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Calandrelli R, Tuzza L, Romeo DM, Arpaia C, Colosimo C, Pilato F. Extremely Preterm Infants with a Near-total Absence of Cerebellum: Usefulness of Quantitative Magnetic Resonance in Predicting the Motor Outcome. CEREBELLUM (LONDON, ENGLAND) 2024; 23:981-992. [PMID: 37603264 DOI: 10.1007/s12311-023-01593-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 08/22/2023]
Abstract
This study aims to evaluate in extremely premature infants the severity of brain structural injury causing total absence or near-total absence of cerebellar hemispheres by using MRI visual and volumetric scoring systems. It also aims to assess the role of the score systems in predicting motor outcome. We developed qualitative and quantitative MRI scoring systems to grade the overall brain damage severity in 16 infants with total absence or near-total absence of cerebellar hemispheres. The qualitative scoring system assessed the severity of macrostructural abnormalities of cerebellum, brainstem, supratentorial gray and white matters, ventricles while the quantitative scoring system weighted the loss of brain tissue volumes, and gross motor function classification system (GMFCS) was used to assess motor function at 1- and 5-year follow-ups.Positive correlations between both MRI scores and GMFCS scales were detected at follow-ups (p > 0.05), but only the volumetric score could identify those infants developing higher levels of motor impairment.Brain volumetric MRI offers an unbiassed assessment of prenatal brain damage. The quantitative scoring system, performed at term equivalent age, can be a helpful tool for predicting the long-term motor outcome in extremely preterm infants with a near-total absence of cerebellum.
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Affiliation(s)
- Rosalinda Calandrelli
- Radiology and Neuroradiology Unit, Department of Imaging, Radiation Therapy and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 1, 00168, Rome, Italy.
| | - Laura Tuzza
- Radiology and Neuroradiology Unit, Department of Imaging, Radiation Therapy and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 1, 00168, Rome, Italy
| | - Domenico Marco Romeo
- Pediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy
- Pediatric Neurology Unit, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Chiara Arpaia
- Pediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy
- Pediatric Neurology Unit, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Cesare Colosimo
- Radiology and Neuroradiology Unit, Department of Imaging, Radiation Therapy and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 1, 00168, Rome, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fabio Pilato
- Research Unit of Neurology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, -00128, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, -00128, Rome, Italy
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Hajihashemi A, Geravandi M. Unilateral cerebellar hypoplasia in a 9-year-old child with chronic granulomatous disease: A case report. Radiol Case Rep 2023; 18:3908-3911. [PMID: 37663569 PMCID: PMC10473972 DOI: 10.1016/j.radcr.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/18/2023] [Accepted: 08/02/2023] [Indexed: 09/05/2023] Open
Abstract
Unilateral cerebellar hypoplasia is a rare neurological condition that affects the development of the cerebellum, causing symptoms like poor coordination, balance issues, tremors, and speech problems. Unilateral cerebellar hypoplasia can occur as an isolated finding or as part of a larger neurological disorder or hereditary disease. There have been rare recorded instances where patients with chronic granulomatosis disease have been found to have neurological symptoms, such as brain abscesses or persistent inflammation, even though that CGD primarily affects the immune system and causes recurrent infections. A 9-year-old male with a known diagnosis of CGD presented to our neurology outpatient department with complaints of frequent falls and speech abnormalities. His parents described suspicious seizure-like movements and poor scholarly performance. Neurologic examination showed ataxic gait, slurred speech, and right-sided plantar extensor reflex. Initial laboratory findings were normal. MRI revealed marked reduced volume of the left cerebellar hemisphere with intact vermis and asymmetry of the posterior fossa. The residual left cerebellar hemisphere showed a normal folia and gray-white matter differentiation pattern. CSF filled the space created by the left hypoplastic cerebellum. A diagnosis of unilateral cerebellar hypoplasia was made. There is no known direct association between chronic granulomatous disease and unilateral cerebellar hypoplasia. However, more research is required to discover whether there is any connection between them. Although it is possible for a child to have CGD and UCH, managing such cases requires a multidisciplinary approach involving neurologists, immunologists, and other specialists to provide appropriate care and treatment.
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Affiliation(s)
- Ali Hajihashemi
- Department of Radiology, Isfahan University of Medical Sciences, Hezar Jerib Ave, Isfahan, Iran
| | - Mahsa Geravandi
- Department of Radiology, Isfahan University of Medical Sciences, Hezar Jerib Ave, Isfahan, Iran
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Poretti A, Boltshauser E, Huisman TAGM. Prenatal Cerebellar Disruptions: Neuroimaging Spectrum of Findings in Correlation with Likely Mechanisms and Etiologies of Injury. Neuroimaging Clin N Am 2017; 26:359-72. [PMID: 27423799 DOI: 10.1016/j.nic.2016.03.006] [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: 11/26/2022]
Abstract
There is increasing evidence that the cerebellum is susceptible to prenatal infections and hemorrhages and that congenital morphologic anomalies of the cerebellum may be caused by disruptive (acquired) causes. Starting from the neuroimaging pattern, this report describes a spectrum of prenatal cerebellar disruptions including cerebellar agenesis, unilateral cerebellar hypoplasia, cerebellar cleft, global cerebellar hypoplasia, and vanishing cerebellum in Chiari type II malformation. The neuroimaging findings, possible causative disruptive events, and clinical features of each disruption are discussed. Recognition of cerebellar disruptions and their differentiation from cerebellar malformations is important in terms of diagnosis, prognosis, and genetic counselling.
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Affiliation(s)
- Andrea Poretti
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Charlotte R. Bloomberg Children's Center, The Johns Hopkins University School of Medicine, Sheikh Zayed Tower, Room 4174, 1800 Orleans Street, Baltimore, MD 21287-0842, USA; Department of Pediatric Neurology, University Children's Hospital, Steinwiesstrasse 75, Zurich 8032, Switzerland.
| | - Eugen Boltshauser
- Department of Pediatric Neurology, University Children's Hospital, Steinwiesstrasse 75, Zurich 8032, Switzerland
| | - Thierry A G M Huisman
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Charlotte R. Bloomberg Children's Center, The Johns Hopkins University School of Medicine, Sheikh Zayed Tower, Room 4174, 1800 Orleans Street, Baltimore, MD 21287-0842, USA
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McCollom D, Rashidian J. Prenatal Diagnosis of Unilateral Cerebellar Hypoplasia. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2016. [DOI: 10.1177/8756479303251089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Fetal cerebellar anomalies are rarely isolated or asymmetric. Cerebellar hypoplasia is frequently diagnosed by second trimester prenatal sonology. The prognosis for cerebellar hypoplasia is dismal when associated with a trisomy, spina bifida, or other anomalies such as Arnold-Chiari malformation. Presented is a case of unilateral cerebellar hypoplasia with apparently normal neurologic outcome. The fetal brain anatomy appeared normal at 24 weeks gestation. Unilateral cerebellar hypoplasia was diagnosed at 32 weeks demonstrating destruction of a normally formed fetal structure. The cause was unknown.
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Hayashi M, Poretti A, Gorra M, Farzin A, Graham EM, Huisman TAGM, Northington FJ. Prenatal cerebellar hemorrhage: fetal and postnatal neuroimaging findings and postnatal outcome. Pediatr Neurol 2015; 52:529-34. [PMID: 25724371 DOI: 10.1016/j.pediatrneurol.2015.01.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 01/20/2015] [Accepted: 01/22/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite significant progress in fetal neuroimaging techniques, only a few well-documented examples of prenatal cerebellar hemorrhages are available in the literature. In the majority of these individuals, the diagnosis of prenatal cerebellar hemorrhages led to termination of pregnancy or death occurred in utero; data about postnatal outcome of children with prenatal diagnosis of cerebellar hemorrhages are scant. We describe fetal and postnatal neuroimaging findings and the neurodevelopmental outcome of a child with a large cerebellar hemorrhage that occurred at approximately 27 weeks' gestation. METHOD Data about neurological features and neurodevelopmental outcome were collected from the clinical history and follow-up examination. All pre- and postnatal MRI data were qualitatively evaluated for infra- and supratentorial abnormalities. RESULTS Fetal MRI at 27 weeks' gestation showed a T1-hyperintense and T2-hypointense lesion within the cerebellum suggestive of bilateral cerebellar hemorrhages with extension into the adjacent subarachnoid, subdural, and intraventricular spaces. The prenatal cerebellar hemorrhage was possibly related to maternal sepsis. Postnatal MRI showed encephalomalacic changes involving the vermis and both cerebellar hemispheres. Neurodevelopmental follow-up at 15 months of age was concerning for global developmental delay and significant right esotropia. CONCLUSION This child illustrates (1) the role of prenatal neuroimaging in the diagnosis of fetal cerebellar hemorrhages, (2) the significance of cerebellar involvement for neurodevelopment, and (3) the importance of the collection of postnatal outcome data in children with prenatal diagnosis of cerebellar hemorrhage.
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Affiliation(s)
- Madoka Hayashi
- Division of Neonatology, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Neuro Intensive Care Nursery Group, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrea Poretti
- Neuro Intensive Care Nursery Group, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Azadeh Farzin
- Division of Neonatology, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Neuro Intensive Care Nursery Group, The Johns Hopkins University School of Medicine, Baltimore, Maryland; International Center for Maternal and Newborn Health, Department of International Health, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland
| | - Ernest M Graham
- Neuro Intensive Care Nursery Group, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Thierry A G M Huisman
- Neuro Intensive Care Nursery Group, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Frances J Northington
- Division of Neonatology, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Neuro Intensive Care Nursery Group, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Benbir G, Kara S, Yalcinkaya BC, Karlıkaya G, Tuysuz B, Kocer N, Yalcinkaya C. Unilateral Cerebellar Hypoplasia with Different Clinical Features. THE CEREBELLUM 2010; 10:49-60. [DOI: 10.1007/s12311-010-0225-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Poretti A, Limperopoulos C, Roulet-Perez E, Wolf NI, Rauscher C, Prayer D, Müller A, Weissert M, Kotzaeridou U, Du Plessis AJ, Huisman TAGM, Boltshauser E. Outcome of severe unilateral cerebellar hypoplasia. Dev Med Child Neurol 2010; 52:718-24. [PMID: 19863638 DOI: 10.1111/j.1469-8749.2009.03522.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM Complete or subtotal absence of one cerebellar hemisphere is exceptional; only single cases have been described. We aimed to assess the long-term outcome in children with severe unilateral cerebellar hypoplasia (UCH). METHOD As part of a retrospective study we describe neuroimaging features, clinical findings, and cognitive outcomes of seven children with UCH (five males, two females; age at first magnetic resonance imaging [MRI]: median 1y 3mo, range 9d-8y 10mo; age at latest follow-up: median 6y 6mo, range 2y 3mo-14y 11mo). RESULTS One child had abnormalities on prenatal MRI at 21 weeks' gestation. The left cerebellar hemisphere was affected in five children, and the right hemisphere in two children. The vermis was involved in five children. The volume of the posterior fossa was variable. At the latest follow-up, neurological findings included truncal ataxia and muscular hypotonia in five children, limb ataxia in three patients, and head nodding in two patients. Three children had learning disability*, five had speech and language disorders, and one had a severe behavioural disorder. INTERPRETATION Severe UCH is a residual change after a disruptive prenatal cerebellar insult, most likely haemorrhagic. The outcome is variable, ranging from almost normal development to marked developmental impairment. Ataxia is a frequent but not a leading sign. It seems that involvement of the cerebellar vermis is often, but not consistently, associated with a poorer cognitive outcome, whereas an intact vermis is associated with normal outcome and no truncal ataxia.
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Affiliation(s)
- Andrea Poretti
- Department of Neurology, University Children's Hospital of Zurich, Zurich, Switzerland
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Poretti A, Prayer D, Boltshauser E. Morphological spectrum of prenatal cerebellar disruptions. Eur J Paediatr Neurol 2009; 13:397-407. [PMID: 18945628 DOI: 10.1016/j.ejpn.2008.09.001] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2008] [Revised: 06/25/2008] [Accepted: 09/01/2008] [Indexed: 02/06/2023]
Abstract
There is increasing evidence that the cerebellum is susceptible to both prenatal infections and haemorrhages as well as being vulnerable in extremely preterm babies, but not to perinatal and postnatal hypoxic-ischaemic injuries. Starting with the imaging appearance we describe and illustrate a spectrum of prenatal cerebellar disruptions: cerebellar agenesis; unilateral cerebellar hypoplasia; unilateral cerebellar cleft; global cerebellar hypoplasia; vanishing cerebellum in myelomeningocele; and disruption of cerebellar development in preterm infants. We discuss neuroradiological characteristics, possible disruptive events, and clinical findings in the different morphological patterns. Remarkably, the same disruptive agent can cause different neuroradiological patterns, which appear likely to represent a morphological spectrum. The analysis of imaging patterns is crucial in recognising cerebellar disruptions. Recognition of cerebellar disruptions and their differentiation from cerebellar malformations is important in terms of diagnosis, prognosis, and genetic counselling.
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Affiliation(s)
- Andrea Poretti
- Department of Paediatric Neurology, University Children's Hospital of Zurich, Zurich, Switzerland
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Gocmen-Mas N, Pelin C, Canan S, Yazici AC, Zagyapan R, Senan S, Karabekir HS, Sahin B. Stereological evaluation of volumetric asymmetry in healthy human cerebellum. Surg Radiol Anat 2008; 31:177-81. [DOI: 10.1007/s00276-008-0424-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Accepted: 09/26/2008] [Indexed: 11/24/2022]
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Sherer DM, Sokolovski M, Dalloul M, Pezzullo JC, Osho JA, Abulafia O. Nomograms of the axial fetal cerebellar hemisphere circumference and area throughout gestation. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2007; 29:32-37. [PMID: 17171631 DOI: 10.1002/uog.3879] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE The widely applied transcerebellar diameter (TCD) obtained at axial cranial imaging, measures the distance between the lateral aspects of the cerebellum and incorporates the width of the cerebellar vermis. Our objective was to create reference ranges of axial fetal cerebellar hemisphere circumference (CHC) and area (CHA), independent of the cerebellar vermis, throughout gestation. METHODS This cross-sectional study involved pregnant patients between 14 and 41 weeks of gestation. Inclusion criteria consisted of well-established dates (confirmed by early ultrasound), non-anomalous singleton fetuses and intact amniotic membranes. Sonographic measurements included biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femur length (FL), humerus length (HL), TCD, and estimated fetal weight (EFW). Values of axial fetal CHC and CHA were each calculated as the mean of three separate measurements. The 5th, 50th and 95th centiles were estimated at each week of gestational age (GA) by least-squares regression for the mean and standard deviation (SD) of the CHC and CHA as functions of GA. r2 and associated P-values for the relationships of CHC and CHA with other sonographic biometric measurements were calculated. RESULTS The study included 651 consecutive patients. All attempts at obtaining axial fetal CHC and CHA were successful. Mean maternal age was 27.3+/-6.7 years, median gravidity was 1 (range 1-16), and median parity was 1 (range 0-6). Mean CHC (cm) throughout gestation was modeled as -2.091+0.2563xGA (weeks) (SD=-0.075+0.0164xGA), and mean CHA (cm2) was modeled as 0.245-0.0765xGA+0.00506xGA2 (SD=1.167-0.1565xGA+0.006785xGA(2)-0.00008028xGA3). Fetal axial CHC and CHA correlated significantly and strongly with BPD, HC, AC, HL, FL, TCD and EFW (all R2 values were >or=0.95, and all P-values were <0.001). CONCLUSION Nomograms of axial fetal cerebellar hemisphere circumference and area throughout gestation, independent of the cerebellar vermis, have been provided.
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Affiliation(s)
- D M Sherer
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Medical Center, Brooklyn, New York, USA
| | - M Sokolovski
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Medical Center, Brooklyn, New York, USA
| | - M Dalloul
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Medical Center, Brooklyn, New York, USA
| | - J C Pezzullo
- Department of Pharmacology, Georgetown University, Washington, DC, USA
| | - J A Osho
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Medical Center, Brooklyn, New York, USA
| | - O Abulafia
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Medical Center, Brooklyn, New York, USA
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Gupta P, Hedgire S, Kalyanpur T, Sr J, Madhavram B, Sekhar N, V I, Raja D, Mehta P, Cherian M. Isolated unilateral cerebellar hypoplasia. A case report. Neuroradiol J 2006; 19:606-8. [PMID: 24351262 DOI: 10.1177/197140090601900508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Accepted: 10/29/2006] [Indexed: 11/16/2022] Open
Abstract
Isolated cerebellar malformations are relatively rare CNS anomalies, when they do occur they are frequently symptomatic. Some cases of asymptomatic cerebellar malformations have been reported. Unilateral cerebellar hypoplasia is one such entity. We describe a case of unilateral cerebellar hypoplasia presenting with non-specific neurological complaints.
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Affiliation(s)
- P Gupta
- Kovai Medical Center and Hospital Coimbatore; Tamil Nadu, India -
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Boltshauser E. Cerebellum-small brain but large confusion: a review of selected cerebellar malformations and disruptions. Am J Med Genet A 2004; 126A:376-85. [PMID: 15098235 DOI: 10.1002/ajmg.a.20662] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Defining and classifying congenital disorders of the cerebellum can be difficult and confusing. One reason is that some abnormalities called "malformations" are not truly (primary) developmental malformations. This applies to Chiari I "malformations" as well as to Chiari II "malformations." The latter results mainly from a prenatal cerebrospinal fluid (CSF) leak. Also disruptive cerebellar lesions are not uncommon, examples being the "vanishing cerebellum" in myelomeningocele, cerebellar lesions in very low birth weight prematurely born infants, unilateral cerebellar hypoplasia/aplasia, and probably some instances of cerebellar agenesis (CA). The cerebellar hypoplasias consist of a heterogeneous group of inherited and prenatally acquired conditions. The concept of pontocerebellar hypoplasias will need to be expanded beyond the two main types (PCH-1 and PCH-2), and demonstrate that a classification system of cerebellar malformations cannot be based on neuroimaging criteria only. Additional studies are expected to show that this also applies to the molar tooth sign, which was initially described in Joubert syndrome (JS). The JS is the prototype of midhindbrain malformation, but its delineation is still unsolved. JS may well be an overdiagnosed entity; many cases likely not having JS are on record. Rhombencephalosynapsis (RS) has been increasingly diagnosed with the advent of neuroimaging. No familial cases have been observed. Although many affected individuals have variable impairments, RS can be found in children with normal cognitive function. In this review, some of the cerebellar anomalies are briefly discussed.
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Affiliation(s)
- Eugen Boltshauser
- Department of Pediatric Neurology, University Children's Hospital, Zurich, Switzerland.
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Chang CH, Chang FM, Yu CH, Ko HC, Chen HY. Assessment of fetal cerebellar volume using three-dimensional ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2000; 26:981-988. [PMID: 10996698 DOI: 10.1016/s0301-5629(00)00225-8] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The purposes of this study were to assess the fetal cerebellar volume during normal gestation using three-dimensional (3-D) ultrasound (US) and to establish a normal chart of fetal cerebellar volume using Altman's model of statistics. In total, 231 healthy fetuses were studied for assessment of cerebellar volume using a 3-D US volume scanner. The fetuses to be studied were selected to give a cross-sectional series (i.e., each fetus was examined only once). Polynomial regression analysis was calculated to find the best-fit model using gestational age as the independent variable and cerebellar volume as the dependent variable. Altman's model was used to calculate the age-related reference centiles for the variance of cerebellar volume. In addition, common fetal growth indices, such as biparietal diameter, occipitofrontal diameter, head circumference, abdominal circumference, femur length and estimated fetal weight, were also measured for the correlation between cerebellar volume and these indices. Our results indicated that the fetal cerebellar volume was highly correlated with gestational age in normal pregnancies with the best-fit polynomial regression equation of a second-order (r = 0.91, p < 0.0001). In addition, fetal cerebellar volume in normal gestation is also highly correlated with common fetal growth indices, such as biparietal diameter, occipitofrontal diameter, head circumference, abdominal circumference, femur length and estimated fetal weight (all p < 0.0001). Following the Altman's model, a normal growth chart of fetal cerebellar volume was established for clinical reference. In conclusion, with 3-D US, the assessment of fetal cerebellar volume becomes feasible. We believe that fetal cerebellar volume assessed by 3-D US may be useful in detecting cerebellar hypoplasia and relevant syndromes prenatally.
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Affiliation(s)
- C H Chang
- Department of Obstetrics and Gynecology, National Cheng Kung University Medical College, Tainan, Taiwan
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Chang CH, Chang FM, Yu CH, Ko HC, Chen HY. Three-dimensional ultrasound in the assessment of fetal cerebellar transverse and antero-posterior diameters. ULTRASOUND IN MEDICINE & BIOLOGY 2000; 26:175-182. [PMID: 10722905 DOI: 10.1016/s0301-5629(99)00123-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Fetal cerebellum scanning by prenatal ultrasound (US) is very important for early detection of fetal central-nervous-system anomaly, as well as for the determination of gestational age (GA). Due to the small organ size and the unique shape of the fetal cerebellum (CL), accurate measurement of the dimensions of CL by two-dimensional (2-D) US is not easy if the appropriate plane cannot be reached. With the advent of three-dimensional (3-D) US, the disadvantages of 2-D US in assessing the fetal CL dimensions can be avoided. The purpose of this study was to assess the fetal cerebellar transverse diameter (CTD) and cerebellar antero-posterior diameter (CAD) using 3-D US. First, we compared the reproducibility of 2-D and 3-D US on the assessment of fetal cerebellar dimensions. Second, we prospectively measured CTD and CAD in 223 healthy fetuses using a cross-sectional design with an attempt to establish the normal growth charts of fetal CL. Our results showed 3-D US is superior to 2-D US in the reproducibility test of fetal cerebellar dimensions. In addition, with GA as the dependent variable, polynomial regression analysis showed that the best-fit equations for both CTD vs. GA and CAD vs. GA were the first-order. The best-fit predictive equation of GA by CTD was GA (week) = 9.0281 + 0. 58533 x CTD (mm) (r = 0.95, n = 223, SE = 1.82 weeks, p < 0.0001), and the best-fit predictive equation of GA by CAD was GA (week) = 10. 855 + 1.1672 x CAD (mm) (r = 0.82, n = 223, SE = 3.41 weeks, p < 0. 0001). Furthermore, all the correlation coefficients of CTD or CAD vs. the common fetal growth indexes were also highly significant (all p < 0.0001). In conclusion, our data of fetal CL dimensions assessed by 3-D US may serve as a useful reference in assessing fetal CL growth, dating GA or detecting fetal CL anomalies.
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Affiliation(s)
- C H Chang
- Department of Obstetrics and Gynecology, National Cheng Kung University Medical College, Tainan, Taiwan
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