1
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Fujimoto Y, Takikawa K, Takeshita Y. Surgical Treatment of Chondrodysplasia Punctata Tibial-Metacarpal Type Until Skeletal Maturity: A Case Report. JBJS Case Connect 2022; 12:01709767-202212000-00013. [PMID: 36820636 DOI: 10.2106/jbjs.cc.22.00332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/14/2022] [Indexed: 02/24/2023]
Abstract
CASE An infant boy with chondrodysplasia punctata tibial-metacarpal type (CDP-TM) was followed up till skeletal maturity. The patient underwent surgeries for bilateral patellar dislocations at the age of 9 years of age, left leg length discrepancy at 12 years, and atlantoaxial subluxation at 14 years. At the final follow-up at 18 years, he had no complaints or limitation of his daily life activities. CONCLUSION CDP-TM may require multiple orthopedic surgeries such as patellofemoral instability, limb length discrepancy, and upper cervical dysplasia until skeletal maturity, and should be followed in order to identify them early.
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Affiliation(s)
- Yoh Fujimoto
- Department of Pediatric Orthopedics, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Kazuharu Takikawa
- Department of Pediatric Orthopedics, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Yujiro Takeshita
- Department of Orthopaedic Surgery, Yokohama Rosai Hospital, Kanagawa, Japan
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2
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Zhang L, Hu H, Liang D, Li Z, Wu L. Prenatal Diagnosis in a Fetus With X-Linked Recessive Chondrodysplasia Punctata: Identification and Functional Study of a Novel Missense Mutation in ARSE. Front Genet 2021; 12:722694. [PMID: 34630518 PMCID: PMC8498588 DOI: 10.3389/fgene.2021.722694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/17/2021] [Indexed: 11/13/2022] Open
Abstract
X-Linked recessive chondrodysplasia punctata (CDPX1) is a rare skeletal dysplasia characterized by stippled epiphyses, brachytelephalangy, and nasomaxillary hypoplasia. CDPX1 is caused by function loss of arylsulfatase E (ARSE, also known as ARSL). Pathogenic mutations in ARSE are responsible for CDPX1 in newborns or adults; however, studies have not fully explored prenatal cases. In the current study, a novel missense mutation (c.265A > G) in ARSE was identified in a fetus with short limbs using whole-exome sequencing (WES). Bioinformatic analysis showed that the variant was pathogenic, and RT-qPCR, Western blot, and enzymatic assays were performed to further explore pathogenicity of the variant. The findings showed that the variant decreased transcription and protein expression levels and led to loss of enzymatic activity of the protein. The novel mutation c.265A > G in ARSE was thus the genetic cause for the phenotype presented by the fetus. The current study presents a prenatal case in Chinese population using functional analysis of ARSE, which helps the family to predict recurrence risks for future pregnancies and provides more information for understanding this rare condition. The findings show that WES is a feasible method for prenatal diagnosis of fetuses with CDPX1.
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Affiliation(s)
- Li Zhang
- Center for Medical Genetics, Hunan Key Laboratory of Medical Genetics, Hunan Key Laboratory of Animal Models for Human Diseases, School of Life Sciences, Central South University, Changsha, China
| | - Haoran Hu
- Center for Medical Genetics, Hunan Key Laboratory of Medical Genetics, Hunan Key Laboratory of Animal Models for Human Diseases, School of Life Sciences, Central South University, Changsha, China
| | - Desheng Liang
- Center for Medical Genetics, Hunan Key Laboratory of Medical Genetics, Hunan Key Laboratory of Animal Models for Human Diseases, School of Life Sciences, Central South University, Changsha, China.,Hunan Jiahui Genetics Hospital, Changsha, China
| | - Zhuo Li
- Center for Medical Genetics, Hunan Key Laboratory of Medical Genetics, Hunan Key Laboratory of Animal Models for Human Diseases, School of Life Sciences, Central South University, Changsha, China
| | - Lingqian Wu
- Center for Medical Genetics, Hunan Key Laboratory of Medical Genetics, Hunan Key Laboratory of Animal Models for Human Diseases, School of Life Sciences, Central South University, Changsha, China.,Hunan Jiahui Genetics Hospital, Changsha, China
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3
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Garel C, Vande Perre S, Guilbaud L, Soupre V, Blondiaux E, Ducou le Pointe H. Contribution of computed tomography and magnetic resonance imaging in the analysis of fetal craniofacial malformations. Pediatr Radiol 2021; 51:1917-1928. [PMID: 33852025 DOI: 10.1007/s00247-021-05033-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/15/2020] [Accepted: 02/21/2021] [Indexed: 11/26/2022]
Abstract
A wide range of craniofacial malformations can be diagnosed in utero using ultrasonography. However, even with highly experienced sonographers and diagnostic physicians and optimal conditions of examination, some anatomical structures cannot be properly analyzed by this technique. The aim of this pictorial essay is to show the additional value of fetal magnetic resonance imaging and computed tomography in this setting and to illustrate the role of these modalities in facial clefts; craniosynostosis; ear, eye and nose abnormalities; otomandibular dysplasias; and facial cephaloceles.
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Affiliation(s)
- Catherine Garel
- Service de Radiologie, Hôpital d´Enfants Armand-Trousseau APHP, 26 Avenue du Dr Arnold Netter, 75012, Paris, France.
| | - Saskia Vande Perre
- Service de Radiologie, Hôpital d´Enfants Armand-Trousseau APHP, 26 Avenue du Dr Arnold Netter, 75012, Paris, France
| | - Lucie Guilbaud
- Service de Médecine Fœtale, Hôpital d´Enfants Armand-Trousseau APHP, Sorbonne Université, Paris, France
| | - Véronique Soupre
- Service de Chirurgie Maxillo-faciale et Chirurgie Plastique, Hôpital Necker Enfants-Malades APHP, Paris, France
- Centre de référence Fentes et Malformations Faciales, APHP, Paris, France
| | - Eléonore Blondiaux
- Service de Radiologie, Hôpital d´Enfants Armand-Trousseau APHP, 26 Avenue du Dr Arnold Netter, 75012, Paris, France
| | - Hubert Ducou le Pointe
- Service de Radiologie, Hôpital d´Enfants Armand-Trousseau APHP, 26 Avenue du Dr Arnold Netter, 75012, Paris, France
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4
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Kato S, Fujita N, Suzuki S, Tsuji O, Nagoshi N, Okada E, Yagi M, Watanabe K, Nakamura M, Matsumoto M. Posterior and Anterior Fusion for Severe Cervical Kyphosis in a Patient with Chondrodysplasia Punctata: A Case Report. JBJS Case Connect 2021; 11:01709767-202103000-00051. [PMID: 33724960 DOI: 10.2106/jbjs.cc.20.00646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 4-year-old girl with spastic gait and hand clumsiness who was diagnosed with cervical myelopathy caused by atlantoaxial dislocation and midcervical severe kyphosis associated with chondrodysplasia punctata (CDP). The patient underwent posterior instrumentation and anterior spinal fusion and successful correction with osseous fusion was obtained 8 months after surgery. In addition, the preoperative neurological symptoms were completely recovered. CONCLUSION Owing to the characteristics of CDP, the treatment for the cervical lesion is extremely complicated. Successful stabilization and improvement of the neurological symptom were achieved by combining posterior and anterior fusion with instrumentation in this case.
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Affiliation(s)
- Shuzo Kato
- Department of Orthopaedic Surgery, Keio University, Tokyo, Japan
| | - Nobuyuki Fujita
- Department of Orthopaedic Surgery, Fujita Medical University, Aichi, Japan
| | - Satoshi Suzuki
- Department of Orthopaedic Surgery, Keio University, Tokyo, Japan
| | - Osahiko Tsuji
- Department of Orthopaedic Surgery, Keio University, Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University, Tokyo, Japan
| | - Eijiro Okada
- Department of Orthopaedic Surgery, Keio University, Tokyo, Japan
| | - Mitsuru Yagi
- Department of Orthopaedic Surgery, Keio University, Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University, Tokyo, Japan
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5
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He G, Yin Y, Zhao J, Wang X, Yang J, Chen X, Ding L, Bai Y. Prenatal findings in a fetus with X-linked recessive type of chondrodysplasia punctata (CDPX1): a case report with novel mutation. BMC Pediatr 2019; 19:250. [PMID: 31337364 PMCID: PMC6647267 DOI: 10.1186/s12887-019-1629-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 07/16/2019] [Indexed: 11/28/2022] Open
Abstract
Background X-linked recessive chondrodysplasia punctate (CDPX1) is a rare congenital disorder of bone and cartilage development, caused by a mutation in the arylsulfatase E (ARSE) gene located on chromosome Xp22.3. Although most of the affected men had mild symptoms, some had more severe symptoms, and had a poor prognosis. Case presentation We present the case of a male fetus diagnosed with CDPX1. Ultrasound clearly showed that hypoplasia of the midface, flatness of face, low flatness of the nose, collapse of the tip of the nose, accompanied by severe spinal stenosis and secondary ossification center of the femoral metaphysis appeared in advance. Chromosome analysis of the amniotic fluid cells revealed 46, XY. Whole exome sequencing showed that there was a novel missense mutation of c.640G > A in ARSE gene on X chromosome. Three protein function prediction software FATHMM、Polyphen-2、PROVEAN have shown that the novel missense mutation of c.640G > A in this study was pathogenic. Conclusions Our case is a novel mutation and presents a typical characterization of the disease, which can expand the spectrum of mutations of the ARSE gene and is helpful for prenatal ultrasound diagnosis of this disease.
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Affiliation(s)
- Guannan He
- Department of Ultrasound, Women and Children's Hospital of Sichuan Province, No.290, Shayan West 2nd Road, Chengdu, 610031, Sichuan Province, China
| | - Yan Yin
- Department of Prenatal Diagnosis, Women and Children's Hospital of Sichuan Province, No.290, Shayan West 2nd Road, Chengdu, 610031, Sichuan Province, China
| | - Jing Zhao
- Department of Ultrasound, Women and Children's Hospital of Sichuan Province, No.290, Shayan West 2nd Road, Chengdu, 610031, Sichuan Province, China.
| | - Xueyan Wang
- Department of Prenatal Diagnosis, Women and Children's Hospital of Sichuan Province, No.290, Shayan West 2nd Road, Chengdu, 610031, Sichuan Province, China.
| | - Jiaxiang Yang
- Department of Ultrasound, Women and Children's Hospital of Sichuan Province, No.290, Shayan West 2nd Road, Chengdu, 610031, Sichuan Province, China
| | - Xi Chen
- Department of Ultrasound, Women and Children's Hospital of Sichuan Province, No.290, Shayan West 2nd Road, Chengdu, 610031, Sichuan Province, China
| | - Li Ding
- Department of Radiology, Women and Children's Hospital of Sichuan Province, Chengdu, 610031, China
| | - Yan Bai
- Department of Ultrasound, Women and Children's Hospital of Sichuan Province, No.290, Shayan West 2nd Road, Chengdu, 610031, Sichuan Province, China
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6
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Bosselut H, Panuel M, Sigaudy S, Gorincour G, Chaumoitre K, Bretelle F. The complementary role of imaging modalities in Binder phenotype. Can prognostic factors of neonatal respiratory distress be found? Prenat Diagn 2019; 39:549-562. [PMID: 31046133 DOI: 10.1002/pd.5469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 04/15/2019] [Accepted: 04/24/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate the complementarity between prenatal ultrasound, computed tomography, and MRI scans for fetuses with Binder phenotype. METHODS We carried out a retrospective study from January 1, 2009, to June 30, 2018, of fetuses with Binder phenotype. Prenatal ultrasound (US) data were collected. A systematic survey of the entire skeleton was performed to look for associated abnormalities such as calcifications, brachytelephalangy, and spinal stenosis. Parents were systematically offered fetal skeletal computed tomography (CT). RESULTS Thirteen cases were included. Two cases of perinatal respiratory distress (18%) were observed. Chondrodysplasia punctata was diagnosed from the presence of calcifications, especially of the proximal femoral epiphyses and tarsal bones, in five cases (38%) by US and in 10 cases (83%) by CT. Calcifications of the hyoid bone were detected by CT in three cases (25%) one of which had respiratory distress. Polyhydramnios was associated with the Binder phenotype in four cases (30%) one of which had respiratory distress. One single fetus had combined polyhydramnios and laryngeal calcifications, and he suffered from perinatal respiratory distress. CONCLUSION An antenatal diagnosis of Binder phenotype is often associated with chondrodysplasia punctata. We recommend the use of fetal CT as a complement to US in this condition.
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Affiliation(s)
- Hortense Bosselut
- Centre Pluridisciplinaire de Diagnostic Prénatal, AP-HM La Timone, 264 Rue Saint Pierre, 13005, Marseille, France
| | - Michel Panuel
- Service d'Imagerie Médicale, AP-HM Hôpital Nord, Chemin des Bourrely, 13015, Marseille, France.,Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France
| | - Sabine Sigaudy
- Département de Génétique Médicale, AP-HM La Timone, 264 Rue Saint Pierre, 13005, Marseille, France
| | - Guillaume Gorincour
- Centre Pluridisciplinaire de Diagnostic Prénatal, AP-HM La Timone, 264 Rue Saint Pierre, 13005, Marseille, France.,Service d'Imagerie Pédiatrique et Prénatale, AP-HM La Timone, 264 Rue Saint Pierre, 13005, Marseille, France
| | - Kathia Chaumoitre
- Service d'Imagerie Médicale, AP-HM Hôpital Nord, Chemin des Bourrely, 13015, Marseille, France.,Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France
| | - Florence Bretelle
- Centre Pluridisciplinaire de Diagnostic Prénatal, AP-HM La Timone, 264 Rue Saint Pierre, 13005, Marseille, France.,Service de Gynécologie Obstérique, Gynépole, AP-HM Hôpital Nord, Chemin des Bourrely, 13015, Marseille, France.,Unité de Recherche sur les Maladies Infectieuses Tropicales et Emergentes, UM63, CNRS 7278, IRD 198, INSERM, 1095, Marseille, France
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7
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Successful Treatment of Atlantoaxial Subluxation in an Adolescent Patient with BrachytelephalangicChondrodysplasia Punctata. Case Rep Orthop 2019; 2019:5974281. [PMID: 30809406 PMCID: PMC6369497 DOI: 10.1155/2019/5974281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/27/2018] [Accepted: 01/15/2019] [Indexed: 11/25/2022] Open
Abstract
Brachytelephalangic chondrodysplasia punctata (CDPX1) is characterized by brachytelephalangy and nasomaxillary hypoplasia, in addition to stippled epiphyses. Some reports have described infants with CDPX1 who exhibited cervical spinal stenosis. However, the natural course of cervical spinal lesions in this condition has not been elucidated. Here, we report a very rare adolescent case of CDPX1, which demonstrated progressive myelopathy caused by atlantoaxial subluxation and a subsequent retroodontoid pseudotumor, successfully treated with surgery. Our case highlights a new clinically important fact that upper cervical spinal lesions in CDPX1 can deteriorate even after childhood and thus need close monitoring.
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8
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Morota N, Ihara S, Ogiwara H, Tamura G. Surgical management of cervical spine deformity in chondrodysplasia punctata. J Neurosurg Pediatr 2017; 20:378-387. [PMID: 28799855 DOI: 10.3171/2017.5.peds16554] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Chondrodysplasia punctata (CDP), a rare skeletal dysplasia, can lead to cervical spine instability and deformity. However, an optimal neurosurgical intervention has yet to be established. Thus, a retrospective study was conducted to assess the efficacy of various surgical interventions for children with CDP. METHODS The authors retrospectively reviewed 9 cases of CDP in which cervical decompression with or without posterior fusion was performed between April 2007 and May 2016. Patient demographics, preoperative clinical conditions, radiographic findings, surgical procedures, and the postoperative course were analyzed in detail. RESULTS A total of 12 operations were carried out in 9 patients (8 male, 1 female) during the study period. The patients' ages at the initial surgery ranged from 2 months to 2 years. Seven of the children had CDPX1, 1 had CDPX2, and 1 had tibia-metacarpal type CDP (CDP-TM). The lesion occurred at the craniovertebral junction (CVJ) in 7 cases and involved a subaxial deformity in 2 cases. The initial surgery was C-1 laminectomy with occipitocervical fusion (OCF) followed by halo external fixation in 5 cases, OCF alone in 1 case, and C-1 laminectomy alone in 3 cases. Three children required additional surgery. In one of these cases, a staged operation was required because the patient's head was too small to attach a halo ring at the time of the initial procedure (C-1 laminectomy). In another case, OCF was performed 11 months after C-1 laminectomy because of intramedullary signal change on serial MRI, although the child remained asymptomatic. In the third case, additional posterior fusion was performed 17 months after an initial laminectomy and OCF due to newly developed cervical dislocation caudal to the original fusion. This last patient required a third operation 9 months after the second because of deep wound infection. Surgery improved the motor function of all 7 children with CDPX1, but 3 children who had already suffered respiratory failure preoperatively required continued respiratory support. At the time of this report, 7 of the 9 children were alive and in stable condition. One child died due to restrictive respiratory insufficiency, and another died in an accident unrelated to CDP. CONCLUSIONS Surgical decompression with or without fusion for CVJ and subaxial cervical lesions in infants and toddlers with CDP generally saves lives and increases the likelihood of motor function recovery. However, in this case series the patients' preoperative condition had a strong effect on postoperative respiratory function. The surgery was not straightforward, and a second operation was required in some cases. Nevertheless, the findings indicate that early surgical intervention for CDP with cervical involvement is feasible, suggesting that the role of neurosurgery should be reevaluated.
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Affiliation(s)
- Nobuhito Morota
- Division of Neurosurgery, Tokyo Metropolitan Children's Medical Center; and
| | - Satoshi Ihara
- Division of Neurosurgery, Tokyo Metropolitan Children's Medical Center; and
| | - Hideki Ogiwara
- Divison of Neurosurgery, National Center for Child Health and Development, Tokyo, Japan
| | - Goichiro Tamura
- Division of Neurosurgery, Tokyo Metropolitan Children's Medical Center; and
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9
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Wagner MW, Poretti A, Benson JE, Huisman TAGM. Neuroimaging Findings in Pediatric Genetic Skeletal Disorders: A Review. J Neuroimaging 2016; 27:162-209. [PMID: 28000960 DOI: 10.1111/jon.12413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 11/01/2016] [Indexed: 12/15/2022] Open
Abstract
Genetic skeletal disorders (GSDs) are a heterogeneous group characterized by an intrinsic abnormality in growth and (re-)modeling of cartilage and bone. A large subgroup of GSDs has additional involvement of other structures/organs beside the skeleton, such as the central nervous system (CNS). CNS abnormalities have an important role in long-term prognosis of children with GSDs and should consequently not be missed. Sensitive and specific identification of CNS lesions while evaluating a child with a GSD requires a detailed knowledge of the possible associated CNS abnormalities. Here, we provide a pattern-recognition approach for neuroimaging findings in GSDs guided by the obvious skeletal manifestations of GSD. In particular, we summarize which CNS findings should be ruled out with each GSD. The diseases (n = 180) are classified based on the skeletal involvement (1. abnormal metaphysis or epiphysis, 2. abnormal size/number of bones, 3. abnormal shape of bones and joints, and 4. abnormal dynamic or structural changes). For each disease, skeletal involvement was defined in accordance with Online Mendelian Inheritance in Man. Morphological CNS involvement has been described based on extensive literature search. Selected examples will be shown based on prevalence of the diseases and significance of the CNS involvement. CNS involvement is common in GSDs. A wide spectrum of morphological abnormalities is associated with GSDs. Early diagnosis of CNS involvement is important in the management of children with GSDs. This pattern-recognition approach aims to assist and guide physicians in the diagnostic work-up of CNS involvement in children with GSDs and their management.
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Affiliation(s)
- Matthias W Wagner
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD.,Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Andrea Poretti
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jane E Benson
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Thierry A G M Huisman
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD
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10
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Okazaki T, Saito Y, Ueda R, Sugihara S, Tamasaki A, Nishimura Y, Ohno K, Togawa M, Ohno T, Horie A, Honda M, Takenaka A, Nagashima H, Maegaki Y. Effect of Intrathecal Baclofen on Delayed-Onset Paroxysmal Dystonia due to Compression Injury Resulting From Congenital and Progressive Spinal Bone Deformities in Chondrodysplasia Punctata. Pediatr Neurol 2016; 56:80-85.e2. [PMID: 26777981 DOI: 10.1016/j.pediatrneurol.2015.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 11/18/2015] [Accepted: 11/22/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Dystonia due to spinal lesions in adult patients is characterized by the provocation and/or amelioration of the spasm by somatosensory stimulation with a sensory trick. PATIENT DESCRIPTION An infant with brachytelephalangic chondrodysplasia punctata developed flaccid tetraplegia due to cervical cord compression resulting from congenital atlantoaxial dislocation. Episodic, tonic extension of the extremities, neck, and trunk had appeared daily since age two years and was often provoked by tactile stimulation. Although decompression surgery was performed at age three years, progressive spinal deformity resulted in the aggravation of episodic dystonia thereafter, lasting for hours. Foot dorsiflexion and wearing a truncal brace for scoliosis inhibited these spasms. Intrathecal baclofen bolus injection transiently ameliorated the paroxysmal dystonia and detrusor-sphincter dyssynergia in the lower urinary tract. CONCLUSION Paroxysmal dystonia is unusual in children with spinal cord lesions; however, it should be recognized for appropriate individualized clinical management.
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Affiliation(s)
- Tetsuya Okazaki
- Division of Child Neurology, Institute of Neurological Sciences, Faculty of Medicine, Tottori University, Yonago, Japan.
| | - Yoshiaki Saito
- Division of Child Neurology, Institute of Neurological Sciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Riyo Ueda
- Division of Child Neurology, Institute of Neurological Sciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Susumu Sugihara
- Division of Child Neurology, Institute of Neurological Sciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Akiko Tamasaki
- Division of Child Neurology, Institute of Neurological Sciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Yoko Nishimura
- Division of Child Neurology, Institute of Neurological Sciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Koyo Ohno
- Division of Child Neurology, Institute of Neurological Sciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Masami Togawa
- Division of Child Neurology, Institute of Neurological Sciences, Faculty of Medicine, Tottori University, Yonago, Japan; Department of Pediatrics, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Takako Ohno
- Western Shimane Medical and Welfare Center for the Disabled, Shimane, Japan
| | - Akiyoshi Horie
- Department of Pediatrics, Shimane University, Faculty of Medicine, Shimane, Japan
| | - Masashi Honda
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan
| | - Atsushi Takenaka
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan
| | - Hideki Nagashima
- Department of Orthopedic Surgery, Tottori University, Yonago, Tottori, Japan
| | - Yoshihiro Maegaki
- Division of Child Neurology, Institute of Neurological Sciences, Faculty of Medicine, Tottori University, Yonago, Japan
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11
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Brachytelephalangic chondrodysplasia punctata caused by new small hemizygous deletion in a boy presenting with hearing loss. Mol Cytogenet 2015; 8:83. [PMID: 26526591 PMCID: PMC4628305 DOI: 10.1186/s13039-015-0187-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 10/27/2015] [Indexed: 11/30/2022] Open
Abstract
X-linked recessive type chondrodysplasia punctata (CDPX1) is a congenital disorder of cartilage and bone development with typical findings of stippled epyphises, nasomaxillary hypoplasia and short distal phalanges in a male patient. Disease is caused due to the loss of arylsulfatase E activity and only 55 patients with genetically confirmed disease have been reported so far. In 60–75 % of all patients the mutation in ARSE gene is detected by sequence analysis and in further 25 % of patients Xp deletions or rearrangements are causative and may be identified by classical chromosome studies. We report on a male patient refered to clinical geneticist for congenital hearing loss and mild dysplastic signs, both phenotypic features being relatively unspecific and non suggestive of CDPX1 in first instance. Array comparative genomic hybridisation showed approximatelly 3 kb big deletion, spaning intron and exon 7 of arylsulfatase E gene located in Xp22.33. This explained the cause of hearing loss, being present in 26–89 % od CDPX1 patients, as well as additional non prominent skeletal characteristics described by geneticist in our patient - mild midface hypoplasia and mild brachytelephalangy. Reported case introduces different presenting clinical phenotype for CDPX1, emphasizing different expressivity in this disorder.
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12
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Ochiai D, Takamura K, Nishimura G, Ikeda T, Yakubo K, Fukuiya T. Prenatal diagnosis of cervical spinal cord compression in chondrodysplasia punctata brachytelephalangic type: A case report and literature review. Congenit Anom (Kyoto) 2013; 53:160-2. [PMID: 24712475 DOI: 10.1111/cga.12003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 10/17/2012] [Indexed: 11/27/2022]
Abstract
Chondrodysplasia punctata brachytelephalangic type is a common subset of a heterogeneous group of chondrodysplasia punctata. Most affected children generally do not have significant physical disabilities; however, a small number of patients are at risk of cervical canal stenosis with cervical cord compression leading to serious morbidity and early mortality. Very little is known about the in utero manifestation of severe complications. We report an affected child in whom the Binder phenotype was found on antenatal ultrasound and cervical spinal cord compression on fetal magnetic resonance imaging. Prenatal diagnosis of chondrodysplasia punctata brachytelephalangic type and its complications are beneficial for timely, prompt medical intervention.
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Affiliation(s)
- Daigo Ochiai
- Department of Obstetrics and Gynecology, Saitama City Hospital, Saitama-shi, Saitama, Japan
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13
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Jurkiewicz E, Marcinska B, Bothur-Nowacka J, Dobrzanska A. Clinical and radiological pictures of two newborn babies with manifestations of chondrodysplasia punctata and review of available literature. Pol J Radiol 2013; 78:57-64. [PMID: 23807887 PMCID: PMC3693839 DOI: 10.12659/pjr.883947] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 03/12/2013] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Chondrodysplasia punctata (CDP) is a rare, heterogeneous congenital skeletal dysplasia, characterized by punctate or dot-like calcium deposits in cartilage observed on neonatal radiograms. A number of inborn metabolic diseases are associated with CDP, including peroxisomal and cholesterol biosynthesis dysfunction and other inborn errors of metabolism such as: mucolipidosis type II, mucopolysacharidosis type III, GM1 gangliosidosis. CDP is also related to disruption of vitamin K-dependent metabolism, causing secondary effects on the embryo, as well as fetal alcohol syndrome (FAS), chromosomal abnormalities that include trisomies 18 and 21, Turner syndrome. CASE REPORT This article presents clinical data and diagnostic imaging findings of two newborn babies with chondrodysplasia punctata. Children presented with skeletal and cartilage anomalies, dysmorphic facial feature, muscles tone abnormalities, skin changes and breathing difficulties. One of the patients demonstrated critical stenosis of spinal canal with anterior subluxation of C1 vertebra relative to C2. The aim of this article is to present cases and briefly describe current knowledge on etiopathogenesis as well as radiological and clinical symptoms of diseases coexisting with CDP. CONCLUSIONS Radiological diagnostic imaging allows for visualization of punctate focal mineralization in bone epiphyses during neonatal age and infancy. Determining the etiology of chondrodysplasia punctata requires performing various basic as well as additional examinations, including genetic studies.
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Affiliation(s)
- Elżbieta Jurkiewicz
- Department of Imaging Diagnostics, Children’s Health Memorial Institute, Warsaw, Poland
| | - Beata Marcinska
- Department of Imaging Diagnostics, Children’s Health Memorial Institute, Warsaw, Poland
| | - Joanna Bothur-Nowacka
- Department of Neonatology, Pathology and Intensive Neonatal Care, Children’s Health Memorial Institute, Warsaw, Poland
| | - Anna Dobrzanska
- Department of Neonatology, Pathology and Intensive Neonatal Care, Children’s Health Memorial Institute, Warsaw, Poland
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14
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A prospective study of brachytelephalangic chondrodysplasia punctata: identification of arylsulfatase E mutations, functional analysis of novel missense alleles, and determination of potential phenocopies. Genet Med 2013; 15:650-7. [DOI: 10.1038/gim.2013.13] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 01/07/2013] [Indexed: 02/03/2023] Open
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15
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Vogel TW, Menezes AH. Natural history and management of cervical spine disease in chondrodysplasia punctata and coumarin embryopathy. Childs Nerv Syst 2012; 28:609-19. [PMID: 22274407 DOI: 10.1007/s00381-012-1694-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 01/09/2012] [Indexed: 02/06/2023]
Abstract
PURPOSE Chondrodysplasia punctata (CDP) is a group of skeletal dysplasias manifesting with progressive cervical instability that leads to neurological deficits and eventual death. The major clinical features of CDP also present in a phenocopy known as coumarin embryopathy (CE) which results from coumarin exposure during pregnancy. The objective of this study was to assess treatment strategies employed for children affected by CDP or CE with cervical instability and to determine a strategy on how best to diagnose and treat affected neonates. METHODS We performed a systematic review of the English literature for cases reporting cervical spine involvement in CDP and CE and identified 44 such patients. We extracted clinical information on these disorders and identified two patients from our craniovertebral junction database of over 6,000 patients evaluated at our institution. RESULTS Patients most frequently present with hyperreflexia (21%) and weakness (21%), and there were various conservative treatment strategies. Twenty-one percent of patients who were treated conservatively had neurological complications in their clinical course. There were two deaths reported, one resulting from conservative treatment and one from surgical treatment. We also report long-term follow-up analysis for a patient treated at our institution for the last 30 years and agree with all other reports that suggest that monitoring patients for neurological changes is essential to prevent further neurological injury. CONCLUSIONS This study emphasizes the need for careful neurological and surgical evaluation of pediatric patients with cervical spine abnormalities affected by CDP or CE in order to prevent progressive instability.
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Affiliation(s)
- Timothy W Vogel
- Department of Neurosurgery, Children's Hospital Boston, Harvard Medical School, Harvard University, Boston, MA 02115, USA.
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16
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Spondyloepiphyseal dysplasia tarda with progressive arthropathy complicated with paraplegia. Am J Phys Med Rehabil 2011; 90:490-4. [PMID: 21273896 DOI: 10.1097/phm.0b013e3182063b01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Spondyloepiphyseal dysplasia tarda with progressive arthropathy is characterized by short stature resulting from platyspondylia and progressive arthropathy. This disorder may cause a predisposition to disk herniations, which may rarely lead to spastic paraplegia. We report a 21-yr-old male patient with spondyloepiphyseal dysplasia tarda with progressive arthropathy who developed spastic paraplegia because of spinal stenosis caused by thoracic disk herniations.
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17
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Benaicha A, Dommergues M, Jouannic JM, Jacquette A, Alexandre M, Le Merrer M, Ducou Le Pointe H, Garel C. Prenatal diagnosis of brachytelephalangic chondrodysplasia punctata: case report. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 34:724-726. [PMID: 19856318 DOI: 10.1002/uog.7452] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Brachytelephalangic chondrodysplasia punctata is a rare congenital skeletal dysplasia. Within the heterogeneous group of chondrodysplasia punctata, the brachytelephalangic type is noteworthy because it has a better prognosis than do the other types. We report a case of brachytelephalangic chondrodysplasia punctata diagnosed by ultrasound imaging at 30 weeks' gestation; it was associated with polyhydramnios and a normal cervical spinal canal. Imaging features are described and differential diagnosis with other forms of chondrodysplasia punctata is discussed.
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Affiliation(s)
- A Benaicha
- Department of Radiologie, Hôpital d'Enfants Armand-Trousseau, Paris, France
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18
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Mundinger GS, Weiss C, Fishman EK. Severe tracheobronchial stenosis and cervical vertebral subluxation in X-linked recessive chondrodysplasia punctata. Pediatr Radiol 2009; 39:625-8. [PMID: 19238369 DOI: 10.1007/s00247-009-1181-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2008] [Revised: 12/21/2008] [Accepted: 01/22/2009] [Indexed: 11/26/2022]
Abstract
Radiologic manifestations of X-linked chondrodysplasia punctata (CDPX1) typically include chondrodysplasia, epiphyseal stippling, punctate calcification of cartilage, distal phalangeal hypoplasia, and nasal/midface hypoplasia. We present an infant with CDPX1 demonstrating calcification and stenosis of the entire trachea and mainstem bronchi, as well as possible anterior C1 subluxation due to progression of congenital vertebral dysplasia.
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Affiliation(s)
- Gerhard S Mundinger
- Division of Plastic, Reconstructive, and Maxillofacial Surgery, Johns Hopkins Hospital, Baltimore, MD 21287-0006, USA.
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19
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Levaillant JM, Moeglin D, Zouiten K, Bucourt M, Burglen L, Soupre V, Baumann C, Jaquemont ML, Touraine R, Picard A, Vuillard E, Belarbi N, Oury JF, Verloes A, Vazquez MP, Labrune P, Delezoide AL, Gérard-Blanluet M. Binder phenotype: clinical and etiological heterogeneity of the so-called Binder maxillonasal dysplasia in prenatally diagnosed cases, and review of the literature. Prenat Diagn 2009; 29:140-50. [PMID: 19156647 DOI: 10.1002/pd.2167] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Prenatal Binder profile is a well known clinical phenotype, defined by a flat profile without nasal eminence, contrasting with nasal bones of normal length. Binder profile results of a hypoplasia of the nasal pyramid (sometimes referred to as maxillonasal dysplasia). We report 8 fetuses prenatally diagnosed as Binder phenotype, and discuss their postnatal diagnoses. METHODS Ultrasonographic detailed measurements in 2D and 3D were done on the 8 fetuses with Binder profile, and were compared with postnatal phenotype. RESULTS All fetuses have an association of verticalized nasal bones, abnormal convexity of the maxilla, and some degree of chondrodysplasia punctata. The final diagnoses included fetal warfarin syndrome (one patient), infantile sialic acid storage (one patient), probable Keutel syndrome (one patient), and five unclassifiable types of chondrodysplasia punctata. CONCLUSION This series demonstrates the heterogeneity of prenatally diagnosed Binder phenotype, and the presence of chondrodysplasia punctata in all cases. An anomaly of vitamin K metabolism, possibly due to environmental factors, is suspected in these mild chondrodysplasia punctata. We recommend considering early prophylactic vitamin K supplementation in every suspected acquired vitamin K deficiency including incoercible vomiting of the pregnancy.
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Affiliation(s)
- J M Levaillant
- Prenatal Diagnosis Unit, APHP Antoine Béclère University Hospital, Clamart, France
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Nino M, Matos-Miranda C, Maeda M, Chen L, Allanson J, Armour C, Greene C, Kamaluddeen M, Rita D, Medne L, Zackai E, Mansour S, Superti-Furga A, Lewanda A, Bober M, Rosenbaum K, Braverman N. Clinical and molecular analysis of arylsulfatase E in patients with brachytelephalangic chondrodysplasia punctata. Am J Med Genet A 2008; 146A:997-1008. [DOI: 10.1002/ajmg.a.32159] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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