Morning glory syndrome in children. Association with endocrine and central nervous system anomalies

Morning Glory Syndrome in a Newborn Aged 2 Weeks

This case report describes a diagnosis of morning glory syndrome in a 2-week-old infant who presented with divergent strabismus, cleft lip, and hypertelorism.

Morning Glory Disc Anomaly with Contractile Peripapillary Staphyloma in an 18-Month-Old Girl

We present an 18-month-old girl with strabismus and a variable esotropia of the left eye. Fixation of the affected eye was intermittent with a relative afferent pupillary defect. A fundus photography of the left eye displayed a combination of features of both morning glory disc anomaly and peripapillary staphyloma. A B-scan ultrasonography examination of the left eye showed a conical excavation of the posterior pole. Cycloplegic refraction measurements showed a large amount of anisometropia. Correction with glasses and part-time occlusion was prescribed and a strict follow-up routine was advised. No other systemic associations with the disease have been discovered so far in our patient. We support the theory that morning glory disc anomaly and peripapillary staphyloma may represent two different morphologies in the spectrum of the same disease.

Morning glory disc anomaly-associated maculopathy: multimodal imaging

Morning glory disc anomaly (MGDA) is most commonly found in white females in childhood with reduced vision. One in two cases have been reported to develop maculopathy or posterior pole retinal detachment as they grow older. The pathophysiology of MGDA-associated maculopathy is not well understood.We describe a 31-year-old black woman, who presented with gradual reduction of vision in the right eye due to MGDA-associated maculopathy. We identified morphological characteristics of the optic disc and macula with multicolour and optical coherence tomography imaging.We speculate that the centripetal inner retina traction and cerebrospinal fluid pressure fluctuation play an important role in inner retinal fluid accumulation in the pathology of retinoschisis in MGDA. Further studies will shed some light of a potential cause-and-effect relationship between MGDA and retinoschisis.

Contractile morning glory disk anomaly: analysis of the cyclic contractions and literature review

PURPOSE

To investigate the contraction mechanism of morning glory disk anomaly using computer-assisted analysis of the cyclic contractions frame by frame and to review the literature on contractile morning glory disk anomaly cases.

METHODS

The fundus video of the patient under anesthesia was recorded using RetCam C300 lens. Frames at 1 second intervals were extracted to quality-preserving TIFF images and manually selected areas of cup, disk, and pigmented ring were measured with image analysis software. Measurements were repeated twice, and estimated uncertainties were calculated.

RESULTS

Two full-contraction phases and 1 half- and 1 full-dilation phase were recorded and analyzed. At the end of the second dilation phase, cup, disk, and pigmented ring were dilated to 93.7%, 97.6%, and 98.3% of their areas after first dilation. At the end of the second contraction cup, disk and pigmented ring areas remained 1.24, 1.01, and 1.01 times larger, respectively, than the areas at the end of the first contraction.

CONCLUSIONS

Ectopic cholinergic muscle contraction alone is unlikely to explain the cyclic contraction dilation movements under constant stimulus. Potentially present smooth muscle cells can be provoked by the stretch caused by the influx of fluid into the subretinal space. Change in spatial configuration and oscillations with decreasing magnitudes can be explained by decreasing contractions due to decreasing stretch with decreasing fluid influx in each cycle after the initial triggering of outside pressure, causing the greatest pressure gradient and the greatest fluid influx.

Congenital anomalies of the optic disc: insights from optical coherence tomography imaging

PURPOSE OF REVIEW

Congenital anomalies of the optic nerve are rare but significant causes of visual dysfunction in children and adults. Accurate diagnosis is dependent on a thorough funduscopic examination, but can be enhanced by imaging information garnered from optical coherence tomography (OCT). We review common congenital optic nerve anomalies, including optic disc pit, optic nerve coloboma, morning glory disc anomaly, and hypoplasia of the optic nerve, review their systemic associations, and discuss insights from OCT imaging.

RECENT FINDINGS

Optic disc pits are a result of a defect in the lamina cribrosa and abnormal vitreomacular adhesions have been shown to cause maculopathy. In patients with optic nerve colobomas, OCT can be instrumental in diagnosing choroidal neovascularization, a rare but visually devastating complication. The pathogenesis of morning glory disc anomaly has been more clearly elucidated by OCT as occurring from a secondary postnatal mesenchymal abnormality rather than only the initial neuroectodermal dysgenesis of the terminal optic stalk in isolation. OCT studies of optic nerve hypoplasia have demonstrated significant thinning of the inner and outer retinal layers of the perifoveal region and thicker layers in the fovea itself, resulting in a foveal hypoplasia-like pathology, that is, significantly correlated to poorer visual outcomes.

SUMMARY

OCT provides detailed in-vivo analysis of these anatomic anomalies and their resulting pathologies, shedding new insights on the pathogenesis, diagnosis, and potential visual outcomes of these conditions in children. Further study employing OCT to elucidate structure-function relationships of congenital optic nerve anomalies will help expand the role of OCT in clinical practice related to diagnosis, prognosis, and management of these entities.

Rare bilateral presentation of morning glory disc anomaly

A 4-year-old girl presented with a history of poor vision and oscillation of both eyes since infancy. Ocular examination revealed the best corrected visual acuity of 2/60 in right eye and 3/60 in left eye. Horizontal pendular nystagmus was present in both eyes. Fundus examination revealed morning glory disc anomaly (MGDA) bilaterally. Radiographic imaging of the brain revealed central nervous system anomalies. The guarded visual prognosis was explained and the patient referred for low vision rehabilitation and advised yearly follow-up. MGDA is very rarely bilateral. We aim to highlight the distinguishing features of bilateral MGDA from other excavated optic nerve head anomalies which could also present bilaterally but vary in their associations, management and prognosis.

Morning Glory Syndrome with Carotid and Middle Cerebral Artery Vasculopathy

PURPOSE

To report a case of incidental asymptomatic atypical morning glory syndrome (MGS) with concomitant ipsilateral carotid and middle cerebral dysgenesis.

CASE REPORT

A 6-year-old child was discovered to have incidental findings of MGS, with atypia. All visual functions were normal including vision and stereopsis. Neuroimaging revealed ipsilateral carotid and middle cerebral vascular narrowing without associated collateral vessels or cerebral ischemia commonly seen in Moyamoya disease. Subsequent annual examinations have been stable, without signs of progression.

CONCLUSIONS

This case demonstrates disparity between structural aberrations and final visual and neurological function and reinforces the association between MGS and intracranial vascular disruption. Full ancillary ophthalmic and neuroimaging studies should be performed in all patients with MGS with interval reassessments, even when the patient is asymptomatic and functionally intact.

Morning glory disc anomaly in childhood - a population-based study

PURPOSE

To report prevalence, ocular characteristics and coexisting neurological, behavioural, somatic and neuroradiological abnormalities in children and adolescents with morning glory disc anomaly (MGDA).

METHODS

In a cross-sectional population-based study, 12 patients with MGDA, aged 2-20 years, were identified. All 12 agreed to ophthalmological assessments including visual functions, refraction, fundus photography, optical coherence tomography (OCT) and ocular motor score (OMS). Neurological examinations and behavioural/developmental screening were carried out. Data from previous or new neuroradiological investigations were collected.

RESULTS

The prevalence of MGDA was 2.6/100 000. MGDA was unilateral in 11/12 patients with a best-corrected visual acuity (BCVA) in the MGDA eye ranging from hand motion to 0.65 (median 0.06). Severe microphthalmus prevented unilaterality to be determined in one adolescent. All patients had a binocular BCVA of ≥0.5. OMS showed abnormalities in pupil response, vestibulo-ocular reflex, stereo visual acuity, strabismus and convergence. OCT revealed peripapillary or macular oedema in 5/8 patients and foveal aplasia in 3/8 patients. Three patients had extensive capillary hemangiomas, of which one had PHACES syndrome and one had additional cerebrovascular anomalies and corpus callosum agenesis. Neuroradiology showed craniovascular anomalies in two patients. Neurology was mostly normal. Behavioural/developmental screening showed attention deficit hyperactivity disorder in one patient.

CONCLUSIONS

The prevalence data, previously not reported, of morning glory disc anomaly was 2.6/100 000. Coexisting retinal peripapillary or macular oedema was common, as were cerebral abnormalities and/or cutaneous vascular malformations. The associated findings may not be discovered through routine ophthalmological examination why OCT and neuroimaging are called for.

Systemic abnormalities in children with congenital optic disc excavations

PURPOSE

Together with optic disc hypoplasia, excavated optic disc anomalies represent the most frequent congenital abnormality involving the optic nerve head. The purpose of the present study was to retrospectively review the results of a screening for extraocular abnormalities in children presenting with congenital optic disc excavations.

MATERIALS AND METHODS

The medical records of 37 patients diagnosed with a unilateral or bilateral non glaucomatous optic disc excavation were retrospectively reviewed to analyze the result of the extra ocular evaluation and to report the associated ocular abnormalities.

RESULTS

An ocular abnormality was observed in conjunction with the excavated optic disc in 31% of the eyes. The systematic investigations revealed the presence of at least one extra-ocular disorder in 48% of the cases, and the optic disc excavation could be considered as syndromic in 30% of patients. The prevalence of extraocular malformations was significantly higher in infants presenting with associated ocular malformations or abnormal vision/development.

CONCLUSIONS

The present study suggests that a systematic approach to search for any associated systemic abnormalities could be envisioned in patients presenting with congenital excavated optic discs, and particularly those presenting with abnormal vision, associated ocular defects or abnormal development.

Evaluation of congenital excavated optic disc anomalies with spectral-domain and swept-source optical coherence tomography

PURPOSE

To investigate the anatomic characteristics of congenital excavated optic disc anomalies by using fundus photography, spectral-domain optical coherence tomography (SD-OCT), and swept-source optical coherence tomography (SS-OCT).

METHODS

Fourteen eyes from 13 patients with congenital excavated optic disc anomalies underwent a complete ophthalmologic examination that included best-corrected visual acuity evaluation, fundus photography, and SD-OCT. SS-OCT was performed in cases of peripapillary staphyloma cases in which the excavation depth could not be detected with SD-OCT. On the basis of the funduscopic and OCT findings, patients were classified as morning glory syndrome, optic disc coloboma, or peripapillary staphyloma.

RESULTS

Seven eyes with morning glory syndrome were characterized by the presence of the preretinal tractional membrane in front of the excavated optic disc and could be divided into two groups: three eyes without retinal excavation, and four eyes with retinal excavation. Four eyes with optic disc coloboma showed inferiorly decentered scleral excavations with shallow optic disc excavation detectable by SD-OCT. Three eyes with peripapillary staphyloma showed deep excavation, the depth of which could not be detected by SD-OCT. SS-OCT and enhanced depth imaging SD-OCT images focused on the bottom revealed membranous structure at the bottom of the excavation in two cases with peripapillary staphyloma.

CONCLUSIONS

SD-OCT and SS-OCT are helpful for differential diagnosis of excavated optic disc anomalies. Morning glory syndrome, optic disc coloboma, and peripapillary staphyloma were respectively characterized by the presence of a preretinal tractional membrane, inferiorly decentered excavation, and an excavation deeper than that observed in morning glory syndrome and optic disc coloboma.

Unilateral morning glory optic disc anomaly in a case with Down syndrome

BACKGROUND

This case is unique because it is the first reported case of Down syndrome with morning glory optic disc anomaly in literature.

CASE PRESENTATION

A 15-year-old girl with features of Down syndrome presented to the Clinic of Ophthalmology for a regular ophthalmologic examination. Her best corrected visual acuity was 20/50 in the right eye and 20/20 in the left eye. The fundus examination revealed findings compatible with unilateral morning glory optic disc anomaly in the right eye. The patient underwent a complete ophthalmologic and systemic evaluation to explore possible associated findings.

CONCLUSION

This case report emphasizes the importance of ophthalmic screening-examinations in Down children to rule out any vision relevant pathology.

Morning glory disc anomaly: characteristic MR imaging findings

SUMMARY

Establishing the diagnosis of morning glory disc anomaly is crucial to appropriate patient treatment. Although typically made clinically, the diagnosis is not always straightforward, especially in circumstances where physical examination is limited. The goal of this study was to define the spectrum and frequency of orbital findings in a series of patients with funduscopically-confirmed morning glory disc anomaly by using MR imaging. MR imaging demonstrated 3 findings in all patients: 1) funnel-shaped morphologic pattern of the posterior optic disc with elevation of the adjacent retinal surface; 2) abnormal tissue associated with the distal intraorbital segment of the ipsilateral optic nerve, with effacement of the regional subarachnoid spaces; and 3) discontinuity of the uveoscleral coat. These findings were not observed in any of the unaffected globes of the study patients. In summary, these consistent and characteristic findings of morning glory disc anomaly should allow for accurate differentiation from other ocular anomalies and have the potential to guide appropriate management of this patient population.

Evaluation of morning glory syndrome with spectral optical coherence tomography and echography

PURPOSE

To evaluate eyes affected by morning glory syndrome (MGS) with spectral-domain optical coherence tomography (SD OCT) and echography.

DESIGN

Prospective case series.

PARTICIPANTS

Nineteen patients (22 eyes) with MGS observed at the Eye Department, University of Naples Federico II, Naples, Italy.

METHODS

All patients underwent a complete ophthalmologic examination that included best-correct visual acuity, fundus photography, and echography. Nine patients underwent SD OCT and high-frequency B-scan echography (20 MHz).

MAIN OUTCOME MEASURES

Spectral-domain optical coherence tomography and echographic findings in MGS.

RESULTS

Spectral-domain optical coherence tomography revealed retinal detachment in the conus area of 5 eyes: 4 with noncontractile MGS (NCMGS) and 1 with contractile MGS (CMGS). There was evidence of a retinal break in only 2 cases. All 5 eyes had an abnormal communication between the subarachnoid space and the subretinal space. Spectral-domain optical coherence tomography did not reveal differences between CMGS and NCMGS. Echographic examination did not reveal any anatomic abnormalities of the optic nerve or orbit.

CONCLUSIONS

Spectral-domain optical coherence tomography provides more information than echography about the posterior pole, whereas echographic examination is the only technique that can confirm the anatomic integrity of the optic nerve in the orbital wall. Retinal detachment in MGS generally is ascribed to abnormal communication between the subretinal and subarachnoid or vitreous compartments. These data suggest that myopialike retinal detachment without a retinal break may result from tissue stretching around the peripapillary conus.

Morning glory syndrome associated with posterior lenticonus

The clinical features of the morning glory syndrome (MSG) are demonstrated in a 12-year-old male patient with the posterior lenticonus in the left eye. This patient had retinal detachment in the left eye. A complete ocular examination was performed and the patient underwent a pars plana vitrectomy of the left eye. Slit-lamp examination revealed the posterior lenticonus with the posterior subcapsular opacities in the left eye. The fundus showed the symptoms of MGS. The discs were pink and deeply excavated, surrounded by a ring of chorioretinal pigmentary disturbance. The retina has remained reattached for six months after surgery. Although most cases of MGS present with retinal and vitrea abnormalities, it may also occur in association with the lens anomalies, including the posterior lenticonus and subcapsular cataract. This association may be helpful to explore the pathogenesis of MGS.

Midline craniofacial defects and morning glory disc anomaly. A distinct clinical entity

A case with a severe midline craniofacial defect, comprising a midline cleft lip and palate with a sphenoethmoidal encephalocele, hypertelorism, bilateral dysplastic optic discs and agenesis of the corpus callosum is described. The optic discs are consistent with the spectrum of appearances seen in the Morning Glory Disc Anomaly (MGDA). This anomaly is usually a uniocular problem that may be rarely associated with craniofacial abnormalities. Despite this range of abnormalities this child was developing well with a specific motor delay at the age of eight months. Cases with similar midline craniofacial abnormalities from the literature are reviewed. This condition appears to be a distinct entity within the spectrum of frontonasal dysplasia.

Update on the morning glory disc anomaly

The morning glory disc anomaly has distinctive clinical characteristics and is important to diagnose correctly so that associated central nervous system and vascular abnormalities are promptly identified and treated. This review covers the ophthalmic findings, clinical features, and histopathologic findings in patients with this rare developmental abnormality. The most common systemic associations are described and reviewed.

Basal encephalocele associated with morning glory syndrome: case report

The basal encephaloceles refer to rare entities and they correspond to herniation of brain tissue through defects of skull along the cribiform plate or the sphenoid bone. A rare morning glory syndrome, with characteristic retinal defect has been reported in association with basal encephaloceles. Hypophysis hormonal deficiencies may occur. We accounted for a pituitary dwarfism with delayed diagnosed transsphenoidal encephalocele associated with morning glory syndrome, showing the alterations found in retinography, computed tomography and magnetic resonance imaging.

[Rehabilitation on functional amblyopia in Morning Glory Syndrome]

INTRODUCTION

Morning Glory syndrome, characterized by an enlarged dysplasic optic disc with glial tissue, is one of the congenital anomalies of the optic nerve. This syndrome is rare, prevalent in the girls, and generally unilateral. It can be revealed with nystagmus, strabismus, or amblyopia.

OBSERVATION

We report the clinical observation of a 2.5-year-old girl, referred for the diagnosis of Morning Glory syndrome in the left eye with severe amblyopia (1/10 Rossano 1/20) and esotropia. This syndrome has associated central nervous system anomalies with a basal encephalocele. Treated with functional amblyopia therapy, visual acuity was 7/10 Rossano 1/2 after 1 year.

DISCUSSION

Rehabilitation on functional amblyopia in organic optic nerve anomalies is essential. A child with a Morning Glory syndrome, detected during the period of sensory maturation, must be treated with occlusion therapy, followed by maintenance treatment. This part of the treatment can prevent deep amblyopia. Moreover, regular ophthalmologic follow-up to detect complications of retinal detachment and multidisciplinary follow-up to detect a cytogenetic disease, CHARGE syndrome, or association with endocrine and central nervous system anomalies are necessary.

CONCLUSION

The author recommends occlusion therapy for children with Morning Glory syndrome or other organic asymmetric optic nerve anomalies, during the period of amblyopia reversibility. Most patients' vision improves after treatment. This case is an illustration.

[Morning glory disc anomaly und frontonasal dysplasia]

Morning glory disc anomaly (MGDA) is a rare congenital malformation of the optic disc, which can be associated with midline craniofacial abnormalities, such as basal encephalocele. A female neonate presented with MGDA in the right eye, pendular nystagmus, hypertelorism, a flattened nasal root and cleft lip and palate. MRI revealed a basal encephalocele, agenesis of the corpus callosum and ventricular enlargement. MGDA combined with midline facial clefting should always lead to the suspicion of a basal encephalocele.

Intracranial vascular anomalies in patients with morning glory disk anomaly

PURPOSE

An association between morning glory disk anomaly (MGDA) and intracranial vascular anomalies including Moyamoya disease has been recognized. We evaluated a series of patients with MGDA to ascertain the frequency of cerebrovascular anomalies.

DESIGN

Retrospective observational case series.

METHODS

We reviewed the neurologic histories and neuroimaging studies of twenty patients with MGDA at two institutions between 1982 and 2004. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) of the brain was performed on all patients who had not undergone neuroimaging. MRI/MRA studies done for 40 pediatric patients without MGDA were also evaluated for cerebrovascular anomalies. The prevalence of anomalies in the two groups was compared by Fisher exact test.

RESULTS

Nine of 20 patients (45%) with MGDA had cerebrovascular anomalies. Anomalies ranged from agenesis of the A1 segment of the anterior cerebral artery to bilateral stenosis of the internal carotid arteries with moyamoya disease. Three patients underwent revascularization procedures. Ten of 40 patients (25%) in the control group had any intracranial vascular anomaly, whereas only two of 40 (5%) had an abnormality of the anterior circulation, the most common finding in the MGDA group.

CONCLUSION

We recommend that all patients with MGDA undergo MRI/MRA or computerized tomographic angiography to detect vascular and structural brain anomalies. It may be unclear whether cerebrovascular anomalies represent isolated congenital anomalies or findings of progressive occlusive cerebrovascular disease. Follow-up imaging should be considered in patients with cerebrovascular anomalies and is clearly indicated if neurologic signs or symptoms are present.

Morning glory syndrome: clinical, computerized tomographic, and ultrasonographic findings

OBJECTIVE

To evaluate the ophthalmic, radiologic, and ultrasonographic findings in morning glory syndrome.

PATIENTS AND METHODS

Retrospective review of patients' charts.

RESULTS

Twenty-one patients were included. Visual acuity was 20/200 or better in 50% of the eyes. Three eyes developed a retinal detachment. When computerized tomography of the orbit demonstrated peripapillary scleral staphyloma and intraocular calcifications, this correlated with poor visual acuity. Computerized tomography of the brain revealed abnormalities in three asymptomatic patients. B-scan ultrasonography demonstrated retinal tissue overhanging the peripapillary scleral staphyloma.

CONCLUSIONS

Morning glory syndrome has a spectrum of severity, with most patients retaining useful vision. Orbital and cerebral computerized tomography scan as well as B-scan ultrasonography may help with diagnosis and management.

Congenital disorders of the optic nerve: excavations and hypoplasia

The principal congenital abnormalities of the optic disc that can significantly impair visual function are excavation of the optic disc and optic nerve hypoplasia. The excavated optic disc abnormalities comprise optic disc coloboma, morning glory syndrome, and peripapillary staphyloma. Optic nerve hypoplasia manifests as a small optic nerve, which may or may not be accompanied by a peripapillary ring (the double ring sign). In addition, the optic disc cupping, which occurs as a sequel to some cases of periventricular leucomalacia, can arguably be classified as a type of optic nerve hypoplasia. All of these conditions can be unilateral or bilateral and can impair visual function mildly or severely. It is essential that children with poor vision due to any of these conditions are managed by treating refractive errors, giving occlusion therapy in selected cases, and optimising the conditions at home and at school in an attempt to ensure that impaired vision does not impede development or education.

Morning glory syndrome associated with posterior pituitary ectopia and hypopituitarism

PURPOSE

To report a patient with morning glory syndrome in combination with posterior pituitary ectopia and to emphasize the need for early recognition of this syndrome as an important step towards the diagnosis and treatment of the systemic anomalies that may be associated with it.

METHODS

We present a 7-year-old boy who showed short stature, nystagmus, inward deviation and low vision. Ophthalmological and general physical examinations, further endocrine evaluation and magnetic resonance imaging (MRI) of the brain and sella turcica were performed.

RESULTS

Both fundi showed symptoms of morning glory syndrome. The discs were pink and deeply excavated, and were surrounded by a ring of chorioretinal pigmentary disturbance. Magnetic resonance imaging revealed the absence of the infundibulum and posterior pituitary ectopia. Growth hormone studies confirmed the diagnosis of growth hormone deficiency. Therapy with recombinant human growth hormone was initiated.

CONCLUSIONS

Although most cases of morning glory syndrome occur as isolated ocular abnormalities, it may occur in association with systemic anomalies, including posterior pituitary ectopia and hypopituitarism. A complete general physical examination and growth evaluation is important for early detection and treatment, resulting in benefit for these patients.

Ocular colobomata

Ocular colobomata present diagnostic and therapeutic challenges in patients of all ages, but especially in young children. The "typical" coloboma, caused by defective closure of the fetal fissure, is located in the inferonasal quadrant, and it may affect any part of the globe traversed by the fissure from the iris to the optic nerve. Ocular colobomata are often associated with microphthalmia, and they may be idiopathic or associated with various syndromes. Types and severity of complications vary depending on the location and size of the colobomata. This article reviews the pathogeneses, categorization, genetic bases, differential diagnoses and management of ocular coloboma.

Morning Glory syndrome. MR imaging

We present two cases of the Morning Glory Syndrome (MGS), with the most detailed MR images to date of this rare congenital optic nerve dysplasia. Though the embryology of this syndrome remains controversial, we feel the MR appearance can be diagnostic of the non-familial syndrome and be reliably distinguished from the similar appearing optic disc coloboma, which may be genetically inherited. MR imaging also allows the most sensitive detection and characterization of any associated intracranial anomalies, thus enabling more accurate determination of prognosis for the patient and their family.

Optic disc anomalies and frontonasal dysplasia

AIMS

To document the optic disc abnormalities in patients with frontonasal dysplasia in association with basal encephalocele.

METHODS

Names and hospital numbers of patients with midline clefts were obtained from the ophthalmology and genetics database. Six patients were identified who had the following common findings: midline facial cleft with midline cleft lip and palate; hypertelorism; absent corpus callosum; basal (sphenoethmoidal) encephalocele; and pituitary deficiency (five out of six cases). Ophthalmic examination was performed with fundal photography where possible.

RESULTS

Two patients had unilateral and one a bilateral peripapillary staphyloma. Two patients had bilateral optic disc hypoplasia and one appeared to have a peripapillary staphyloma in one eye and a morning glory disc in the other.

CONCLUSION

Optic disc abnormalities were found in all patients with this constellation of clinical findings. This association appears to represent a distinct subgroup within the spectrum of frontonasal dysplasia. The presence of midline facial anomalies and any dysplastic disc should alert the physician as to the presence of an encephalocele.

Congenital optic disk anomalies

Over the past decade, a wealth of information has accumulated pertaining to the diagnosis and management of patients with congenital optic disk anomalies. As new examples of each entity have been detailed, the diagnostic criteria for each anomaly have become more clearly defined. The advent of sophisticated noninvasive neuroimaging techniques has further refined our ability to accurately detect and categorize the associated CNS anomalies that complicate many of these conditions. In light of recent findings, this review will critically examine many of the well-entrenched concepts pertaining to the diagnosis, evaluation, and treatment of patients with congenital optic disk anomalies. In so doing, it will attempt to dispel some longstanding misconceptions that pervade the literature and obscure our understanding of the pathogenesis, neuroradiological associations, and systemic implications of each anomaly.