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Ní Leidhin C, Erickson JP, Bynevelt M, Lam G, Lock JH, Wang G, Mankad K, Taranath A, Mason M, Lakshmanan R, Shipman P, Warne RR. (What's the story) morning glory? MRI findings in morning glory disc anomaly. Neuroradiology 2024; 66:1225-1233. [PMID: 38717474 DOI: 10.1007/s00234-024-03375-2] [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: 02/12/2024] [Accepted: 05/01/2024] [Indexed: 06/05/2024]
Abstract
PURPOSE Morning glory disc anomaly (MGDA) is a rare congenital ophthalmologic disorder. Historically it has been diagnosed fundoscopically, with little in the literature regarding its imaging findings. The purpose of this study is to further characterize the orbital and associated intracranial magnetic resonance imaging (MRI) findings of MGDA in our tertiary pediatric center. METHODS A retrospective review was performed of fundoscopically-diagnosed cases of MGDA, that had been referred for MRI. All MRI studies were scrutinized for orbital and other intracranial abnormalities known to occur in association with MGDA. RESULTS 18 of 19 cases of MGDA showed three characteristic MRI findings: funnel-shaped morphology of the posterior optic disc, abnormal soft tissue associated with the retrobulbar optic nerve, and effacement of adjacent subarachnoid spaces. The ipsilateral (intraorbital) optic nerve was larger in one patient and smaller in six. The ipsilateral optic chiasm was larger in two patients and smaller in one. CONCLUSION This study represents a comprehensive radiological-led investigation into MGDA. It describes the most frequently-encountered MRI findings in MGDA and emphasizes the importance of MRI in this cohort, i.e., in distinguishing MGDA from other posterior globe abnormalities, in assessing the visual pathway, and in screening for associated intracranial abnormalities - skull base/cerebral, vascular, and facial. It hypothesizes neurocristopathy as an underlying cause of MGDA and its associations. Caliber abnormalities of the ipsilateral optic nerve and chiasm are a frequent finding in MGDA. Optic pathway enlargement should not be labeled "glioma". (239/250).
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Affiliation(s)
- Caoilfhionn Ní Leidhin
- Department of Medical Imaging, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, WA 6009, Australia.
| | - Jonathan P Erickson
- Department of Medical Imaging, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, WA 6009, Australia
| | - Michael Bynevelt
- Department of Medical Imaging, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, WA 6009, Australia
| | - Geoffrey Lam
- Department of Ophthalmology, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, WA 6009, Australia
| | - Jane H Lock
- Department of Ophthalmology, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, WA 6009, Australia
| | - George Wang
- Department of Biostatistics, School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Kshitij Mankad
- Department of Paediatric Neuroradiology, Great Ormond Street Hospital for Children, London, England, UK
| | - Ajay Taranath
- Department of Medical Imaging, Women's and Children's Hospital, Adelaide, SA, Australia
| | - Michael Mason
- Department of Medical Imaging, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, WA 6009, Australia
| | - Rahul Lakshmanan
- Department of Medical Imaging, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, WA 6009, Australia
- Centre for Neuromuscular and Neurological Disorders (Perron Institute), University of Western Australia Medical School, Perth, WA, Australia
| | - Peter Shipman
- Department of Medical Imaging, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, WA 6009, Australia
| | - Richard R Warne
- Department of Medical Imaging, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, WA 6009, Australia
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Li X, Liu G, Ni Y, Song D, Yang F, Wang X, Niu Y, Zhang C, Zhang Y. Analysis of macula structural changes in Moyamoya disease using AI-assisted OCT. Photodiagnosis Photodyn Ther 2024; 45:103939. [PMID: 38161035 DOI: 10.1016/j.pdpdt.2023.103939] [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: 10/04/2023] [Revised: 11/27/2023] [Accepted: 12/15/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE To investigate macula structure thickness and volume changes in patients with moyamoya disease (MMD). METHOD In this cross-sectional study, we used artificial intelligence (AI) -assisted optical coherence tomography (OCT) to analyze the thickness and volume of macula in Moyamoya patients. ETDRS zoning divides the macula into nine different regions. In 15 patients with radial scanning OCT, the average thickness and volume of retina, RNFL, GCL, and choroid in these regions were measured. In 30 patients with radial or horizontal scanning OCT, based on the anatomical structure, the macula is divided into seven segments. Mean Sattler layer-choriocapillaris complex thickness (SLCCT), Haller layer thickness, and total choroidal thickness were measured for each segment using AI-assisted OCT. RESULTS We recruited 30 patients (59 eyes) with MMD. In the 15 patients (29 eyes) who underwent radial scanning OCT, no significant change in retina, RNFL, GCL, and choroidal thickness was identified between the two groups (p > 0.05). There was no significant change in retina, RNFL, or choroidal volume between the two groups in different ETDRS macula regions (p > 0.05). The GCL volume in the macula's inner ring nasal portion (IN) was significantly lower. SLCCTs were considerably reduced in six macula regions in moyamoya groups (p < 0.05). There was no statistically significant change in Haller layer thickness. Only the nasal perifovea (PE_N) exhibited a significant variation in choroidal thickness. The Moyamoya group showed reduced choroidal thickness in PE_N segment. CONCLUSION In patients with MMD, there is thinning of the Sattler layer-choriocapillaris complex in the choroid.
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Affiliation(s)
- Xiaochun Li
- Department of Ophthalmology, Peking University International Hospital, Beijing, China
| | - Guangfeng Liu
- Department of Ophthalmology, Peking University International Hospital, Beijing, China.
| | - Yuan Ni
- Ping An Technology, Shanghai, China
| | - Dan Song
- Department of Ophthalmology, Peking University International Hospital, Beijing, China
| | - Fei Yang
- Department of Ophthalmology, Peking University International Hospital, Beijing, China
| | - Xijuan Wang
- Department of Ophthalmology, Peking University International Hospital, Beijing, China
| | - Yaqian Niu
- Department of Ophthalmology, Peking University International Hospital, Beijing, China
| | - Chengxia Zhang
- Department of Ophthalmology, Peking University International Hospital, Beijing, China
| | - Yan Zhang
- Department of Ophthalmology, Peking University International Hospital, Beijing, China
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Kumar J, Adenuga OO, Singh K, Ahuja AA, Kannan NB, Ramasamy K. Clinical characteristics of morning glory disc anomaly in South India. Taiwan J Ophthalmol 2021; 11:57-63. [PMID: 33767956 PMCID: PMC7971437 DOI: 10.4103/tjo.tjo_52_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 07/21/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE: Reports of morning glory disc anomaly (MGDA) in India have mostly been case reports. The aim of this study was to describe the demographic and clinical profile of patients with MGDA in South India. MATERIALS AND METHODS: A retrospective review of the medical records of patients with MGDA seen at a tertiary eye hospital in South India over a period of 8 years was carried out. The patients' demographic and clinical data were extracted from the case files and were entered into Epi Info reporting software version 7.2.3.0 and then analyzed. RESULTS: There were 51 eyes of 44 patients with MGDA comprised 25 (56.8%) males and 19 (43.2%) females. Seven (15.9%) patients had bilateral MGDA. The mean age for females was 5.8 years (standard deviation [SD]: 5.8) and for males, 11.2 years (SD: 12.1). This difference was not statistically significant with a P = 0.07. The most common ocular associations were strabismus, refractive error, and retinal detachment, whereas the most common systemic associations were cleft lip and cleft palate. Fifty-one percent of eyes were blind at presentation. CONCLUSION: Patients with MGDA in India tend to present late with poor visual prognosis. Early diagnosis and prompt treatment of blinding complications are crucial in reducing the risk of irreversible visual loss. Associated systemic abnormalities highlight the importance of a multidisciplinary approach in the management of patients with this condition.
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Affiliation(s)
- Jayant Kumar
- Department of Vitreo- Retina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Olukorede O Adenuga
- Department of Ophthalmology, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Kritika Singh
- Department of Vitreo- Retina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Ashish A Ahuja
- Retina Unit, Sadhu Kamal Eye Hospital, Mumbai Central, Maharashtra, India
| | - Naresh B Kannan
- Department of Vitreo- Retina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Kim Ramasamy
- Department of Vitreo- Retina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
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Rodriguez SM, Matharu KS, Epner L, Dunaway D, Foroozan R. Junctional scotoma in moyamoya disease. Can J Ophthalmol 2021; 56:e127-e129. [PMID: 33539822 DOI: 10.1016/j.jcjo.2021.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 11/06/2020] [Accepted: 01/11/2021] [Indexed: 11/30/2022]
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Bhat R, Al-Samarraie M, Nada A, Leiva-Salinas C, Whitehead M, Mahdi E. Spotlight on the pediatric eye: a pictorial review of orbital anatomy and congenital orbital pathologies. Neuroradiol J 2020; 34:21-32. [PMID: 32865127 DOI: 10.1177/1971400920949232] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Orbital lesions in the pediatric population vary from adults in terms of their presentation, unique pathology, and imaging characteristics. The prompt and accurate diagnosis of these lesions is imperative to prevent serious consequences in terms of visual impairment and disfigurement. Along with dedicated ophthalmologic examination, imaging is instrumental in characterizing these lesions, both for accurate diagnosis and subsequent management. In our pictorial essay, we provide a basic review of orbital embryology, anatomy, and congenital orbital pathologies, with emphasis on radiological findings.
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Affiliation(s)
- Roopa Bhat
- Department of Radiology, University of Missouri Health Care, USA
| | | | - Ayman Nada
- Department of Radiology, University of Missouri Health Care, USA
| | | | - Matthew Whitehead
- Diagnostic Imaging and Radiology, Children's National Health Systems, USA.,George Washington University Hospital, USA
| | - Eman Mahdi
- Department of Radiology, University of Missouri Health Care, USA
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Wang YY, Zhou KY, Ye Y, Song F, Yu J, Chen JC, Yao K. Moyamoya Disease Associated With Morning Glory Disc Anomaly and Other Ophthalmic Findings: A Mini-Review. Front Neurol 2020; 11:338. [PMID: 32499749 PMCID: PMC7242724 DOI: 10.3389/fneur.2020.00338] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/07/2020] [Indexed: 12/01/2022] Open
Abstract
Moyamoya disease (MMD) is a chronic cerebrovascular disease that frequently results in intracranial ischemia or hemorrhage. Its concurrence with varying ophthalmic findings is relatively rare yet may lead to irreversible blindness. We performed a search and review of the literature to characterize the relevance of MMD (excluding moyamoya syndrome) and ophthalmic findings. As a result, a total of 38 articles identified from PubMed and Web of Science were included in this mini-review. Patients with MMD sometimes present with decreased visual acuity or visual field defects before the onset of symptomatic cerebrovascular dysfunction. The most predominant ophthalmic condition in MMD patients is the morning glory disc anomaly (MGDA). Deficiency during neuroectodermal genesis and subsequent mesodermal changes may be responsible for the association between these two diseases. Thus, it may be beneficial for patients with MGDA to receive cerebral vascular examinations as the precaution against life-threatening intracranial angiopathy. Other ophthalmic findings reported in cases of MMD include retinal vascular occlusion, optic disc pallor, cortical blindness, etc. For most of the patients with MMD, retinal examinations would be recommended to prevent potential loss of vision. It is essential for both neurologists and ophthalmologists to be aware of the correlation between cerebrovascular diseases such as MMD and ocular manifestations to achieve a comprehensive diagnosis.
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Affiliation(s)
- Yue-Ye Wang
- Eye Center, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Ke-Yao Zhou
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yang Ye
- Eye Center, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Fan Song
- Eye Center, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Jin Yu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jin-Cao Chen
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ke Yao
- Eye Center, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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Solomou A, Spiliopoulos KC, Vasilagkos G, Vagionis A, Zampakis P. Internal carotid artery origin of the anterior cerebral artery: A rare anatomic intracranial arterial variation in a child with morning glory disc anomaly and moyamoya vascular pattern; case report and review of literature. Brain Circ 2020; 6:133-138. [PMID: 33033785 PMCID: PMC7511914 DOI: 10.4103/bc.bc_10_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/15/2020] [Accepted: 06/03/2020] [Indexed: 11/19/2022] Open
Abstract
Morning glory disc anomaly (MGDA) characterizes a congenital dysgenetic disorder of the optic disc, coexisting with arterial intracranial abnormalities, including Moyamoya vascular disease, a significantly rare disease in the European populations. We report a 2.5-year-old female child from Greece previously diagnosed with MGDA, who presented with right-hand paresis, accompanied by focal epileptic spasms, followed by an episode of brief absence seizure, as well as some arm clonic spasms. Magnetic resonance angiography scan revealed the presence of an anomalous origin of the anterior cerebral artery (ACA) from the internal carotid artery (ICA) along with vascular abnormalities, compatible with Moyamoya pattern. To the very best of our knowledge, this is the first reported case of anomalous origin of ACA from the supraclinoid ICA accompanied by severe occlusive intracranial disease (moyamoya-like pattern) in a patient with known MGDA, highlighting the embryonic character of the vascular manifestations in MGDA. It also verifies the association of Moyamoya pattern with MGDA, thus linking vascular dysgenesis as a possible cause of MGDA.
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Affiliation(s)
- Aikaterini Solomou
- MRI Unit, Department of Radiology, University Hospital of Patras, Patras, Greece
| | | | - Georgios Vasilagkos
- MRI Unit, Department of Radiology, University Hospital of Patras, Patras, Greece
| | - Athanasios Vagionis
- MRI Unit, Department of Radiology, University Hospital of Patras, Patras, Greece
| | - Petros Zampakis
- MRI Unit, Department of Radiology, University Hospital of Patras, Patras, Greece
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