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Samara A, Gusman M, Aker L, Parsons MS, Mian AY, Eldaya RW. The Forgotten Phacomatoses: A Neuroimaging Review of Rare Neurocutaneous Disorders. Curr Probl Diagn Radiol 2021; 51:747-758. [PMID: 34607749 DOI: 10.1067/j.cpradiol.2021.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 07/07/2021] [Accepted: 07/18/2021] [Indexed: 01/05/2023]
Abstract
Phakomatoses, or neurocutaneous syndromes, are a heterogeneous group of rare genetic disorders that predominantly affect structures arising from the embryonic ectoderm, namely the skin, eye globe, retina, tooth enamel, and central nervous system. Other organs are also involved in some syndromes, mainly cardiovascular, pulmonary, renal, and musculoskeletal systems. Currently, more than sixty distinct entities belonging to this category have been described in the literature. Common phakomatoses include conditions like Neurofibromatosis and Tuberous sclerosis. Several review papers have focused on various aspects of these common conditions, including clinical presentation, genetic and molecular basis, and neuroimaging features. In this review, we focus on rare neurocutaneous syndromes: Melanophakomatoses (Ie, Neurocutaneous Melanosis, and Incontinentia Pigmenti), Vascular Phakomatoses (Ie, Ataxia Telangiectasia and PHACE Syndrome), and other conditions such as Cowden Syndrome, Basal Nevus Syndrome, Schwannomatosis, Progressive Facial Hemiatrophy, Gomez-Lopez-Hernandez Syndrome, Wyburn-Mason Syndrome, CHILD Syndrome, and Proteus Syndrome. We also review the neuroradiologic manifestations of these conditions as a guide for neurologists and neuroradiologists in their daily practice.
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Affiliation(s)
- Amjad Samara
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO..
| | - Mariya Gusman
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Loai Aker
- Department of Radiology, Hamad General Hospital, Doha, Qatar
| | - Matthew S Parsons
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Ali Y Mian
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Rami W Eldaya
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
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Barros FS, Marussi VHR, Amaral LLF, da Rocha AJ, Campos CMS, Freitas LF, Huisman TAGM, Soares BP. The Rare Neurocutaneous Disorders: Update on Clinical, Molecular, and Neuroimaging Features. Top Magn Reson Imaging 2018; 27:433-462. [PMID: 30516694 DOI: 10.1097/rmr.0000000000000185] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Phakomatoses, also known as neurocutaneous disorders, comprise a vast number of entities that predominantly affect structures originated from the ectoderm such as the central nervous system and the skin, but also the mesoderm, particularly the vascular system. Extensive literature exists about the most common phakomatoses, namely neurofibromatosis, tuberous sclerosis, von Hippel-Lindau and Sturge-Weber syndrome. However, recent developments in the understanding of the molecular underpinnings of less common phakomatoses have sparked interest in these disorders. In this article, we review the clinical features, current pathogenesis, and modern neuroimaging findings of melanophakomatoses, vascular phakomatoses, and other rare neurocutaneous syndromes that may also include tissue overgrowth or neoplastic predisposition.
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Affiliation(s)
- Felipe S Barros
- Division of Neuroradiology, BP Medicina Diagnóstica, Hospital da Beneficência Portuguesa de São Paulo
| | - Victor Hugo R Marussi
- Division of Neuroradiology, BP Medicina Diagnóstica, Hospital da Beneficência Portuguesa de São Paulo
| | - Lázaro L F Amaral
- Division of Neuroradiology, BP Medicina Diagnóstica, Hospital da Beneficência Portuguesa de São Paulo
| | - Antônio José da Rocha
- Division of Neuroradiology, Department of Radiology, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Christiane M S Campos
- Division of Neuroradiology, BP Medicina Diagnóstica, Hospital da Beneficência Portuguesa de São Paulo
| | - Leonardo F Freitas
- Division of Neuroradiology, BP Medicina Diagnóstica, Hospital da Beneficência Portuguesa de São Paulo
| | - Thierry A G M Huisman
- Division of Pediatric Radiology and Pediatric Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Bruno P Soares
- Division of Pediatric Radiology and Pediatric Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
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Mulkey SB, Ramakrishnaiah RH, Balmakund TM. Cerebral Arteriopathy in a Newborn With Incontinentia Pigmenti. Pediatr Neurol 2016; 54:76-81. [PMID: 26706482 PMCID: PMC4691526 DOI: 10.1016/j.pediatrneurol.2015.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 09/10/2015] [Accepted: 09/12/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Incontinentia pigmenti is a rare X-linked neurocutaneous disorder that can present in the neonatal period with seizures and encephalopathy. Brain magnetic resonance imaging and magnetic resonance angiography may reveal cerebral infarction and arteriopathy. PATIENT DESCRIPTION We describe a neonate with the typical rash of incontinentia pigmenti along with seizures and brain magnetic resonance imaging abnormalities. RESULTS Brain magnetic resonance imaging, magnetic resonance angiography, and magnetic resonance spectroscopy at age one week revealed chronic and acute brain injury, arteriopathy of the small and medium-sized cerebral vessels, and elevation of a lactate metabolite peak. By age six months, her magnetic resonance angiogram had normalized. At age 2.5 years, she has well-controlled complex partial seizures, global developmental delay, and residual hemiplegia. CONCLUSION Despite extensive cerebral arteriopathy in association with incontinentia pigmenti, this girl had a relatively stable early clinical course, steady developmental progress over time, and seizures that have been well controlled. Later brain imaging revealed resolution of the arteriopathy.
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Affiliation(s)
- Sarah B. Mulkey
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Tonya M. Balmakund
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Abstract
Neurocutaneous syndromes (or phakomatoses) are a diverse group of congenital disorders that encompass abnormalities of neuroectodermal and, sometimes, mesodermal development, hence commonly involving the skin, eye, and central nervous system. These are often inherited conditions and typically present in early childhood or adolescence. Some of the abnormalities and clinical symptoms may, however, be progressive, and there is an increased risk of neoplastic formation in many of the syndromes. As a group, neurocutaneous syndromes are characterized by distinctive cutaneous stigmata and neurologic symptomology, the latter often representing the most devastating and debilitating features of these diseases. Many of these syndromes are markedly heterogeneous in nature as they affect many organ systems. Given the incurable nature of these conditions and the broad spectrum of pathologies they comprise, treatments vary on a case-by-case basis and tend to be palliative rather than curative. With the advances in molecular genetics, however, greater understanding of biologic functions of the gene products and the correlative phenotypic expression is being attained, and this knowledge may guide future therapeutic developments. This chapter focuses on the cutaneous and neurologic pathology with emphasis on neuroimaging of selective neurocutaneous syndromes, including tuberous sclerosis, Sturge-Weber syndrome, Klippel-Trenaunay syndrome, ataxia-telangiectasia, and incontinentia pigmenti.
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Affiliation(s)
- Nitasha Klar
- Division of Neuroradiology, Russell H. Morgan Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bernard Cohen
- Departments of Dermatology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Doris D M Lin
- Division of Neuroradiology, Russell H. Morgan Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Poziomczyk CS, Recuero JK, Bringhenti L, Maria FDS, Campos CW, Travi GM, Freitas AM, Maahs MAP, Zen PRG, Fiegenbaum M, Almeida STD, Bonamigo RR, Bau AEK. Incontinentia pigmenti. An Bras Dermatol 2014; 89:26-36. [PMID: 24626645 PMCID: PMC3938351 DOI: 10.1590/abd1806-4841.20142584] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 04/09/2013] [Indexed: 12/25/2022] Open
Abstract
Incontinentia pigmenti is a rare genodermatosis in which the skin involvement occurs
in all patients. Additionally, other ectodermal tissues may be affected, such as the
central nervous system, eyes, hair, nails and teeth. The disease has a X-linked
dominant inheritance pattern and is usually lethal to male fetuses. The
dermatological findings occur in four successive phases, following the lines of
Blaschko: First phase - vesicles on an erythematous base; second phase - verrucous
hyperkeratotic lesions; third phase - hyperchromic spots and fourth phase -
hypochromic atrophic lesions.
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Affiliation(s)
- Cláudia Schermann Poziomczyk
- Porto Alegre Health Sciences Federal University, Pathology Post-graduation Program, Porto AlegreRS, Brazil, MD, Dermatologist - MSc (in course) at the Pathology Post-graduation Program at Porto Alegre Health Sciences Federal University (UFCSPA) - Porto Alegre (RS), Brazil
| | - Júlia Kanaan Recuero
- Porto Alegre Health Sciences Federal University, Porto AlegreRS, Brazil, Medical Student at Porto Alegre Health Sciences Federal University (UFCSPA) - Porto Alegre (RS), Brazil
| | - Luana Bringhenti
- Porto Alegre Health Sciences Federal University, Porto AlegreRS, Brazil, Medical Student at Porto Alegre Health Sciences Federal University (UFCSPA) - Porto Alegre (RS), Brazil
| | - Fernanda Diffini Santa Maria
- Porto Alegre Health Sciences Federal University, Pathology Post-graduation Program, Porto AlegreRS, Brazil, DDS - MSc (in course) at the Pathology Post-graduation Program at Porto Alegre Health Sciences Federal University (UFCSPA) - Porto Alegre (RS), Brazil
| | - Carolina Wiltgen Campos
- Santa Casa de Misericórdia de Porto Alegre, Ophthalmology Program, Porto AlegreRS, Brazil, MD - Resident in the Ophthalmology Program at Santa Casa de Misericórdia de Porto Alegre - Porto Alegre (RS), Brazil
| | - Giovanni Marcos Travi
- Santa Casa de Misericórdia de Porto Alegre, Porto AlegreRS, Brazil, MD - Ophthalmologist with specialization in Pediatric Ophthalmology and Strabismus Licensed physician at Santa Casa de Misericórdia de Porto Alegre- Porto Alegre (RS), Brazil
| | - André Moraes Freitas
- Santa Casa de Misericórdia de Porto Alegre Ophthalmology Service, Ophthalmology Service, Retina Sector, Porto AlegreRS, Brazil, MD - Ophthalmologist - Chief of the Retina Sector at Santa Casa de Misericórdia de Porto Alegre Ophthalmology Service - Porto Alegre (RS), Brazil
| | - Marcia Angelica Peter Maahs
- Rio Grande do Sul Federal University, Porto AlegreRS, Brazil, DDS - Specialist in Orthodontics and Facial Orthopedics at Rio Grande do Sul Federal University (UFRGS). PhD in Dentistry at Rio Grande do Sul Pontifical Catholic University (PUCRS) - Substitute Professor of the Discipline of Orthodontics Applied to Speech Therapy at Porto Alegre Health Sciences Federal University (UFCSPA) - Porto Alegre (RS), Brazil
| | - Paulo Ricardo Gazzola Zen
- Porto Alegre Health Sciences Federal University, Pathology Post-graduation Program, Porto AlegreRS, Brazil, MD, PhD at the Pathology Post-graduation Program at Porto Alegre Health Sciences Federal University (UFCSPA) - Adjunct Professor of Genetics at Porto Alegre Health Sciences Federal University (UFCSPA) - Porto Alegre (RS), Brazil
| | - Marilu Fiegenbaum
- Porto Alegre Health Sciences Federal University, Basic Health Sciences Department, Porto AlegreRS, Brazil, Pharm. D. - PhD in Genetics and Molecular Biology at Rio Grande do Sul Federal University (UFRGS) - Adjunct Professor at the Basic Health Sciences Department at Porto Alegre Health Sciences Federal University (UFCSPA) - Porto Alegre (RS), Brazil
| | - Sheila Tamanini de Almeida
- Porto Alegre Health Sciences Federal University, Speech Therapy Department, Porto AlegreRS, Brazil, Speech-Language Pathologist (SLPs) - Specialist in Orofacial Motricity and Dysphagia. MSc in Health Sciences - Assistant Professor at the Speech Therapy Department at Porto Alegre Health Sciences Federal University (UFCSPA) - Porto Alegre (RS), Brazil
| | - Renan Rangel Bonamigo
- Porto Alegre Health Sciences Federal University, Pathology Postgraduation Program, Porto AlegreRS, Brazil, MD - PhD in Health Sciences at Rio Grande do Sul Federal University (UFRGS) - Head Professor of Dermatology and Professor of the Pathology Postgraduation Program at Porto Alegre Health Sciences Federal University (UFCSPA) - Porto Alegre (RS), Brazil
| | - Ana Elisa Kiszewski Bau
- Porto Alegre Health Sciences Federal University, Porto AlegreRS, Brazil, MD - PhD in Pathology at Porto Alegre Health Sciences Federal University (UFCSPA)- Adjunct Professor of Dermatology at Porto Alegre Health Sciences Federal University (UFCSPA). Pediatric Dermatologist at Santo Antonio Children's Hospital and at Santa Casa de Misericórdia de Porto Alegre - Porto Alegre (RS), Brazil
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Abstract
Incontinentia pigmenti (IP) is a rare X-linked dominant neurocutaneous disorder affecting ectodermal tissue: skin, eyes, central nervous system, hair, nails, and teeth. It is usually lethal for males in utero. The involved gene is NEMO, an essential component of the nuclear factor-kappa B (NF-κB) signaling pathway. Skin lesions are highly diagnostic, occurring in neonates, with a particular distribution on Blaschko lines. The severity of the disease is related to ocular and neurological impairment. The hallmark of ocular IP is retinal vasculopathy including peripheral retinal vascular nonperfusion, macular infarction and neovascularization, and preretinal neovascularization. CNS involvement consists of seizures, mental retardation, hemiparesis, spasticity, microcephaly, cerebellar ataxia, and coma. It often occurs in neonates. Some patients have persistent pharmacoresistant seizures throughout life. MRI findings consist essentially in: white-matter lesions; scattered cortical neuronal necrosis; multiple cerebral infarctions; cerebral atrophy, hypoplasia of the corpus callosum, encephalomalacia and neuronal heterotopia. A predominant role of vascular occlusive phenomena in small vessels is highly suspected. In fact several intricate mechanisms could be discussed: vascular, inflammatory, developmental mechanisms. Their role and predictive factors of IP CNS involvement in neonatal IP need to be better understood to identify effective innovative therapies. Hypomelanosis of Ito can occur in the neonate, infancy, or childhood, be isolated or diffuse, often following the Blaschko lines, and can fade in childhood or adulthood. It is due to reduced melanin in the epidermis. Eye, central nervous (mental retardation, epilepsy, language disabilities, motor system dysfunction, psychiatric symptoms including autism - with frequent cortical malformations including hemimegalencephaly and white matter involvement), and musculoskeletal systems can also be affected. Mosaicism with various chromosomal rearrangements has been reported.
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Affiliation(s)
- Christine Bodemer
- National Reference Centre for Genodermatoses, Department of Dermatology, Hôpital Necker-Enfants Malades, Université René Descartes, Paris, France.
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Meuwissen ME, Mancini GM. Neurological findings in incontinentia pigmenti; a review. Eur J Med Genet 2012; 55:323-31. [DOI: 10.1016/j.ejmg.2012.04.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Accepted: 04/22/2012] [Indexed: 10/28/2022]
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