li
- Departments of Neurosurgery
- International Medical Service, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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15
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Rare functional genetic variants in COL7A1, COL6A5, COL1A2 and COL5A2 frequently occur in Chiari Malformation Type 1. PLoS One 2021; 16:e0251289. [PMID: 33974636 PMCID: PMC8112708 DOI: 10.1371/journal.pone.0251289] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/24/2021] [Indexed: 11/19/2022] Open
Abstract
Chiari Malformation Type 1 (CM-1) is characterized by herniation of the cerebellar tonsils below the foramen magnum and the presence of headaches and other neurologic symptoms. Cranial bone constriction is suspected to be the most common biologic mechanism leading to CM-1. However, other mechanisms may also contribute, particularly in the presence of connective tissue disorders (CTDs), such as Ehlers Danlos Syndrome (EDS). Accumulating data suggest CM-1 with connective tissue disorders (CTD+) may have a different patho-mechanism and different genetic risk factors than CM-1 without CTDs (CTD-). To identify CM-1 genetic risk variants, we performed whole exome sequencing on a single large, multiplex family from Spain and targeted sequencing on a cohort of 186 unrelated adult, Caucasian females with CM-1. Targeted sequencing captured the coding regions of 21 CM-1 and EDS candidate genes, including two genes identified in the Spanish family. Using gene burden analysis, we compared the frequency of rare, functional variants detected in CM-1 cases versus publically available ethnically-matched controls from gnomAD. A secondary analysis compared the presence of rare variants in these genes between CTD+ and CTD- CM-1 cases. In the Spanish family, rare variants co-segregated with CM-1 in COL6A5, ADGRB3 and DST. A variant in COL7A1 was present in affected and unaffected family members. In the targeted sequencing analysis, rare variants in six genes (COL7A1, COL5A2, COL6A5, COL1A2, VEGFB, FLT1) were significantly more frequent in CM-1 cases compared to public controls. In total, 47% of CM-1 cases presented with rare variants in at least one of the four significant collagen genes and 10% of cases harbored variants in multiple significant collagen genes. Moreover, 26% of CM-1 cases presented with rare variants in the COL6A5 gene. We also identified two genes (COL7A1, COL3A1) for which the burden of rare variants differed significantly between CTD+ and CTD- CM-1 cases. A higher percentage of CTD+ patients had variants in COL7A1 compared to CTD+ patients, while CTD+ patients had fewer rare variants in COL3A1 than did CTD- patients. In summary, rare variants in several collagen genes are particularly frequent in CM-1 cases and those in COL6A5 co-segregated with CM-1 in a Spanish multiplex family. COL6A5 has been previously associated with musculoskeletal phenotypes, but this is the first association with CM-1. Our findings underscore the contribution of rare genetic variants in collagen genes to CM-1, and suggest that CM-1 in the presence and absence of CTD symptoms is driven by different genes.
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16
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Chauhan AK, Chandra PS, Goyal N, Chowdhury MR, Banerjee J, Tripathi M, Kabra M. Weak Ligaments and Sloping Joints: A New Hypothesis for Development of Congenital Atlantoaxial Dislocation and Basilar Invagination. Neurospine 2021; 17:843-856. [PMID: 33401861 PMCID: PMC7788422 DOI: 10.14245/ns.2040434.217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/17/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Developmental bony craniovertebral junction (CVJ) anomalies seem to have a genetic basis and also abnormal joint morphology causing atlantoaxial dislocation (AAD) and basilar invagination (BI). METHODS DNA extracted polymerase chain reaction single-stranded conformation polymorphism (SSCP) performed for mutation screening of FBN1 gene (n = 50 cases+ 50 age/sex-matched normal; total: 100). Samples with a deviated pattern of bands in SSCP were sequenced to detect the type of variation. Computed tomography (CT) scans of 100 patients (15-45 years old) compared with an equal number of age/sex-matched controls (21.9 ± 8.2 years). Joint parameters studied: sagittal joint inclination (SI), craniocervical tilt (CCT), coronal joint inclination (CI). RESULTS Thirty-nine samples (78%) showed sequence variants. Exon 25, 26, 27, and 28 showed variable patterns of DNA bands in SSCP, which on sequencing gives various types of DNA sequence variations in intronic region of the FBN1 gene in 14%, 14%, 6%, and 44% respectively. CT radiology:SI and CCT correlated with both BI and AAD (p < 0.01). The mean SI value in controls: 83.35° ± 8.65°, and in patients with BI and AAD:129° ± 24.05°. Mean CCT in controls: 60.2° ± 9.2°, and in patients with BI and AAD: 86.0° ± 18.1°. Mean CI in controls:110.3° ± 4.23°, and in cases: 125.15° ± 16.4°. CONCLUSION The study showed mutations in FBN1 gene (reported in Marfan syndrome). There is also an alteration of joint morphology, correlating with AAD and BI severity. Hence, we propose a double-hit hypothesis: the presence of weak ligaments (due to FB1 gene alterations) and abnormal joint morphology may contribute to AAD and BI.
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Affiliation(s)
- Avnish K Chauhan
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - P Sarat Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Nishant Goyal
- Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, India
| | | | - Jyotirmoy Banerjee
- Department of Biophysics, All India Institute of Medical Sciences, New Delhi, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Madhulika Kabra
- Genetics Center, All India Institute of Medical Sciences, New Delhi, India
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17
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Sadler B, Wilborn J, Antunes L, Kuensting T, Hale AT, Gannon SR, McCall K, Cruchaga C, Harms M, Voisin N, Reymond A, Cappuccio G, Brunetti-Pierri N, Tartaglia M, Niceta M, Leoni C, Zampino G, Ashley-Koch A, Urbizu A, Garrett ME, Soldano K, Macaya A, Conrad D, Strahle J, Dobbs MB, Turner TN, Shannon CN, Brockmeyer D, Limbrick DD, Gurnett CA, Haller G. Rare and de novo coding variants in chromodomain genes in Chiari I malformation. Am J Hum Genet 2021; 108:100-114. [PMID: 33352116 DOI: 10.1016/j.ajhg.2020.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/24/2020] [Indexed: 12/16/2022] Open
Abstract
Chiari I malformation (CM1), the displacement of the cerebellum through the foramen magnum into the spinal canal, is one of the most common pediatric neurological conditions. Individuals with CM1 can present with neurological symptoms, including severe headaches and sensory or motor deficits, often as a consequence of brainstem compression or syringomyelia (SM). We conducted whole-exome sequencing (WES) on 668 CM1 probands and 232 family members and performed gene-burden and de novo enrichment analyses. A significant enrichment of rare and de novo non-synonymous variants in chromodomain (CHD) genes was observed among individuals with CM1 (combined p = 2.4 × 10-10), including 3 de novo loss-of-function variants in CHD8 (LOF enrichment p = 1.9 × 10-10) and a significant burden of rare transmitted variants in CHD3 (p = 1.8 × 10-6). Overall, individuals with CM1 were found to have significantly increased head circumference (p = 2.6 × 10-9), with many harboring CHD rare variants having macrocephaly. Finally, haploinsufficiency for chd8 in zebrafish led to macrocephaly and posterior hindbrain displacement reminiscent of CM1. These results implicate chromodomain genes and excessive brain growth in CM1 pathogenesis.
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Mirabella F, Gulisano M, Capelli M, Lauretta G, Cirnigliaro M, Palmucci S, Stella M, Barbagallo D, Di Pietro C, Purrello M, Ragusa M, Rizzo R. Enrichment and Correlation Analysis of Serum miRNAs in Comorbidity Between Arnold-Chiari and Tourette Syndrome Contribute to Clarify Their Molecular Bases. Front Mol Neurosci 2021; 13:608355. [PMID: 33469418 PMCID: PMC7813987 DOI: 10.3389/fnmol.2020.608355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 12/04/2020] [Indexed: 12/27/2022] Open
Abstract
Due to its rarity, coupled to a multifactorial and very heterogeneous nature, the molecular etiology of Arnold-Chiari (AC) syndrome remains almost totally unknown. Its relationship with other neuropsychiatric disorders such as Tourette syndrome (TS) is also undetermined. The rare comorbid status between both disorders (ACTS) complicates the framework of diagnosis and negatively affects the patients' quality of life. In this exploratory study, we aimed to identify serum microRNA expression profiles as molecular fingerprints for AC, TS, and ACTS, by using a high-throughput approach. For this aim, 10 AC patients, 11 ACTS patients, 6 TS patients, and 8 unaffected controls (NC) were recruited. Nine miRNAs resulted significantly differentially expressed (DE): let-7b-5p (upregulated in ACTS vs. TS); miR-21-5p (upregulated in ACTS vs. AC; downregulated in AC vs. TS); miR-23a-3p (upregulated in TS vs. NCs; downregulated in AC vs. TS); miR-25-3p (upregulated in AC vs. TS and NCs; downregulated in ACTS vs. AC); miR-93-5p (upregulated in AC vs. TS); miR-130a-3p (downregulated in ACTS and TS vs. NCs); miR-144-3p (downregulated in ACTS vs. AC; upregulated in AC vs. TS); miR-222-3p (upregulated in ACTS vs. NCs); miR-451a (upregulated in AC vs. TS and NCs; in ACTS vs. NCs). Altered expression of miRNAs was statistically correlated to neuroimaging and neuropsychological anomalies. Furthermore, computational analyses indicated that DE miRNAs are involved in AC and TS pathomechanisms. Finally, we propose the dysregulation of the miRNA set as a potential molecular tool for supporting the current diagnosis of AC, TS, and ACTS by using liquid biopsies, in an unbiased and non-invasive way.
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Affiliation(s)
- Federica Mirabella
- Section of Biology and Genetics Giovanni Sichel, Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Mariangela Gulisano
- Section of Child and Adolescent Psychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Mara Capelli
- Section of Child and Adolescent Psychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Giovanni Lauretta
- Section of Biology and Genetics Giovanni Sichel, Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Matilde Cirnigliaro
- Section of Biology and Genetics Giovanni Sichel, Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Stefano Palmucci
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies, University Hospital "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | - Michele Stella
- Section of Biology and Genetics Giovanni Sichel, Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Davide Barbagallo
- Section of Biology and Genetics Giovanni Sichel, Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Cinzia Di Pietro
- Section of Biology and Genetics Giovanni Sichel, Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Michele Purrello
- Section of Biology and Genetics Giovanni Sichel, Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Marco Ragusa
- Section of Biology and Genetics Giovanni Sichel, Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy.,Oasi Research Institute-IRCCS, Troina, Italy
| | - Renata Rizzo
- Section of Child and Adolescent Psychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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Kim J, Lee DW, Jang DH. Case Report: Pansynostosis, Chiari I Malformation and Syringomyelia in a Child With Frontometaphyseal Dysplasia 1. Front Pediatr 2021; 9:574402. [PMID: 34277511 PMCID: PMC8280522 DOI: 10.3389/fped.2021.574402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 06/08/2021] [Indexed: 11/13/2022] Open
Abstract
Frontometaphyseal dysplasia 1 (FMD1) is a rare otopalatodigital spectrum disorder (OPDSD) that is inherited as an X-linked trait and it is caused by gain-of-function mutations in the FLNA. It is characterized by generalized skeletal dysplasia, and craniofacial abnormalities including facial dysmorphism (supraorbital hyperostosis, hypertelorism, and down-slanting palpebral fissures). The involvement of the central nervous system in patients with OPDSD is rare. Herein, we present the case of a 12-year-old boy with facial dysmorphism, multiple joint contractures, sensorineural hearing loss, scoliosis, craniosynostosis, and irregular sclerosis with hyperostosis of the skull. Brain and whole-spine magnetic resonance imaging revealed Chiari I malformation with extensive hydrosyringomyelia from the C1 to T12 levels. Targeted next-generation sequencing identified a hemizygous pathologic variant (c.3557C>T/p.Ser1186Leu) in the FLNA, confirming the diagnosis of FMD1. This is the first report of a rare case of OPDSD with pansynostosis and Chiari I malformation accompanied by extensive syringomyelia.
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Affiliation(s)
- Jaewon Kim
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Dong-Woo Lee
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Dae-Hyun Jang
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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AVŞAR T, ÇALIŞ Ş, YILMAZ B, DEMİRCİ OTLUOĞLU G, HOLYAVKİN C, KILIÇ T. Genome-wide identification of Chiari malformation type I associated candidate genes and chromosomal variations. Turk J Biol 2020; 44:449-456. [PMID: 33402871 PMCID: PMC7759189 DOI: 10.3906/biy-2009-19] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 10/12/2020] [Indexed: 01/12/2023] Open
Abstract
Chiari malformation type I (CMI) is a brain malformation that is characterized by herniation of the cerebellum into the spinal canal. Chiari malformation type I is highly heterogeneous; therefore, an accurate explanation of the pathogenesis of the disease is often not possible. Although some studies showed the role of genetics in CMI, the involvement of genetic variations in CMI pathogenesis has not been thoroughly elucidated. Therefore, in the current study we aim to reveal CMI-associated genomic variations in familial cases.Four CMI patients and 7 unaffected healthy members of two distinct families were analyzed. A microarray analysis of the affected and unaffected individuals from two Turkish families with CMI was conducted. Analyses of single nucleotide variations (SNVs) and copy number variations (CNVs) were performed by calculation of B allele frequency (BAF) and log R ratio (LRR) values from whole genome SNV data. Two missense variations, OLFML2A (rs7874348) and SLC4A9 (rs6860077), and a 5'UTR variation of COL4A1 (rs9521687) were significantly associated with CMI. Moreover, 12 SNVs in the intronic regions of FAM155A, NR3C1, TRPC7, ASTN2, and TRAF1 were determined to be associated with CMI. The CNV analysis showed that the 11p15.4 chromosome region is inherited in one of the families. The use of familial studies to explain the molecular pathogenesis of complex diseases such as CMI is crucial. It has been suggested that variations in OLFML2A, SLC4A9, and COL4A1 play a role in CMI molecular pathogenesis. The CNV analysis of individuals in both families revealed a potential chromosomal region, 11p15.4, and risk regions that are associated with CMI.
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Affiliation(s)
- Timuçin AVŞAR
- Department of Medical Biology, School of Medicine, Bahçeşehir University, İstanbulTurkey
- Neuroscience Program, Health Sciences Institute, Bahçeşehir University, İstanbulTurkey
- Neuroscience Laboratory, Health Sciences Institute, Bahçeşehir University, İstanbulTurkey
| | - Şeyma ÇALIŞ
- Neuroscience Laboratory, Health Sciences Institute, Bahçeşehir University, İstanbulTurkey
- Molecular Biology, Genetics, and Biotechnology Graduate Program, Graduate School of Science, Engineering, and Technology, İstanbul Technical University, İstanbulTurkey
| | - Baran YILMAZ
- Department of Neurosurgery, School of Medicine, Bahçeşehir University, İstanbulTurkey
| | | | - Can HOLYAVKİN
- Molecular Biology, Genetics, and Biotechnology Graduate Program, Graduate School of Science, Engineering, and Technology, İstanbul Technical University, İstanbulTurkey
| | - Türker KILIÇ
- Neuroscience Program, Health Sciences Institute, Bahçeşehir University, İstanbulTurkey
- Neuroscience Laboratory, Health Sciences Institute, Bahçeşehir University, İstanbulTurkey
- Department of Neurosurgery, School of Medicine, Bahçeşehir University, İstanbulTurkey
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21
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Frič R, Eide PK. Chiari type 1-a malformation or a syndrome? A critical review. Acta Neurochir (Wien) 2020; 162:1513-1525. [PMID: 31656982 DOI: 10.1007/s00701-019-04100-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/08/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE As the understanding of pathophysiology behind Chiari malformation still is limited, the treatment of Chiari malformation type 1 remains rather empirical. This may result in suboptimal treatment strategy and outcome in many cases. In this review, we critically address whether the condition known today as Chiari malformation type I should rather be denoted Chiari syndrome. METHODS The current knowledge of Chiari malformation type 1 is summarized from the historical, etymological, genetic, clinical, and in particular pathophysiological perspectives. RESULTS There are several lines of evidence that Chiari malformation type 1 represents a condition significantly different from types 2 to 4. Unlike the other types, the type 1 should rather be considered a syndrome, thus supporting the reasons to reappraise the traditional classification of Chiari malformations. CONCLUSION We propose that Chiari malformation type 1 should rather be denoted Chiari syndrome, while the notation malformation is maintained for types 2-4.
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Affiliation(s)
- Radek Frič
- Department of Neurosurgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway.
| | - Per Kristian Eide
- Department of Neurosurgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
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22
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Prevalence and Impact of Underlying Diagnosis and Comorbidities on Chiari 1 Malformation. Pediatr Neurol 2020; 106:32-37. [PMID: 32113729 PMCID: PMC7156318 DOI: 10.1016/j.pediatrneurol.2019.12.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/09/2019] [Accepted: 12/12/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Chiari malformation type 1 affects approximately one in 1,000 people symptomatically, although one in 100 meet radiological criteria, making it a common neurological disorder. The diagnosis of underlying conditions has become more sophisticated, and new radiological markers of disease have been described. We sought to determine the prevalence and impact of additional comorbidities and underlying diagnoses in patients with Chiari malformation type 1 on symptomatology and surgical treatment. METHODS A retrospective review of 612 pediatric patients with a Chiari malformation type 1 diagnosis and imaging data evaluated between 2008 and 2018 was performed. Because of extensive clinical heterogeneity, patients were separated into four categories based on their primary comorbidities (nonsyndromic, central nervous system, skeletal, and multiple congenital anomalies) to identify associations with age of onset, radiographic measurements, syringomyelia, and surgical treatment. RESULTS The largest group had nonsyndromic Chiari malformation type 1 (70%) and the latest age at diagnosis of any group. In the syndromic group, 6% were diagnosed with a known genetic abnormality, with overgrowth syndromes being the most common. Patients with multiple congenital anomalies had the earliest Chiari malformation type 1 onset, the most severe tonsillar ectopia and obex position, and were overrepresented among surgical cases. Although there were no statistically significant differences between groups and rates of syrinx, we observed differences in individual diagnoses. CONCLUSION The underlying diagnoses and presence of comorbidities in patients with Chiari malformation type 1 impacts rates of syringomyelia and surgery. Although most Chiari malformation type 1 cases are nonsyndromic, clinical evaluation of growth parameters, scoliosis, and joint hypermobility should be routine for all patients as they are useful to determine syringomyelia risk and may impact treatment.
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23
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Bronstein R, Capowski EE, Mehrotra S, Jansen AD, Navarro-Gomez D, Maher M, Place E, Sangermano R, Bujakowska KM, Gamm DM, Pierce EA. A combined RNA-seq and whole genome sequencing approach for identification of non-coding pathogenic variants in single families. Hum Mol Genet 2020; 29:967-979. [PMID: 32011687 PMCID: PMC7158377 DOI: 10.1093/hmg/ddaa016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 11/23/2019] [Accepted: 01/21/2020] [Indexed: 12/13/2022] Open
Abstract
Inherited retinal degenerations (IRDs) are at the focus of current genetic therapeutic advancements. For a genetic treatment such as gene therapy to be successful, an accurate genetic diagnostic is required. Genetic diagnostics relies on the assessment of the probability that a given DNA variant is pathogenic. Non-coding variants present a unique challenge for such assessments as compared to coding variants. For one, non-coding variants are present at much higher number in the genome than coding variants. In addition, our understanding of the rules that govern the non-coding regions of the genome is less complete than our understanding of the coding regions. Methods that allow for both the identification of candidate non-coding pathogenic variants and their functional validation may help overcome these caveats allowing for a greater number of patients to benefit from advancements in genetic therapeutics. We present here an unbiased approach combining whole genome sequencing (WGS) with patient-induced pluripotent stem cell (iPSC)-derived retinal organoids (ROs) transcriptome analysis. With this approach, we identified and functionally validated a novel pathogenic non-coding variant in a small family with a previously unresolved genetic diagnosis.
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Affiliation(s)
- Revital Bronstein
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Ocular Genomics Institute, Boston, MA 02114, USA
| | - Elizabeth E Capowski
- Waisman Center Stem Cell Research Program, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Sudeep Mehrotra
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Ocular Genomics Institute, Boston, MA 02114, USA
| | - Alex D Jansen
- Waisman Center Stem Cell Research Program, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Daniel Navarro-Gomez
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Ocular Genomics Institute, Boston, MA 02114, USA
| | - Mathew Maher
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Ocular Genomics Institute, Boston, MA 02114, USA
| | - Emily Place
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Ocular Genomics Institute, Boston, MA 02114, USA
| | - Riccardo Sangermano
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Ocular Genomics Institute, Boston, MA 02114, USA
| | - Kinga M Bujakowska
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Ocular Genomics Institute, Boston, MA 02114, USA
| | - David M Gamm
- Department of Ophthalmology and Visual Sciences, Waisman Center Stem Cell Research Program, McPherson Eye Research Institute, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Eric A Pierce
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Ocular Genomics Institute, Boston, MA 02114, USA
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24
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Bogdanov EI, Faizutdinova AT, Mendelevich EG, Sozinov AS, Heiss JD. Epidemiology of Symptomatic Chiari Malformation in Tatarstan: Regional and Ethnic Differences in Prevalence. Neurosurgery 2020; 84:1090-1097. [PMID: 29788393 DOI: 10.1093/neuros/nyy175] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 04/09/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Epidemiology can assess the effect of Chiari I malformation (CM1) on the neurological health of a population and evaluate factors influencing CM1 development. OBJECTIVE To analyze the regional and ethnic differences in the prevalence of CM1. METHODS The population of the Republic of Tatarstan (RT) in the Russian Federation was evaluated for patients with CM1 symptoms over an 11-yr period. Typical symptoms of CM1 were found in 868 patients. Data from neurological examination and magnetic resonance imaging (MRI) measurement of posterior cranial fossa structures were analyzed. RESULTS MRI evidence of CM1, defined as cerebellar tonsils lying at least 5 mm inferior to the foramen magnum, was found in 67% of symptomatic patients. Another 33% of symptomatic patients had 2 to 4 mm of tonsillar ectopia, which we defined as "borderline Chiari malformation type 1 (bCM1)." The period prevalence in the entire RT for symptomatic CM1 was 20:100 000; for bCM1 was 10:100 000; and for CM1 and bCM1 together was 30:100 000. Prevalence of patients with CM1 symptoms was greater in the northern than southern districts of Tatarstan, due to a high prevalence (413:100 000) of CM1 in the Baltasy region in one of the northern districts. CONCLUSION One-third of patients with typical symptoms of CM1 had less than 5 mm of tonsillar ectopia (bCM1). Assessments of the health impact of CM1-type symptoms on a patient population should include the bCM1 patient group. A regional disease cluster of patients with Chiari malformation was found in Baltasy district of RT and needs further study.
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Affiliation(s)
- Enver I Bogdanov
- Department of Neurology and Rehabilitation, Kazan State Medical University, Kazan, Republic of Tatarstan, Russian Federation.,Department of Neurology, Republican Clinical Hospital, Kazan, Republic of Tatarstan, Russian Federation
| | - Aisylu T Faizutdinova
- Department of Neurology and Rehabilitation, Kazan State Medical University, Kazan, Republic of Tatarstan, Russian Federation.,Clinical Expert Department, Republican Clinical Hospital, Kazan, Republic of Tatarstan, Russian Federation
| | - Elena G Mendelevich
- Department of Neurology and Rehabilitation, Kazan State Medical University, Kazan, Republic of Tatarstan, Russian Federation
| | - Alexey S Sozinov
- Department of Biological and Medical Ethics, Kazan State Medical University, Kazan, Republic of Tatarstan, Russian Federation
| | - John D Heiss
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
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25
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Capra V, Iacomino M, Accogli A, Pavanello M, Zara F, Cama A, De Marco P. Chiari malformation type I: what information from the genetics? Childs Nerv Syst 2019; 35:1665-1671. [PMID: 31385087 DOI: 10.1007/s00381-019-04322-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 07/28/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE Chiari malformation type I (CMI), a rare disorder of the craniocerebral junction with an estimated incidence of 1 in 1280, is characterized by the downward herniation of the cerebellar tonsils of at least 5 mm through the foramen magnum, resulting in significant neurologic morbidity. Classical CMI is thought to be caused by an underdeveloped occipital bone, resulting in a posterior cranial fossa which is too small to accommodate the normal-sized cerebellum. In this review, we dissect the lines of evidence supporting a genetic contribution for this disorder. METHODS We present the results of two types of approaches: animal models and human studies encompassing different study designs such as whole genome linkage analysis, case-control association studies, and expression studies. The update of the literature also includes the most recent findings emerged by whole exome sequencing strategy. RESULTS Despite evidence for a genetic component, no major genes have been identified and the genetics of CMI is still very much unknown. One major challenge is the variability of clinical presentation within CMI patient population that reflects an underlying genetic heterogeneity. CONCLUSIONS The identification of the genes that contribute to the etiology of CMI will provide an important step to the understanding of the underlying pathology. The finding of a predisposing gene may lead to the development of simple and accurate diagnostic tests for better prognosis, counseling, and clinical management of patients and their relatives.
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Affiliation(s)
- Valeria Capra
- UOC Neurochirurgia, IRCCS Istituto Giannina Gaslini, v. G. Gaslini 5, 16147, Genoa, Italy
| | - Michele Iacomino
- UOC Neurochirurgia, IRCCS Istituto Giannina Gaslini, v. G. Gaslini 5, 16147, Genoa, Italy.,UOSD Laboratorio Neurogenetica e Neuroscienze, IRCCS Istituto Giannina Gaslini, v. G. Gaslini 5, 16147, Genoa, Italy
| | - Andrea Accogli
- UOC Neurochirurgia, IRCCS Istituto Giannina Gaslini, v. G. Gaslini 5, 16147, Genoa, Italy
| | - Marco Pavanello
- UOC Neurochirurgia, IRCCS Istituto Giannina Gaslini, v. G. Gaslini 5, 16147, Genoa, Italy
| | - Federico Zara
- UOSD Laboratorio Neurogenetica e Neuroscienze, IRCCS Istituto Giannina Gaslini, v. G. Gaslini 5, 16147, Genoa, Italy
| | - Armando Cama
- UOC Neurochirurgia, IRCCS Istituto Giannina Gaslini, v. G. Gaslini 5, 16147, Genoa, Italy
| | - Patrizia De Marco
- UOSD Laboratorio Neurogenetica e Neuroscienze, IRCCS Istituto Giannina Gaslini, v. G. Gaslini 5, 16147, Genoa, Italy.
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26
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Eppelheimer MS, Biswas D, Braun AM, Houston JR, Allen PA, Bapuraj JR, Labuda R, Loth DM, Frim D, Loth F. Quantification of changes in brain morphology following posterior fossa decompression surgery in women treated for Chiari malformation type 1. Neuroradiology 2019; 61:1011-1022. [PMID: 31119343 DOI: 10.1007/s00234-019-02206-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 04/01/2019] [Indexed: 01/08/2023]
Abstract
PURPOSE While 84% of patients surgically treated for Chiari malformation type 1 (CM1) demonstrate improved quality of life after posterior fossa decompression surgery, there are many risks associated with this surgery. Surgical planning to identify candidates likely to improve postoperatively may benefit from an improved understanding of morphological changes after decompression surgery. To evaluate these changes, we quantified 59 morphological parameters on 42 CM1 adult female patients before and after CM1 decompression surgery. METHODS Fifty-nine morphological parameters in the posterior cranial fossa, cranio-cervical, and intracranial regions in the midsagittal plane were evaluated using 42 T1-weighted magnetic resonance images of female CM1 patients before and after surgery, and 42 healthy female controls. Morphological differences before and after surgery were compared through the development of a technique to establish the opisthion location, a key reference point not present after surgery. RESULTS In addition to the expected reduction of the cranio-caudal dimension of the cerebellum, objective analyses showed a significant increase in the area of the cerebrospinal fluid spaces, posterior (6×) and inferior (2.6×) to the cerebellum (+ 112 ± 102 and + 140 ± 127 mm2, respectively). This increased area was primarily impacted by an average reduction in the occipital bone length of 24.5 ± 7.3 mm following surgery. Based on multiple angles, results demonstrated a 2°-4° anterior rotation of the cerebellum after surgery. CONCLUSION Our results show that decompression surgery results in significant changes in the cerebellum and cerebrospinal fluid spaces. Further investigation should determine how these morphological changes impact clinical outcomes.
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Affiliation(s)
- Maggie S Eppelheimer
- Conquer Chiari Research Center, Department of Biomedical Engineering, The University of Akron, Akron, OH, USA.
| | - Dipankar Biswas
- Conquer Chiari Research Center, Department of Mechanical Engineering, The University of Akron, Akron, OH, USA
| | - Audrey M Braun
- Conquer Chiari Research Center, Department of Mechanical Engineering, The University of Akron, Akron, OH, USA
| | - James R Houston
- Department of Psychology, Middle Tennessee State University, Murfreesboro, TN, USA
| | - Philip A Allen
- Conquer Chiari Research Center, Department of Psychology, The University of Akron, Akron, OH, USA
| | | | | | - Dorothy M Loth
- Conquer Chiari Research Center, Department of Psychology, The University of Akron, Akron, OH, USA
| | - David Frim
- Department of Neurosurgery, University of Chicago, Chicago, IL, USA
| | - Francis Loth
- Conquer Chiari Research Center, Department of Biomedical Engineering, The University of Akron, Akron, OH, USA
- Conquer Chiari Research Center, Department of Mechanical Engineering, The University of Akron, Akron, OH, USA
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27
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Small posterior fossa in Chiari I malformation affected families is significantly linked to 1q43-44 and 12q23-24.11 using whole exome sequencing. Eur J Hum Genet 2019; 27:1599-1610. [PMID: 31227808 DOI: 10.1038/s41431-019-0457-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 05/01/2019] [Accepted: 06/04/2019] [Indexed: 11/08/2022] Open
Abstract
The posterior fossa of the cranium contains the cerebellum and brainstem. Processes that reduce the volume of the posterior fossa squeeze the cerebellum and brainstem caudally, resulting in Chiari I malformation (CM1). CM1 causes neck pain, balance issues, decreased motor skills and headaches in those affected. We have posterior fossa measurements and whole exome sequence data on individuals from 7 extended families from Russia that have a family history of CM1. We performed parametric linkage analyses using an autosomal dominant inheritance model with a disease allele frequency of 0.01 and a penetrance of 0.8 for carriers and 0.0 for non-carriers. Variant-based two-point linkage analysis and gene-based linkage analysis was performed. Our results found a genome-wide significant signal on chromosome 1q43-44 (max HLOD = 3.3) in the variant-based analysis and 12q23 (max HLOD = 4.2) in the gene-based analysis. In both cases, the signal was driven by a single (different) family that contained a long, linked haplotype across the region in question. Using functional annotation, we were able to identify several rare nonsynonymous variants that were enriched in each family. The best candidate genes were rs765865412:G>A in MYBPC1 for the 12q haplotype and rs61749963:A>G in COX20 for the 1q haplotype. Good candidate variants in the 1q haplotype were also identified in CEP170 and AKT. Further laboratory work is planned to verify the causality of these genes.
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28
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Cognitive Functioning in Chiari Malformation Type I Without Posterior Fossa Surgery. THE CEREBELLUM 2019; 17:564-574. [PMID: 29766459 DOI: 10.1007/s12311-018-0940-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Chiari Malformation type I (CM-I) is a neurological disorder characterized by a displacement of the cerebellar tonsils through the foramen magnum into the spinal canal. Most research has focused on physical symptomatology but few studies include neuropsychological examinations. Moreover, although current research highlights the involvement of the cerebellum on higher cognitive functions, little is known about cognitive consequences associated with CM-I. The aim of this study is to analyze cognitive functioning between 39 CM-I patients and 39 healthy controls, matched by gender, age and years of education. Participants have been examined on a large battery of neuropsychological tests, including executive functioning, verbal fluency, spatial cognition, language, verbal memory, processing speed, facial recognition and theory of mind. Results show a poorer performance of the clinical group compared to the control group, even after controlling the effect of physical pain and anxious-depressive symptomatology. The findings suggest the presence of a generalized cognitive deficit associated with CM-I, which makes it necessary to focus attention not only on physical consequences, but also on cognitive ones.
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29
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Keser N, Kuskucu A, Is M, Celikoglu E. Familial Chiari Type 1: A Molecular Karyotyping Study in a Turkish Family and Review of the Literature. World Neurosurg 2018; 121:e852-e857. [PMID: 30315983 DOI: 10.1016/j.wneu.2018.09.235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/28/2018] [Accepted: 09/29/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The etiology of Chiari I malformation (CMI) has not been fully elucidated. Therefore, we performed a genetic study of a Turkish family in which 3 sisters had a diagnosis of CMI with or without syringomyelia. METHODS In a family with 7 children, 4 daughters complained of occipital headaches. In 2 of these daughters, CMI had been diagnosed during their 30s, and CMI plus syrinx had been diagnosed in the other daughter in her 40s. Cranial magnetic resonance imaging of the fourth daughter who had developed headaches during her 30s showed normal findings. Because the other siblings in the family were asymptomatic, radiological examinations were not performed. The family had a history of distant consanguineous marriage between parents. Additionally, the father had died, and the mother was asymptomatic, with radiologically normal findings. Array comparative genome hybridization studies were performed for 12 persons from 3 generations of this family. RESULTS None of the 12 cases examined harbored copy number variations. CONCLUSIONS This family with 3 sisters having CMI suggested a possible autosomal recessive single-gene etiology. Cases of familial CMI are unusual but important to study because they could reveal the specific genes involved in posterior fossa/foramen magnum structure and function and provide insights into the cause of sporadic cases.
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Affiliation(s)
- Nese Keser
- Department of Neurological Surgery, TR University of Health Sciences, Istanbul Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey.
| | - Aysegul Kuskucu
- Department of Genetics, Yeditepe University Faculty of Medicine, Istanbul, Turkey
| | - Merih Is
- Department of Neurological Surgery, TR University of Health Sciences, Istanbul Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | - Erhan Celikoglu
- Department of Neurological Surgery, TR University of Health Sciences, Istanbul Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
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30
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Knowler SP, Galea GL, Rusbridge C. Morphogenesis of Canine Chiari Malformation and Secondary Syringomyelia: Disorders of Cerebrospinal Fluid Circulation. Front Vet Sci 2018; 5:171. [PMID: 30101146 PMCID: PMC6074093 DOI: 10.3389/fvets.2018.00171] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 07/04/2018] [Indexed: 01/01/2023] Open
Abstract
Chiari-like Malformation (CM) and secondary syringomyelia (SM), as well as their analogous human conditions, is a complex developmental condition associated with pain and accompanying welfare concerns. CM/SM is diagnosed ever more frequently, thanks in part to the increased availability of magnetic resonance imaging in veterinary medicine. Research over the last two decades has focused primarily on its pathophysiology relating to overcrowding of the cranial caudal fossa. More recent characterizations of CM/SM include brachycephaly with osseous reduction and neural parenchymal displacement involving the entire brain and craniocervical junction to include rostral flattening, olfactory bulb rotation, increased height of the cranium, reduced cranial base with spheno-occipital synchondrosis angulation, reduced supraoccipital and interparietal crest and rostral displacement of the axis and atlas with increased odontoid angulation. The most shared manifestation of CM is the development of fluid-filled pockets (syrinx, syringes) in the spinal cord that can be readily quantified. Dogs with symptomatic CM without SM have a reduced basioccipital bone, compensatory increased cranial fossa height with displaced parenchyma whereby the cerebellum is invaginated beneath the occipital lobes but without compromising cerebrospinal fluid channels enough to cause SM. Thus, broadly defined, CM might be described as any distortion of the skull and craniocervical junction which compromises the neural parenchyma and cerebrospinal fluid circulation causing pain and/or SM. The etiology of CM is multifactorial, potentially including genetically-influenced, breed-specific abnormalities in both skeletal and neural components. Since causation between specific morphologic changes and SM or clinical signs is unproven, CM might be more appropriately considered as a brachycephalic obstructive CSF channel syndrome (BOCCS) rather than a single malformation. Understanding the normal development of the brain, skull and craniocervical junction is fundamental to identifying deviations which predispose to CM/SM. Here we review its anatomical, embryological, bio-mechanical, and genetic underpinnings to update the profession's understanding of this condition and meaningfully inform future research to diminish its welfare impact.
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Affiliation(s)
- Susan P Knowler
- Department of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Gabriel L Galea
- Developmental Biology of Birth Defects, Great Ormond Street Institute of Child Health, University College London, London,, United Kingdom
| | - Clare Rusbridge
- Department of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom.,Fitzpatrick Referrals Veterinary Specialist Hospital, Surrey, United Kingdom
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31
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de Arruda JA, Figueiredo E, Monteiro JL, Barbosa LM, Rodrigues C, Vasconcelos B. Orofacial clinical features in Arnold Chiari type I malformation: A case series. J Clin Exp Dent 2018; 10:e378-e382. [PMID: 29750100 PMCID: PMC5937955 DOI: 10.4317/jced.54419] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 03/14/2018] [Indexed: 11/05/2022] Open
Abstract
Background Arnold Chiari malformation (ACM) is characterized by an anatomical defect at the base of the skull where the cerebellum and the spinal cord herniate through the foramen magnum into the cervical spinal canal. Among the subtypes of the condition, ACM type I (ACM-I) is particularly outstanding because of the severity of symptoms. This study aimed to analyze the orofacial clinical manifestations of patients with ACM-I, and discuss their demographic distribution and clinical features in light of the literature. Material and Methods A case series with patients with ACM-I treated between 2012 and 2015 was described. The sample consisted of patients who were referred by the Department of Neurosurgery to the Oral and Maxillofacial Surgery Service of Hospital da Restauração in Brazil for the assessment of facial symptomatology. A questionnaire was applied to evaluate the presence of painful orofacial findings. Data are reported using descriptive statistical methods. Results Mean patient age was 39.3 years and the sample consisted mostly of male patients. A high prevalence of headache (50%) and pain in the neck (66.7%) and masticatory muscles (50%) was found. Only one patient reported difficulty in performing mandibular movements and two reported jaw clicking sounds. Mean mouth opening was 40.83 mm. Conclusions ACM-I patients may exhibit orofacial symptoms which may mimic temporomandibular joint disorders. This study brings interesting information that could help clinicians and oral and maxillofacial surgeons to understand this uncommon condition and also help with the diagnosis of patients with similar physical characteristics by referring them to a neurosurgeon. Key words:Arnold-Chiari malformation, facial pain, diagnosis, orofacial.
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Affiliation(s)
- José-Alcides de Arruda
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - João-Luiz Monteiro
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Universidade de Pernambuco, Camaragibe, PE, Brazil
| | - Livia-Mirelle Barbosa
- Department of Maxillofacial Prosthesis and Surgery, School of Dentistry, Universidade Federal de Pernambuco, Recife, PE, Brazil
| | - Cleomar Rodrigues
- Department of Oral Imaging, School of Dentistry, Faculdades Integradas da União Educacional do Planalto Central, Brasília, DF, Brazil
| | - Belmiro Vasconcelos
- Hospital da Restauração, Universidade de Pernambuco, Recife, PE, Brazil.,Department of Oral and Maxillofacial Surgery, School of Dentistry, Universidade de Pernambuco, Camaragibe, PE, Brazil
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32
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Grilli G, Moffa AP, Perfetto F, Specchiulli LP, Vinci R, Macarini L, Zizzo L. Neuroimaging Features of Tuberous Sclerosis Complex and Chiari Type I Malformation: A Rare Association. J Pediatr Neurosci 2018; 13:224-228. [PMID: 30090143 PMCID: PMC6057178 DOI: 10.4103/jpn.jpn_76_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
An 8-year-old girl was admitted during the night in our emergency department for an acute episode of seizures. The patient underwent computed-tomography (CT) brain scan (Toshiba ® Aquilion 64-TSX-101A/HC) and magnetic resonance imaging (MRI) brain scan (Philips® Achieva 1.5T). CT scan showed left frontal calcified nodules and calcified periventricular subependymal nodules. Subsequently, MRI evaluation revealed cortical and subcortical nodules that showed low signal with respect to the white matter on T1-weighted imaging sequences and high signal both in T2-weighted imaging sequences and in fluid-attenuated inversion recovery sequences. We also showed a herniation of cerebellar tonsils through the foramen magnum (Chiari malformation Type I [CMI]) with the associated hydrosyringomyelic cavity. Our report showed a rare association between tuberous sclerosis complex and CMI.
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Affiliation(s)
| | | | | | | | - Roberta Vinci
- Department of Radiology, University of Foggia, Italy
| | - Luca Macarini
- Department of Radiology, University of Foggia, Italy
| | - Luciano Zizzo
- Department of Child Neuropsychiatry, Riuniti Hospital of Foggia, Italy
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Eppelheimer MS, Houston JR, Bapuraj JR, Labuda R, Loth DM, Braun AM, Allen NJ, Heidari Pahlavian S, Biswas D, Urbizu A, Martin BA, Maher CO, Allen PA, Loth F. A Retrospective 2D Morphometric Analysis of Adult Female Chiari Type I Patients with Commonly Reported and Related Conditions. Front Neuroanat 2018; 12:2. [PMID: 29403363 PMCID: PMC5785719 DOI: 10.3389/fnana.2018.00002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 01/05/2018] [Indexed: 02/02/2023] Open
Abstract
Purpose: Researchers have sought to better understand Chiari type I malformation (CMI) through morphometric measurements beyond tonsillar position (TP). Soft tissue and bone structures within the brain and craniocervical junction have been shown to be different for CMI patients compared to healthy controls. Yet, several morphological characteristics have not been consistently associated with CMI. CMI is also associated with different prevalent conditions (PCs) such as syringomyelia, pseudotumor, Ehlers-Danlos syndrome (EDS), scoliosis, and craniocervical instability. The goal of this study was two-fold: (1) to identify unique morphological characteristics of PCs, and (2) to better explain inconsistent results from case-control comparisons of CMI. Methods: Image, demographic, and PC information was obtained through the Chiari1000, a self-report web-accessed database. Twenty-eight morphometric measurements (MMs) were performed on the cranial MR images of 236 pre-surgery adult female CMI participants and 140 female healthy control participants. Custom software was used to measure 28 structures within the posterior cranial fossa (PCF) compartment, craniocervical junction, oral cavity, and intracranial area on midsagittal MR images for each participant. Results: Morphometric analysis of adult females indicated a smaller McRae line length in CMI participants with syringomyelia compared to those without syringomyelia. TP was reduced in CMI participants with EDS than those without EDS. Basion to posterior axial line was significantly longer in CMI participants with scoliosis compared to those without scoliosis. No additional MMs were found to differ between CMI participants with and without a specific PC. Four morphometric differences were found to be consistently different between CMI participants and healthy controls regardless of PC: larger TP and a smaller clivus length, fastigium, and corpus callosum height in CMI participants. Conclusion: Syringomyelia, EDS, and scoliosis were the only PCs that showed significant morphometric differences between CMI participants. Additionally, four midsagittal MR-based MMs were found to be significantly different between healthy controls and CMI participants regardless of the presence of one or more PCs. This study suggests that the prevalence of comorbid conditions are not strongly related to CMI morphology, and that inconsistent findings in the radiographic literature cannot be explained by varying prevalence of comorbid conditions in CMI study samples.
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Affiliation(s)
- Maggie S Eppelheimer
- Department of Biomedical Engineering, Conquer Chiari Research Center, University of Akron, Akron, OH, United States
| | - James R Houston
- Department of Psychology, Conquer Chiari Research Center, University of Akron, Akron, OH, United States
| | - Jayapalli R Bapuraj
- Department of Radiology, University of Michigan Health System, Ann Arbor, MI, United States
| | | | - Dorothy M Loth
- Department of Psychology, Conquer Chiari Research Center, University of Akron, Akron, OH, United States
| | - Audrey M Braun
- Department of Mechanical Engineering, Conquer Chiari Research Center, University of Akron, Akron, OH, United States
| | - Natalie J Allen
- Department of Mechanical Engineering, Conquer Chiari Research Center, University of Akron, Akron, OH, United States
| | - Soroush Heidari Pahlavian
- Department of Mechanical Engineering, Conquer Chiari Research Center, University of Akron, Akron, OH, United States
| | - Dipankar Biswas
- Department of Mechanical Engineering, Conquer Chiari Research Center, University of Akron, Akron, OH, United States
| | - Aintzane Urbizu
- Department of Mechanical Engineering, Conquer Chiari Research Center, University of Akron, Akron, OH, United States.,Duke University Medical Center, Duke Molecular Physiology Institute, Durham, NC, United States
| | - Bryn A Martin
- Department of Biological Engineering, University of Idaho, Moscow, ID, United States
| | - Cormac O Maher
- Department of Neurosurgery, University of Michigan Health System, Ann Arbor, MI, United States
| | - Philip A Allen
- Department of Psychology, Conquer Chiari Research Center, University of Akron, Akron, OH, United States
| | - Francis Loth
- Department of Biomedical Engineering, Conquer Chiari Research Center, University of Akron, Akron, OH, United States.,Department of Mechanical Engineering, Conquer Chiari Research Center, University of Akron, Akron, OH, United States
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Urbizu A, Martin BA, Moncho D, Rovira A, Poca MA, Sahuquillo J, Macaya A, Español MI. Machine learning applied to neuroimaging for diagnosis of adult classic Chiari malformation: role of the basion as a key morphometric indicator. J Neurosurg 2017; 129:779-791. [PMID: 29053075 DOI: 10.3171/2017.3.jns162479] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The current diagnostic criterion for Chiari malformation Type I (CM-I), based on tonsillar herniation (TH), includes a diversity of patients with amygdalar descent that may be caused by a variety of factors. In contrast, patients presenting with an overcrowded posterior cranial fossa, a key characteristic of the disease, may remain misdiagnosed if they have little or no TH. The objective of the present study was to use machine-learning classification methods to identify morphometric measures that help discern patients with classic CM-I to improve diagnosis and treatment and provide insight into the etiology of the disease. METHODS Fifteen morphometric measurements of the posterior cranial fossa were performed on midsagittal T1-weighted MR images obtained in 195 adult patients diagnosed with CM. Seven different machine-learning classification methods were applied to images from 117 patients with classic CM-I and 50 controls matched by age and sex to identify the best classifiers discriminating the 2 cohorts with the minimum number of parameters. These classifiers were then tested using independent CM cohorts representing different entities of the disease. RESULTS Machine learning identified combinations of 2 and 3 morphometric measurements that were able to discern not only classic CM-I (with more than 5 mm TH) but also other entities such as classic CM-I with moderate TH and CM Type 1.5 (CM-1.5), with high accuracy (> 87%) and independent of the TH criterion. In contrast, lower accuracy was obtained in patients with CM Type 0. The distances from the lower aspect of the corpus callosum, pons, and fastigium to the foramen magnum and the basal and Wackenheim angles were identified as the most relevant morphometric traits to differentiate these patients. The stronger significance (p < 0.01) of the correlations with the clivus length, compared with the supraoccipital length, suggests that these 5 relevant traits would be affected more by the relative position of the basion than the opisthion. CONCLUSIONS Tonsillar herniation as a unique criterion is insufficient for radiographic diagnosis of CM-I, which can be improved by considering the basion position. The position of the basion was altered in different entities of CM, including classic CM-I, classic CM-I with moderate TH, and CM-1.5. The authors propose a predictive model based on 3 parameters, all related to the basion location, to discern classic CM-I with 90% accuracy and suggest considering the anterior alterations in the evaluation of surgical procedures and outcomes.
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Affiliation(s)
- Aintzane Urbizu
- 1Conquer Chiari Research Center and.,2Pediatric Neurology Research Group
| | - Bryn A Martin
- 3Department of Biological Engineering, University of Idaho, Moscow, Idaho; and
| | - Dulce Moncho
- 4Department of Clinical Neurophysiology.,5Neurotraumatology and Neurosurgery Research Unit
| | - Alex Rovira
- 6Magnetic Resonance Unit (IDI), Department of Radiology, and
| | - Maria A Poca
- 5Neurotraumatology and Neurosurgery Research Unit.,7Department of Neurosurgery, Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain
| | - Juan Sahuquillo
- 5Neurotraumatology and Neurosurgery Research Unit.,7Department of Neurosurgery, Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain
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Houston JR, Eppelheimer MS, Pahlavian SH, Biswas D, Urbizu A, Martin BA, Bapuraj JR, Luciano M, Allen PA, Loth F. A morphometric assessment of type I Chiari malformation above the McRae line: A retrospective case-control study in 302 adult female subjects. J Neuroradiol 2017; 45:23-31. [PMID: 28826656 DOI: 10.1016/j.neurad.2017.06.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 06/23/2017] [Accepted: 06/30/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Type I Chiari malformation (CMI) is a radiologically-defined structural dysmorphism of the hindbrain and posterior cranial fossa (PCF). Traditional radiographic identification of CMI relies on the measurement of the cerebellar tonsils in relation to the foramen magnum with or without associated abnormalities of the neuraxis. The primary goal of this retrospective study was to comprehensively assess morphometric parameters above the McRea line in a group of female CMI patients and normal controls. MATERIAL AND METHODS Twenty-nine morphological measurements were taken on 302 mid-sagittal MR images of adult female CMI patients (n=162) and healthy controls (n=140). All MR images were voluntarily provided by CMI subjects through an online database and control participant images were obtained through the Human Connectome Project and a local hospital system. RESULTS Analyses were performed on the full dataset of adult female MR images and a restricted dataset of 229 participants that were equated for age, race, and body mass index. Eighteen group differences were identified in the PCF area that we grouped into three clusters; PCF structures heights, clivus angulation, and odontoid process irregularity. Fourteen group differences persisted after equating our CMI and control groups on demographic characteristics. CONCLUSION PCF structures reliably differ in adult female CMI patients relative to healthy controls. These differences reflect structural abnormalities in the osseous and soft tissue structures of the clivus, odontoid process, and cerebellum. Clinical and pathophysiological implications are discussed.
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Affiliation(s)
- James R Houston
- Department of Psychology, Conquer Chiari Research Center, The University of Akron, Akron, OH, 44325, USA
| | - Maggie S Eppelheimer
- Department of Biomedical Engineering, Conquer Chiari Research Center, The University of Akron, Akron, OH, 44325, USA
| | - Soroush Heidari Pahlavian
- Department of Mechanical Engineering, Conquer Chiari Research Center, The University of Akron, Akron, OH, 44325, USA
| | - Dipankar Biswas
- Department of Mechanical Engineering, Conquer Chiari Research Center, The University of Akron, Akron, OH, 44325, USA
| | - Aintzane Urbizu
- Department of Mechanical Engineering, Conquer Chiari Research Center, The University of Akron, Akron, OH, 44325, USA; Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC, 27703, USA
| | - Bryn A Martin
- Department of Biological Engineering, University of Idaho, Moscow, ID, 83844, USA
| | - Jayapalli Rajiv Bapuraj
- Department of Radiology, Division of Neuroradiology, University of Michigan Health System, Ann Arbor, MI, 48103, USA
| | - Mark Luciano
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Philip A Allen
- Department of Psychology, Conquer Chiari Research Center, The University of Akron, Akron, OH, 44325, USA
| | - Francis Loth
- Department of Biomedical Engineering, Conquer Chiari Research Center, The University of Akron, Akron, OH, 44325, USA; Department of Mechanical Engineering, Conquer Chiari Research Center, The University of Akron, Akron, OH, 44325, USA.
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Chu M, Zhu X, Wang C, Rong J, Wang Y, Wang S, Xing B, Tao Y, Zhuang X, Jiang L. The rs4238326 polymorphism in ALDH1A2 gene potentially associated with non-post traumatic knee osteoarthritis susceptibility: a two-stage population-based study. Osteoarthritis Cartilage 2017; 25:1062-1067. [PMID: 28089900 DOI: 10.1016/j.joca.2017.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 12/27/2016] [Accepted: 01/06/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE A recent genome-wide association study reported significant associations of genetic variants within the ALDH1A2 gene with osteoarthritis (OA) of the hand in European populations. However, these findings have not been well generalized to other joints, or to other populations. METHODS We performed a two-stage population-based case-control study including 196 non-post traumatic knee OA cases and 442 controls in the first stage and independent 143 non-post traumatic knee OA cases and 238 controls in the second stage in a Chinese population by genotyping eight tagging polymorphisms in ALDH1A2. RESULTS In the first stage, the single nucleotide polymorphism (SNP) rs4238326 was found to be potentially associated with knee OA risk (additive model: odds ratio [OR] = 0.70; 95% confidence interval [95% CI] = 0.49-1.01; P = 0.055), which was further confirmed in the second stage with similar effect (additive model: OR = 0.60; 95% CI = 0.38-0.95; P = 0.029). After combining the two stages, we found that the variant C allele of rs4238326 was probably associated with decreased risk of knee OA (additive model: OR = 0.65; 95% CI = 0.49-0.86; P = 0.003). Furthermore, interaction analyses showed that rs4238326 interacted multiplicatively with age to contribute to knee OA risk (interaction P = 0.041). CONCLUSIONS These findings indicate that the SNP rs4238326 in ALDH1A2 gene may potentially modify individual susceptibility to knee OA in the Chinese population. Beyond that, further studies are warranted to validate and extend our findings, and future functional studies are required to clarify the possible mechanisms.
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Affiliation(s)
- M Chu
- Department of Epidemiology, School of Public Health, Nantong University, Nantong, Jiangsu Province, PR China
| | - X Zhu
- Department of Epidemiology, School of Public Health, Nantong University, Nantong, Jiangsu Province, PR China
| | - C Wang
- College of Chemistry and Chemical Engineering, Nantong University, Nantong, Jiangsu Province, PR China
| | - J Rong
- Second Department of Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, PR China
| | - Y Wang
- Department of Epidemiology, School of Public Health, Nantong University, Nantong, Jiangsu Province, PR China
| | - S Wang
- Second Department of Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, PR China
| | - B Xing
- Hongqi Community Health Service Center, Xiangfang District, Harbin, Heilongjiang Province, PR China
| | - Y Tao
- Department of Health Education, Public Health College, Harbin Medical University, Harbin, Heilongjiang Province, PR China
| | - X Zhuang
- Department of Epidemiology, School of Public Health, Nantong University, Nantong, Jiangsu Province, PR China
| | - L Jiang
- Department of Epidemiology, School of Public Health, Nantong University, Nantong, Jiangsu Province, PR China.
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Moncho D, Poca MA, Minoves T, Ferré A, Cañas V, Sahuquillo J. Are evoked potentials clinically useful in the study of patients with Chiari malformation Type 1? J Neurosurg 2017; 126:606-619. [DOI: 10.3171/2015.11.jns151764] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
In this study, the authors describe the brainstem auditory evoked potential (BAEP) and somatosensory evoked potential (SSEP) alterations found in a large cohort of patients with Chiari malformation Type 1 (CM-1), the relationship between the BAEPs/SSEPs and the clinical findings, the abnormalities in patients with associated syringomyelia, and the clinical and neuroradiological risk factors that are associated with abnormal evoked potentials (EPs).
METHODS
A prospectively collected database containing 545 patients with CM-1 was queried to search for patients satisfying the following criteria: 1) an age of at least 14 years, 2) neuroradiological criteria of CM-1, 3) no prior Chiari-related surgeries, and 4) preoperative EP studies conducted at the authors' institution. The 200 patients included in this cohort were classified into CM-0, CM-1, and CM-1.5 subtypes. Linear, planimetric, and angular measurements of the posterior fossa were conducted, as well as syringomyelia measurements. Two separate multiple logistic regression models were used, one to predict the covariates associated with abnormal BAEPs, and a second model to explore the variables associated with an abnormal SSEP. In these models, the BAEPs and SSEPs were dichotomized as being normal or abnormal.
RESULTS
Headaches were the main symptom in 70.5% of the patients, and Valsalva-induced headaches were most frequent in patients with CM-1 and CM-1.5 compared with patients with CM-0 (p = 0.031). BAEPs were abnormal in 38.5% of patients, and abnormal SSEPs were found in 43.5% of the entire cohort. Syringomyelia was most frequent in patients with CM-0 (64.3%) and CM-1 (51.1%) compared with those with CM-1.5 (34.7%; p = 0.03). Age (OR 1.03, 95% CI 1.00–1.06), the degree of tonsillar herniation (OR 1.08, 95% CI 1.01–1.16), and lower cranial nerve dysfunction (OR 3.99, 95% CI 1.29–14.01) had a statistically significant correlation with abnormal BAEPs. Only age (OR 1.07, 95% CI 1.04–1.10) and the degree of tonsillar herniation (OR 1.11, 95% CI 1.04–1.19) had a statistically significant correlation with abnormal SSEPs.
CONCLUSIONS
A high percentage of patients with CM-1 exhibited EP alterations regardless of their clinical or radiological findings. These findings suggest that EPs do not add any clinically relevant information nor are they helpful in establishing which symptomatic patients with CM should undergo surgical treatment. However, BAEP and SSEP studies clearly play an important role in incidentally detected patients with CM and may help to establish objective evidence of subclinical dysfunctions. In addition, neurophysiological studies may help to define subgroups of patients who require further testing and follow-up to personalize strategies for the management of incidental and oligosymptomatic patients.
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Affiliation(s)
- Dulce Moncho
- 1Clinical Neurophysiology Department,
- 3Neurotraumatology and Neurosurgery Research Unit (UNINN), Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Spain
| | - Maria A. Poca
- 2Neurosurgical Department, and
- 3Neurotraumatology and Neurosurgery Research Unit (UNINN), Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Spain
| | | | - Alejandro Ferré
- 1Clinical Neurophysiology Department,
- 3Neurotraumatology and Neurosurgery Research Unit (UNINN), Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Spain
| | - Victoria Cañas
- 3Neurotraumatology and Neurosurgery Research Unit (UNINN), Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Spain
| | - Juan Sahuquillo
- 2Neurosurgical Department, and
- 3Neurotraumatology and Neurosurgery Research Unit (UNINN), Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Spain
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The Relationship of the Posterior Cranial Fossa, the Cerebrum, and Cerebellum Morphometry with Tonsiller Herniation. IRANIAN JOURNAL OF RADIOLOGY 2016. [DOI: 10.5812/iranjradiol.24436] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Pozetti M, Belsuzarri TAB, Belsuzarri NCB, Seixas NB, Araujo JFM. Neurofibromatosis type 1 and Chiari type 1 malformation: A case report and literature review of a rare association. Surg Neurol Int 2016; 7:S469-72. [PMID: 27500008 PMCID: PMC4960925 DOI: 10.4103/2152-7806.185778] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 04/26/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The association between neurofibromatosis type 1 (NF-I) and Chiari I malformation (CMI) is rare, and not many studies are reported in the literature. Performing magnetic resonance imaging (MRI) in patients with NF-1 is essential because several cases of Chiari type I are completely asymptomatic. We emphasize the need for inclusion of Chiari I as diagnosis in association with NF-1. CASE DESCRIPTION The patient was a 51-year-old black man who presented with complaints of pain and decreased motion and sensibility of his hands, wrists, and forearms, along with progressive dysarthria. Even though the computed tomography (CT) scan of the skull did not show changes, the MRI showed hydro/syringomyelia in the cervical spine area. Midline suboccipital craniectomy with total laminectomy of c1 and partial laminectomy of c2 was performed; tonsillectomy was also performed for cistern expansion because of intense thickening and obliteration of the obex by the cerebellar tonsils. Following treatment, the patient showed remission of symptoms. CONCLUSION NF-1 in association with CMI is rare, and early diagnosis and surgical treatment are essential to slow down the myelopathy; although they prevent neurological damages, patients with NF-1 must remain under doctor's attention in case of association with CMI. Our literature review showed that symptoms can vary and include headache, gait disturbance, and sensory/motor diminution, until asymptomatic patients. Moreover, the incidence of NF-1 is considerably higher in CMI patients in comparison to the global incidence (8.6-11.8% and 0.775%, respectively). The surgical technique must be evaluated case by case according to the degree of cerebrospinal fluid obstruction.
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Affiliation(s)
- Marianne Pozetti
- Faculty of Medicine, Pontifical Catholic University of Campinas, Campinas, São Paulo, Brazil
| | - Telmo Augusto Barba Belsuzarri
- Department of Neurosurgery of Hospital e Maternidade Celso Pierro, Pontifical Catholic University of Campinas, Campinas, São Paulo, Brazil
| | | | - Naira B. Seixas
- Faculty of Medicine, Pontifical Catholic University of Campinas, Campinas, São Paulo, Brazil
| | - João F. M. Araujo
- Department of Neurosurgery of Hospital e Maternidade Celso Pierro, Pontifical Catholic University of Campinas, Campinas, São Paulo, Brazil
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Srour M, Caron V, Pearson T, Nielsen SB, Lévesque S, Delrue MA, Becker TA, Hamdan FF, Kibar Z, Sattler SG, Schneider MC, Bitoun P, Chassaing N, Rosenfeld JA, Xia F, Desai S, Roeder E, Kimonis V, Schneider A, Littlejohn RO, Douzgou S, Tremblay A, Michaud JL. Gain-of-Function Mutations inRARBCause Intellectual Disability with Progressive Motor Impairment. Hum Mutat 2016; 37:786-93. [DOI: 10.1002/humu.23004] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 04/04/2016] [Accepted: 04/12/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Myriam Srour
- CHU Sainte-Justine Research Center; Montréal H3T 1C5 Canada
- Department of Pediatrics; Neurology and Neurosurgery; McGill University; Montreal H3A 1A4 Canada
| | | | - Toni Pearson
- Department of Neurology; Icahn School of Medicine at Mount Sinai; New York New York 10029
| | | | - Sébastien Lévesque
- Division of Medical Genetics; Department of Pediatrics; Centre Hospitalier Universitaire de Sherbrooke; Sherbrooke J1H 5N4 Canada
| | - Marie-Ange Delrue
- Department of Pediatrics; Université de Montréal; Montreal H3T 1J4 Canada
| | - Troy A. Becker
- Division of Genetics and Metabolism; All Children's Hospital; St-Petersburg Florida 33701
| | - Fadi F. Hamdan
- CHU Sainte-Justine Research Center; Montréal H3T 1C5 Canada
| | - Zoha Kibar
- CHU Sainte-Justine Research Center; Montréal H3T 1C5 Canada
- Department of Neurosciences; Université de Montréal; Montreal H3T 1J4 Canada
| | | | | | - Pierre Bitoun
- Génétique Médicale; Hôpital Jean Verdier AP-HP; C.H.U. Paris Nord Bondy 93140 France
| | - Nicolas Chassaing
- Service de Génétique Médicale; Hôpital Purpan; CHU Toulouse Toulouse 31059 France
- Université Paul-Sabatier; Toulouse III, EA-4555 and Inserm U1056 Toulouse 31000 France
| | | | - Fan Xia
- Baylor College of Medicine; Houston Texas 77030
| | - Sonal Desai
- Department of Neurogenetics; Kennedy Krieger Institute; Baltimore Maryland 21205
| | | | - Virginia Kimonis
- Division of Genetics and Genomic Medicine; Univerity of California-Irvine Medical Center; Orange California 92868
| | - Adele Schneider
- Division of Genetics and Genomic Medicine; Univerity of California-Irvine Medical Center; Orange California 92868
| | | | - Sofia Douzgou
- Manchester Centre for Genomic Medicine; Central Manchester University Hospitals NHS Foundation Trust; MAHSC; Saint Mary's Hospital; Manchester M13 9WL UK
| | - André Tremblay
- CHU Sainte-Justine Research Center; Montréal H3T 1C5 Canada
- Department of Obstetrics and Gynecology; Université de Montréal; Montreal H3T 1J4 Canada
- Department of Biochemistry and Molecular Medicine; Université de Montréal; Montreal H3T 1J4 Canada
| | - Jacques L. Michaud
- CHU Sainte-Justine Research Center; Montréal H3T 1C5 Canada
- Department of Pediatrics; Université de Montréal; Montreal H3T 1J4 Canada
- Department of Neurosciences; Université de Montréal; Montreal H3T 1J4 Canada
- Department of Biochemistry and Molecular Medicine; Université de Montréal; Montreal H3T 1J4 Canada
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Urbizu A, Ferré A, Poca MA, Rovira A, Sahuquillo J, Martin BA, Macaya A. Cephalometric oropharynx and oral cavity analysis in Chiari malformation Type I: a retrospective case-control study. J Neurosurg 2016; 126:626-633. [PMID: 27153161 DOI: 10.3171/2016.1.jns151590] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Traditionally, Chiari malformation Type I has been related to downward herniation of the cerebellar tonsils as a consequence of an underdeveloped posterior cranial fossa. Although the common symptoms of Chiari malformation Type I are occipital headaches, cervical pain, dizziness, paresthesia, and sensory loss, patients often report symptoms related to pharyngeal dysfunction such as choking, regurgitation, dysphagia, aspiration, chronic cough, and sleep disorders. In addition, tracheal intubation is often difficult in these patients. The purpose of this study was to analyze the morphological features of the oropharynx and oral cavity in patients with Chiari malformation Type I to help identify underlying anatomical anomalies leading to these debilitating symptoms. METHODS Seventy-six adult patients with symptomatic Chiari malformation Type I with cerebellar tonsillar descent greater than 5 mm below the foramen magnum and a small posterior cranial fossa and 49 sex-matched controls were selected to perform a retrospective case-control MRI-based morphometric study in a tertiary hospital. Eleven linear and areal parameters of the oropharyngeal cavity on midsagittal T1-weighted MRI were measured and the average values between patients and control cohorts were compared. Correlations between variables showing or approaching statistical significance in these structures and posterior cranial fossa measurements related with the occipital bone were sought. RESULTS Significant differences were detected for several oropharynx and oral cavity measures in the patient cohort, primarily involving the length and thickness of the soft palate (p = 9.5E-05 and p = 3.0E-03, respectively). A statistically significant (p < 0.01) moderate correlation between some of these variables and posterior cranial fossa parameters was observed. CONCLUSIONS The existence of structural oropharyngeal and oral cavity anomalies in patients with Chiari malformation Type I was confirmed, which may contribute to the frequent occurrence of respiratory and deglutitory complications and sleep disorders in this syndrome.
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Affiliation(s)
- Aintzane Urbizu
- Pediatric Neurology Research Group, Vall d'Hebron Research Institute.,Conquer Chiari Research Center, Department of Mechanical Engineering, The University of Akron, Ohio
| | - Alex Ferré
- Sleep Unit, Department of Clinical Neurophysiology
| | - Maria-Antonia Poca
- Department of Neurosurgery and Neurotraumatology and Neurosurgery Research Unit, and
| | - Alex Rovira
- Magnetic Resonance Unit (IDI), Department of Radiology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain; and
| | - Juan Sahuquillo
- Department of Neurosurgery and Neurotraumatology and Neurosurgery Research Unit, and
| | - Bryn A Martin
- Conquer Chiari Research Center, Department of Mechanical Engineering, The University of Akron, Ohio
| | - Alfons Macaya
- Pediatric Neurology Research Group, Vall d'Hebron Research Institute
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Kinetic characterization and regulation of the human retinaldehyde dehydrogenase 2 enzyme during production of retinoic acid. Biochem J 2016; 473:1423-31. [PMID: 27001866 DOI: 10.1042/bcj20160101] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 03/21/2016] [Indexed: 11/17/2022]
Abstract
Retinoic acid (RA) is an important regulator of embryogenesis and tissue homoeostasis. Perturbation of RA signalling causes developmental disorders, osteoarthritis, schizophrenia and several types of tumours. RA is produced by oxidation of retinaldehyde from vitamin A. The main enzyme producing RA in the early embryo is retinaldehyde dehydrogenase 2 (RALDH2, ALDH1A2). In the present study we describe in depth the kinetic properties and regulation of the human RALDH2 (hRALDH2) enzyme. We show that this enzyme produces RA using in vivo and in vitro assays. We studied the naturally occurring all-trans-, 9-cis- and 13-cis-retinaldehyde isomers as substrates of hRALDH2. Based on the values measured for the Michaelis-Menten constant Km and the maximal rate Vmax, in vitro hRALDH2 displays the same catalytic efficiency for their oxidation. We characterized two known inhibitors of the vertebrate RALDH2 and determined their kinetic parameters on hRALDH2. In addition, RA was studied as a possible inhibitor of hRALDH2 and a regulator of its activity. We show that hRALDH2 is not inhibited by its oxidation product, all-trans-RA, suggesting the absence of a negative feedback regulatory loop. Expression of the Raldh2 gene is known to be regulated by RA itself, suggesting that the main regulation of the hRALDH2 activity level is transcriptional.
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Kovrazhkina EA, Starikova NV, Nadtochiy AG, Gubskiy LV, Panov VO, Volkova KN. Neurologic disturbances in children with cleft lip and cleft palate. Zh Nevrol Psikhiatr Im S S Korsakova 2016; 116:76-82. [DOI: 10.17116/jnevro20161163276-82] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Wong K, Moldrich R, Hunter M, Edwards M, Finlay D, O'Donnell S, MacDougall T, Bain N, Kamien B. A familial 7q36.3 duplication associated with agenesis of the corpus callosum. Am J Med Genet A 2015; 167A:2201-8. [DOI: 10.1002/ajmg.a.37143] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 04/19/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Keith Wong
- The University of Newcastle; School of Medicine and Public Health; Newcastle New South Wales Australia
| | - Randal Moldrich
- The University of Queensland; The UQ Centre for Clinical Research; Brisbane Queensland Australia
| | - Matthew Hunter
- The University of Newcastle; School of Medicine and Public Health; Newcastle New South Wales Australia
- Hunter Genetics; Newcastle New South Wales Australia
| | - Matthew Edwards
- Paediatrics, School of Medicine; University of Western Sydney; Sydney New South Wales Australia
| | - David Finlay
- Faculty of Science, Technology, and Engineering; LaTrobe University; Bundoora Victoria Australia
| | | | - Tom MacDougall
- Department of Radiology; John Hunter Hospital; Newcastle New South Wales Australia
| | - Nicole Bain
- Hunter Area Pathology Service (HAPS); John Hunter Hospital; Newcastle New South Wales Australia
| | - Benjamin Kamien
- The University of Newcastle; School of Medicine and Public Health; Newcastle New South Wales Australia
- Hunter Genetics; Newcastle New South Wales Australia
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Audio-Vestibular Signs and Symptoms in Chiari Malformation Type I. Case Series and Literature Review. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2015. [DOI: 10.1016/j.otoeng.2014.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Jayarao M, Sohl K, Tanaka T. Chiari malformation I and autism spectrum disorder: an underrecognized coexistence. J Neurosurg Pediatr 2015; 15:96-100. [PMID: 25396704 DOI: 10.3171/2014.10.peds13562] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Patients with symptomatic Chiari malformation Type I (CM-I) frequently present with headaches, neck pain, difficulty swallowing, and balance disturbances. In children with autism spectrum disorder (ASD), diagnosing CM-I can be a challenging task. Moreover, even if symptomatic, some patients do not undergo further evaluation or management, as their presentations are attributed to autism and its myriad symptoms. Therefore, cranial MRI findings were reviewed after evaluating and treating patients with coexisting ASD and CM-I. In this paper, the authors report on 5 children with ASD and symptomatic CM-I, including their clinical presentation, imaging studies, management, and outcomes, and discuss the likely underrecognized coexistence of these conditions. METHODS All pediatric patients with ASD and cranial MRI conducted for any reason in the period from 1999 to 2013 were considered for analysis. All cases with concomitant symptomatic CM-I were eligible for this retrospective analysis. RESULTS One hundred twenty-five pediatric patients diagnosed with ASD had undergone MRI, and 9 of them had evidence of cerebellar tonsillar herniation. Five patients were symptomatic and underwent suboccipital craniectomy, a C-1 or a C-1 and C-2 laminectomy, and duraplasty with bovine pericardium or Type I collagen allograft. There were no intraoperative complications. All patients showed symptom improvement and/or resolution of presenting symptoms, which included headache, dysphasia, speech, and irritability. CONCLUSIONS There is no identified cause of autism. Children with ASD can be difficult to assess specifically in a neurological examination. Thus, cranial MRI considered when completing a comprehensive diagnostic evaluation. While cranial MRI is not a routine part of ASD evaluation, this study demonstrates that CM-I and ASD may coexist and be underrecognized. The study reinforces the importance of a comprehensive medical evaluation designed to elucidate neurological findings in children with impaired communication abilities and suggests the judicious use of neuroimaging.
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Affiliation(s)
- Mayur Jayarao
- Division of Neurosurgery, University of Missouri School of Medicine; and
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Guerra Jiménez G, Mazón Gutiérrez Á, Marco de Lucas E, Valle San Román N, Martín Laez R, Morales Angulo C. Audio-vestibular signs and symptoms in Chiari malformation type i. Case series and literature review. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2014; 66:28-35. [PMID: 25195076 DOI: 10.1016/j.otorri.2014.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 05/14/2014] [Accepted: 05/19/2014] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Chiari malformation is an alteration of the base of the skull with herniation through the foramen magnum of the brain stem and cerebellum. Although the most common presentation is occipital headache, the association of audio-vestibular symptoms is not rare. The aim of our study was to describe audio-vestibular signs and symptoms in Chiari malformation type i (CM-I). MATERIALS AND METHODS We performed a retrospective observational study of patients referred to our unit during the last 5 years. We also carried out a literature review of audio-vestibular signs and symptoms in this disease. RESULTS There were 9 patients (2 males and 7 females), with an average age of 42.8 years. Five patients presented a Ménière-like syndrome; 2 cases, a recurrent vertigo with peripheral features; one patient showed a sudden hearing loss; and one case suffered a sensorineural hearing loss with early childhood onset. The most common audio-vestibular symptom indicated in the literature in patients with CM-I is unsteadiness (49%), followed by dizziness (18%), nystagmus (15%) and hearing loss (15%). Nystagmus is frequently horizontal (74%) or down-beating (18%). Other audio-vestibular signs and symptoms are tinnitus (11%), aural fullness (10%) and hyperacusis (1%). Occipital headache that increases with Valsalva manoeuvres and hand paresthesias are very suggestive symptoms. CONCLUSIONS The appearance of audio-vestibular manifestations in CM-I makes it common to refer these patients to neurotologists. Unsteadiness, vertiginous syndromes and sensorineural hearing loss are frequent. Nystagmus, especially horizontal and down-beating, is not rare. It is important for neurotologists to familiarise themselves with CM-I symptoms to be able to consider it in differential diagnosis.
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Affiliation(s)
- Gloria Guerra Jiménez
- Servicio de ORL, Complejo Hospitalario Insular Materno Infantil, Las Palmas, Gran Canaria, España.
| | | | | | | | - Rubén Martín Laez
- Servicio de Neurocirugía, Hospital Universitario Marqués de Valdecilla, Santander, España
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Korzh V. Neurulation continues: The parade commander is… apical constriction. Russ J Dev Biol 2014. [DOI: 10.1134/s1062360414040055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Markunas CA, Lock E, Soldano K, Cope H, Ding CKC, Enterline DS, Grant G, Fuchs H, Ashley-Koch AE, Gregory SG. Identification of Chiari Type I Malformation subtypes using whole genome expression profiles and cranial base morphometrics. BMC Med Genomics 2014; 7:39. [PMID: 24962150 PMCID: PMC4082616 DOI: 10.1186/1755-8794-7-39] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 06/18/2014] [Indexed: 12/02/2022] Open
Abstract
Background Chiari Type I Malformation (CMI) is characterized by herniation of the cerebellar tonsils through the foramen magnum at the base of the skull, resulting in significant neurologic morbidity. As CMI patients display a high degree of clinical variability and multiple mechanisms have been proposed for tonsillar herniation, it is hypothesized that this heterogeneous disorder is due to multiple genetic and environmental factors. The purpose of the present study was to gain a better understanding of what factors contribute to this heterogeneity by using an unsupervised statistical approach to define disease subtypes within a case-only pediatric population. Methods A collection of forty-four pediatric CMI patients were ascertained to identify disease subtypes using whole genome expression profiles generated from patient blood and dura mater tissue samples, and radiological data consisting of posterior fossa (PF) morphometrics. Sparse k-means clustering and an extension to accommodate multiple data sources were used to cluster patients into more homogeneous groups using biological and radiological data both individually and collectively. Results All clustering analyses resulted in the significant identification of patient classes, with the pure biological classes derived from patient blood and dura mater samples demonstrating the strongest evidence. Those patient classes were further characterized by identifying enriched biological pathways, as well as correlated cranial base morphological and clinical traits. Conclusions Our results implicate several strong biological candidates warranting further investigation from the dura expression analysis and also identified a blood gene expression profile corresponding to a global down-regulation in protein synthesis.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Simon G Gregory
- Duke Center for Human Genetics, Duke University Medical Center, Durham, NC, USA.
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Korzh V. Stretching cell morphogenesis during late neurulation and mild neural tube defects. Dev Growth Differ 2014; 56:425-33. [DOI: 10.1111/dgd.12143] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 04/21/2014] [Accepted: 04/22/2014] [Indexed: 01/07/2023]
Affiliation(s)
- Vladimir Korzh
- Institute of Molecular and Cell Biology; Singapore
- Department of Biological Sciences; National University of Singapore; Singapore
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