1
|
Innes AM, McInnes BL, Dyment DA. Clinical and genetic heterogeneity in Dubowitz syndrome: Implications for diagnosis, management and further research. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2019; 178:387-397. [PMID: 30580484 DOI: 10.1002/ajmg.c.31661] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/14/2018] [Accepted: 10/27/2018] [Indexed: 12/12/2022]
Abstract
Dubowitz syndrome was described in 1965 as a recognizable syndrome characterized by microcephaly, short stature, eczema, mild developmental delays, and an increased risk of malignancy. Since its original description, there have been over 200 reported cases though no single gene has been identified to explain a significant proportion of affected individuals. Since the last definitive review of Dubowitz syndrome in 1996, there have been 63 individuals with a clinical, or suspected, diagnosis of Dubowitz syndrome reported in 51 publications. These individuals show a markedly wide spectrum with respect to growth, facial gestalt, psychomotor development, and risk of malignancy; genetic causes were identified in 33% (21/63). Seven individuals had deleterious copy number variants, in particular deletions at 14q32 and 17q24 were reported and showed overlap with the Dubowitz phenotype. Several cases were shown to have single gene disorders that included de novo or biallelic pathogenic variants in several genes including NSUN2 and LIG4 frequently identified by next-generation sequencing methods. It appears that the inability to identify a single gene responsible for Dubowitz syndrome reflects its extreme clinical and genetic heterogeneity. However, detailed phenotyping combined with careful grouping of subsets of unsolved cases and in conjunction with data-sharing will identify novel disease genes responsible for additional cases. In the interim, for those clinically diagnosed with a Dubowitz phenotype, we recommend assessment by a Medical Geneticist, a microarray and, if available, clinical or research based genome-wide sequencing. Management suggestions, including decisions regarding malignancy screening in select patients will be discussed.
Collapse
Affiliation(s)
- A Micheil Innes
- Department of Medical Genetics, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Brenda L McInnes
- Department of Medical Genetics, University of Calgary, Calgary, Alberta, Canada
| | - David A Dyment
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| |
Collapse
|
2
|
Keser N, Kuskucu A, Is M, Celikoglu E. Familial Chiari Type 1: A Molecular Karyotyping Study in a Turkish Family and Review of the Literature. World Neurosurg 2018; 121:e852-e857. [PMID: 30315983 DOI: 10.1016/j.wneu.2018.09.235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/28/2018] [Accepted: 09/29/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The etiology of Chiari I malformation (CMI) has not been fully elucidated. Therefore, we performed a genetic study of a Turkish family in which 3 sisters had a diagnosis of CMI with or without syringomyelia. METHODS In a family with 7 children, 4 daughters complained of occipital headaches. In 2 of these daughters, CMI had been diagnosed during their 30s, and CMI plus syrinx had been diagnosed in the other daughter in her 40s. Cranial magnetic resonance imaging of the fourth daughter who had developed headaches during her 30s showed normal findings. Because the other siblings in the family were asymptomatic, radiological examinations were not performed. The family had a history of distant consanguineous marriage between parents. Additionally, the father had died, and the mother was asymptomatic, with radiologically normal findings. Array comparative genome hybridization studies were performed for 12 persons from 3 generations of this family. RESULTS None of the 12 cases examined harbored copy number variations. CONCLUSIONS This family with 3 sisters having CMI suggested a possible autosomal recessive single-gene etiology. Cases of familial CMI are unusual but important to study because they could reveal the specific genes involved in posterior fossa/foramen magnum structure and function and provide insights into the cause of sporadic cases.
Collapse
Affiliation(s)
- Nese Keser
- Department of Neurological Surgery, TR University of Health Sciences, Istanbul Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey.
| | - Aysegul Kuskucu
- Department of Genetics, Yeditepe University Faculty of Medicine, Istanbul, Turkey
| | - Merih Is
- Department of Neurological Surgery, TR University of Health Sciences, Istanbul Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | - Erhan Celikoglu
- Department of Neurological Surgery, TR University of Health Sciences, Istanbul Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| |
Collapse
|
3
|
Yabe I, Matsushima M, Seki T, Sasaki H. A nationwide survey of familial syringomyelia in Japan. J Neurol Sci 2017; 381:128-129. [PMID: 28991663 DOI: 10.1016/j.jns.2017.08.3237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 07/31/2017] [Accepted: 08/21/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Ichiro Yabe
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masaaki Matsushima
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Toshitaka Seki
- Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hidenao Sasaki
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
| |
Collapse
|
4
|
Zuev AA, Lebedev VB, Pedyash NV, Epifanov DS, Levin RS. [Treatment of syringomyelia associated with adhesive arachnoiditis]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2017; 81:39-47. [PMID: 28665387 DOI: 10.17116/neiro201781339-47] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
UNLABELLED The prevalence of syringomyelia (SM) caused by adhesive arachnoiditis (AA) is 2 to 4 cases per 100000 population. Surgical treatment of this pathology usually includes implantation of shunts into the cyst cavity or opening and drainage of the cavity. In this case, SM continues to progress in 72-100% of patients. Unsatisfactory outcomes of this surgical approach necessitate searching for other treatment options. PURPOSE To define the optimal amount of surgery for SM associated with AA and the criteria for assessment of surgery outcomes. MATERIAL AND METHODS The authors treated 47 SM patients in the period from 2010 to 2015. Of these, 34 (72.3%) patients underwent surgery; a total of 40 operations were performed. The patients' age ranged from 18 to 64 years (mean, 43.5 years). Tethering of the spinal cord was eliminated in 25 patients; 9 patients underwent cyst shunting. RESULTS Among operated patients, 5 patients had grade 1 arachnopathy, 13 patients had grade 2 arachnopathy, 12 patients had grade 3 arachnopathy, and 4 patients had grade 4 arachnopathy. The minimal postoperative follow-up period was 11 months. After shunting, the condition improved in 8 of 9 patients; in 7 patients, the condition returned to the baseline level within the first postoperative year; in 6 (66.7%) of these patients, the disease continued to progress. After surgical release of spinal cord tethering, satisfactory long-term results were achieved in 13 (86.6%) patients with grade 1-2 arachnopathy. In 3 (50%) patients with grade 3 arachnopathy, the condition was stabilized. Among patients with grade 4 arachnopathy, progression of the disease was stopped in 1 patient; the condition worsened in 2 (50%) patients. Among all the operated patients, complications developed in 7 patients. There were no lethal outcomes. CONCLUSIONS In grade 1-2 arachnopathy, progression of SM after release of spinal cord tethering occurs only in 13.4% of patients. Therefore, release of spinal cord tethering is recommended for these patients. In grade 3-4 arachnopathy, the rate of relapse after this surgery is more than 80%. Therefore, given the simplicity and a lower risk of complications of cyst shunting, this procedure is advisable for these patients.
Collapse
Affiliation(s)
- A A Zuev
- Pirogov National Medical and Surgical Center, Moscow, Russia
| | - V B Lebedev
- Pirogov National Medical and Surgical Center, Moscow, Russia
| | - N V Pedyash
- Pirogov National Medical and Surgical Center, Moscow, Russia
| | - D S Epifanov
- Pirogov National Medical and Surgical Center, Moscow, Russia
| | - R S Levin
- Petrovsky Russian Scientific Center of Surgery, Moscow, Russia
| |
Collapse
|
5
|
Kuroki H, Inomata N, Hamanaka H, Higa K, Chosa E, Tajima N. Two siblings with neuropathic scoliosis caused by Chiari malformation type I with syringomyelia. J Orthop Sci 2015; 20:579-83. [PMID: 24379017 DOI: 10.1007/s00776-013-0520-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 12/11/2013] [Indexed: 10/25/2022]
Affiliation(s)
- Hiroshi Kuroki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, 5200 Kihara Kiyotake, 889-1692, Miyazaki, Japan,
| | | | | | | | | | | |
Collapse
|
6
|
Pasoglou V, Janin N, Tebache M, Tegos TJ, Born JD, Collignon L. Familial adhesive arachnoiditis associated with syringomyelia. AJNR Am J Neuroradiol 2014; 35:1232-6. [PMID: 24481329 DOI: 10.3174/ajnr.a3858] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Adhesive arachnoiditis is a rare condition, often complicated by syringomyelia. This pathologic entity is usually associated with prior spinal surgery, spinal inflammation or infection, and hemorrhage. The usual symptoms of arachnoiditis are pain, paresthesia, and weakness of the low extremities due to the nerve entrapment. A few cases have had no obvious etiology. Previous studies have reported one family with multiple cases of adhesive arachnoiditis. We report a second family of Belgian origin with multiple cases of arachnoiditis and secondary syringomyelia in the affected individuals.
Collapse
Affiliation(s)
- V Pasoglou
- From the Departments of Radiology (V.P.)
| | - N Janin
- Genetics (N.J.), Cliniques Universitaires St. Luc, Brussels, Belgium
| | - M Tebache
- Departments of Radiology (M.T., L.C.)
| | - T J Tegos
- Department of Neurology (T.J.T.), AHEPA Hospital, Thessaloniki, Greece
| | - J D Born
- Neurosurgery (J.D.B.), Centre Hospitalier Régional de la Citadelle, Liège, Belgium
| | | |
Collapse
|
7
|
Bizzarri C, Benevento D, Terzi C, Huebner A, Cappa M. Triple A (Allgrove) syndrome: an unusual association with syringomyelia. Ital J Pediatr 2013; 39:39. [PMID: 23800107 PMCID: PMC3704905 DOI: 10.1186/1824-7288-39-39] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 06/19/2013] [Indexed: 01/26/2023] Open
Abstract
Triple A (Allgrove) syndrome was first described by Allgrove in 1978 in two pairs of siblings. Since then, about 100 cases have been reported, all of them displaying an autosomal recessive pattern of inheritance. Clinical picture is characterized by achalasia, alacrimia and ACTH-resistant adrenal failure. A progressive neurological syndrome including central, peripheral and autonomic nervous system impairment, and mild mental retardation is often associated. The triple A syndrome gene, designated AAAS, is localized on chromosome 12q13. It consists of 16 exons, encoding for a 546 aminoacid protein called ALADIN (Alacrimia-Achalasia-aDrenal Insufficiency Neurologic disorder). We report on a 13 year-old boy presenting with Addison’s disease, dysphagia, muscle weakness, excessive fatigue and recent onset gait ataxia. The analysis of the AAAS gene revealed a homozygous missense mutation in exon 12. It was a T > G transversion at nucleotide position 1224, resulting in a change of leucine at amino acid position 381 into arginine (Leu381Arg or L381R). Brain appearance was found normal at magnetic resonance imaging (MRI) and functional spectroscopy analysis showed normal levels of the main metabolites. Spine MRI showed a cystic cavity within the spinal cord (syringomyelia), localized between the sixth cervical vertebra and the first thoracic vertebra. Cerebellar tonsils descended 7 mm caudal to foramen magnum, consistently with a mild type 1 Chiari malformation. Mild posterior inter-vertebral disk protrusions were evident between T9 and T10 and between L4 and L5. To our knowledge, this is the first report describing type 1 Chiari malformation and multiple spinal cord abnormalities in a patient with Allgrove syndrome.
Collapse
|
8
|
Markunas CA, Soldano K, Dunlap K, Cope H, Asiimwe E, Stajich J, Enterline D, Grant G, Fuchs H, Gregory SG, Ashley-Koch AE. Stratified whole genome linkage analysis of Chiari type I malformation implicates known Klippel-Feil syndrome genes as putative disease candidates. PLoS One 2013; 8:e61521. [PMID: 23620759 PMCID: PMC3631233 DOI: 10.1371/journal.pone.0061521] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Accepted: 03/11/2013] [Indexed: 01/08/2023] Open
Abstract
Chiari Type I Malformation (CMI) is characterized by displacement of the cerebellar tonsils below the base of the skull, resulting in significant neurologic morbidity. Although multiple lines of evidence support a genetic contribution to disease, no genes have been identified. We therefore conducted the largest whole genome linkage screen to date using 367 individuals from 66 families with at least two individuals presenting with nonsyndromic CMI with or without syringomyelia. Initial findings across all 66 families showed minimal evidence for linkage due to suspected genetic heterogeneity. In order to improve power to localize susceptibility genes, stratified linkage analyses were performed using clinical criteria to differentiate families based on etiologic factors. Families were stratified on the presence or absence of clinical features associated with connective tissue disorders (CTDs) since CMI and CTDs frequently co-occur and it has been proposed that CMI patients with CTDs represent a distinct class of patients with a different underlying disease mechanism. Stratified linkage analyses resulted in a marked increase in evidence of linkage to multiple genomic regions consistent with reduced genetic heterogeneity. Of particular interest were two regions (Chr8, Max LOD = 3.04; Chr12, Max LOD = 2.09) identified within the subset of "CTD-negative" families, both of which harbor growth differentiation factors (GDF6, GDF3) implicated in the development of Klippel-Feil syndrome (KFS). Interestingly, roughly 3-5% of CMI patients are diagnosed with KFS. In order to investigate the possibility that CMI and KFS are allelic, GDF3 and GDF6 were sequenced leading to the identification of a previously known KFS missense mutation and potential regulatory variants in GDF6. This study has demonstrated the value of reducing genetic heterogeneity by clinical stratification implicating several convincing biological candidates and further supporting the hypothesis that multiple, distinct mechanisms are responsible for CMI.
Collapse
Affiliation(s)
- Christina A. Markunas
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Karen Soldano
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Kaitlyn Dunlap
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Heidi Cope
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Edgar Asiimwe
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Jeffrey Stajich
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - David Enterline
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Gerald Grant
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Herbert Fuchs
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Simon G. Gregory
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Allison E. Ashley-Koch
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| |
Collapse
|
9
|
Markunas CA, Tubbs RS, Moftakhar R, Ashley-Koch AE, Gregory SG, Oakes WJ, Speer MC, Iskandar BJ. Clinical, radiological, and genetic similarities between patients with Chiari Type I and Type 0 malformations. J Neurosurg Pediatr 2012; 9:372-8. [PMID: 22462700 PMCID: PMC3678957 DOI: 10.3171/2011.12.peds11113] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Although Chiari Type I (CM-I) and Type 0 (CM-0) malformations have been previously characterized clinically and radiologically, there have been no studies focusing on the possible genetic link between these disorders. The goal of this study was to identify families in whom CM-0 and CM-I co-occurred and to further assess the similarities between these disorders. METHODS Families were ascertained through a proband with CM-I. Detailed family histories were obtained to identify first-degree relatives diagnosed with CM-0. Several criteria were used to exclude individuals with acquired forms of CM-I and/or syringomyelia. Individuals were excluded with syndromic, traumatic, infectious, or tumor-related syringomyelia, as well as CM-I due to a supratentorial mass, hydrocephalus, history of cervical or cranial surgery unrelated to CM-I, or development of symptoms following placement of a lumbar shunt. Medical records and MR images were used to characterize CM-I and CM-0 individuals clinically and radiologically. RESULTS Five families were identified in which the CM-I proband had a first-degree relative with CM-0. Further assessment of affected individuals showed similar clinical and radiological features between CM-0 and CM-I individuals, although CM-I patients in general had more severe symptoms and skull base abnormalities than their CM-0 relatives. Overall, both groups showed improvement in symptoms and/or syrinx size following craniocervical decompression surgery. CONCLUSIONS There is accumulating evidence suggesting that CM-0 and CM-I may be caused by a common underlying developmental mechanism. The data in this study are consistent with this hypothesis, showing similar clinical and radiological features between CM-0 and CM-I individuals, as well as the occurrence of both disorders within families. Familial clustering of CM-0 and CM-I suggests that these disorders may share an underlying genetic basis, although additional epigenetic and/or environmental factors are likely to play an important role in the development of CM-0 versus CM-I.
Collapse
Affiliation(s)
| | - R. Shane Tubbs
- Section of Pediatric Neurosurgery, Children’s Hospital, Birmingham, Alabama
| | - Roham Moftakhar
- Department of Neurological Surgery, University of Wisconsin, Madison, Wisconsin
| | | | - Simon G. Gregory
- Center for Human Genetics, Duke University Medical Center, Durham, North Carolina
| | - W. Jerry Oakes
- Section of Pediatric Neurosurgery, Children’s Hospital, Birmingham, Alabama
| | - Marcy C. Speer
- Center for Human Genetics, Duke University Medical Center, Durham, North Carolina
| | - Bermans J. Iskandar
- Department of Neurological Surgery, University of Wisconsin, Madison, Wisconsin
| |
Collapse
|
10
|
Nationwide survey on the epidemiology of syringomyelia in Japan. J Neurol Sci 2012; 313:147-52. [DOI: 10.1016/j.jns.2011.08.045] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 08/30/2011] [Indexed: 11/15/2022]
|
11
|
Schanker BD, Walcott BP, Nahed BV, Kahle KT, Li YM, Coumans JVCE. Familial Chiari malformation: case series. Neurosurg Focus 2012; 31:E1. [PMID: 21882906 DOI: 10.3171/2011.6.focus11104] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Chiari malformations (Types I-IV) are abnormalities of the posterior fossa that affect the cerebellum, brainstem, and the spinal cord with prevalence rates of 0.1%-0.5%. Case reports of familial aggregation of Chiari malformation, twin studies, cosegregation of Chiari malformation with known genetic conditions, and recent gene and genome-wide association studies provide strong evidence of the genetic underpinnings of familial Chiari malformation. The authors report on a series of 3 family pairs with Chiari malformation Type I: 2 mother-daughter pairs and 1 father-daughter pair. The specific genetic causes of familial Chiari malformation have yet to be fully elucidated. The authors review the literature and discuss several candidate genes. Recent advances in the understanding of the genetic influences and pathogenesis of familial Chiari malformation are expected to improve management of affected patients and monitoring of at-risk family members.
Collapse
Affiliation(s)
- Benjamin D Schanker
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, 02114, USA
| | | | | | | | | | | |
Collapse
|
12
|
Tubbs RS, Hill M, Loukas M, Shoja MM, Oakes WJ. Volumetric analysis of the posterior cranial fossa in a family with four generations of the Chiari malformation Type I. J Neurosurg Pediatr 2008; 1:21-4. [PMID: 18352798 DOI: 10.3171/ped-08/01/021] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Many authors have concluded that the Chiari malformation Type I (CM-I) is due to a smaller than normal posterior cranial fossa. In order to establish this smaller geometry as the cause of hindbrain herniation in a family, the authors of this paper performed volumetric analysis in a family found to have this malformation documented in 4 generations. METHODS Members from this family found to have a CM-I by imaging underwent volumetric analysis of their posterior cranial fossa using the Cavalieri method. RESULTS No member of this family found to have CM-I on preoperative imaging had a posterior fossa that was significantly smaller than that of age-matched controls. CONCLUSIONS The results of this study demonstrate that not all patients with a CM-I will have a reduced posterior cranial fossa volume. Although the mechanism for the development of hindbrain herniation in this cohort is unknown, this manifestation can be seen in multiple generations of a familial aggregation with normal posterior fossa capacity.
Collapse
Affiliation(s)
- R Shane Tubbs
- Department of Cell Biology, University of Alabama at Birmingham, Birmingham, Alabama 35233, USA.
| | | | | | | | | |
Collapse
|
13
|
Murphy RL, Tubbs RS, Grabb PA, Oakes WJ. Chiari I malformation and idiopathic growth hormone deficiency in siblings: report of three cases. Childs Nerv Syst 2007; 23:1221-3. [PMID: 17534630 DOI: 10.1007/s00381-007-0374-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2005] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The authors report a case of three brothers. CASE DESCRIPTIONS Two of these siblings presented with congenital growth hormone deficiency (GHD) and Chiari I malformation (CIM). The third younger brother has been found not to have GHD or the CIM. DISCUSSION Sparse cases of these two clinical occurrences have been reported. Further, the posterior cranial fossa (PF) has been determined to be altered in patients with CIM and GHD. CONCLUSION Our current case reports strengthen the association between these two pathological entities and, to our knowledge, is the first description of both defects in siblings.
Collapse
Affiliation(s)
- R Lee Murphy
- University of Alabama School of Medicine, Birmingham, AL 35233, USA
| | | | | | | |
Collapse
|
14
|
Ansari S, Dadmehr M, Nejat F. Possible genetic correlation of an occipital dermal sinus in a mother and son. Case report. J Neurosurg 2007; 105:326-8. [PMID: 17328285 DOI: 10.3171/ped.2006.105.4.326] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Occipital dermal sinuses (ODSs) are congenital lesions located in the midline and characterized by a cutaneous pit or dimple. The intracranial extension as well as the associated symptoms are variable. To date, a familial occurrence of these lesions has not been reported. In this paper the authors report on a 2-year-old boy with an ODS and intracranial hypertension. The boy's mother had a similar lesion but did not have any complaints. Following their experience with this case and a literature review, the authors suggest that there may be a genetic basis in certain instances of ODS.
Collapse
Affiliation(s)
- Saeed Ansari
- Department of Neurosurgery and Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | |
Collapse
|
15
|
Weisfeld-Adams JD, Carter MR, Likeman MJ, Rankin J. Three sisters with Chiari I malformation with and without associated syringomyelia. Pediatr Neurosurg 2007; 43:533-8. [PMID: 17992048 DOI: 10.1159/000108803] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2006] [Accepted: 12/04/2006] [Indexed: 11/19/2022]
Abstract
Two daughters of non-consanguineous Ashkenazi Jewish parentage presented with occipital headaches in the second decade of life. Each had a symptomatic Chiari I malformation (CMI) and a large cervicothoracic syrinx. A third sister was diagnosed as having CMI without syrinx after MR screening of first-degree relatives. A fourth (the eldest) sister was asymptomatic and did not have CMI or syrinx. The girls' mother had platybasia on screening MR and a history of cough headaches. All four sisters also had demonstrable platybasic features on MR. The girls' father was asymptomatic and radiologically normal. This family represents the first reported case of three siblings in one family with confirmed CMI with or without syrinx. We discuss the possible genetic and mechanical mechanisms for the development of these abnormalities in this family.
Collapse
|
16
|
Robenek M, Kloska SP, Husstedt IW. Evidence of familial syringomyelia in discordant association with Chiari type I malformation. Eur J Neurol 2006; 13:783-5. [PMID: 16834711 DOI: 10.1111/j.1468-1331.2006.01285.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report a sister and two half brothers who presented with magnetic resonance imaging (MRI)-proven syringomyelia and associated Chiari type I malformation in two cases. The individuals have the same mother but two different fathers. The mother shows no clinical signs of syringomyelia. The two fathers died through unknown causes. In a third healthy son of the mother by a relationship with a third father syringomyelia was excluded by MRI. We believe that an autosomal-dominant predisposition is the primary factor in the appearance of syringomyelia in these cases.
Collapse
Affiliation(s)
- M Robenek
- Department of Neurology, University of Muenster, Muenster, Germany
| | | | | |
Collapse
|
17
|
Murphy RL, Tubbs RS, Grabb PA, Oakes WJ. Chiari I malformation and idiopathic growth hormone deficiency in siblings. Childs Nerv Syst 2006; 22:632-4. [PMID: 16418834 DOI: 10.1007/s00381-005-0041-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2005] [Revised: 07/28/2005] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The authors report a case of three brothers. Two of these siblings presented with congenital growth hormone deficiency and Chiari I malformation. The third and younger brother has been found not to have growth hormone deficiency or the Chiari I malformation. RESULTS Sparse cases of these two clinical occurrences have been reported. Further, the posterior cranial fossa has been determined to be altered in patients with Chiari I malformation and growth hormone deficiency. CONCLUSION Our current case reports strengthen the association between these two pathological entities and are, to our knowledge, the first description of both defects in siblings.
Collapse
Affiliation(s)
- R L Murphy
- School of Medicine, University of Alabama, Birmingham, AL 35233, USA
| | | | | | | |
Collapse
|
18
|
Szewka AJ, Walsh LE, Boaz JC, Carvalho KS, Golomb MR. Chiari in the family: inheritance of the Chiari I malformation. Pediatr Neurol 2006; 34:481-5. [PMID: 16765829 DOI: 10.1016/j.pediatrneurol.2005.09.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2005] [Revised: 09/01/2005] [Accepted: 09/20/2005] [Indexed: 02/06/2023]
Abstract
This report presents three families with Chiari malformation type I that became symptomatic during childhood: a mother and son; a set of monozygotic twins; and two half-siblings and their two maternal cousins. These children presented with various symptoms, including headache, stiff neck, and swallowing difficulty. A review of the relevant literature is presented, with an emphasis on familial examples and proposed inheritance. Less common presentations of Chiari malformation type I are discussed, as well as the possible pathogenesis of Chiari malformation type I and associated syringomyelia.
Collapse
Affiliation(s)
- Aimee J Szewka
- Division of Pediatric Neurology, Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA
| | | | | | | | | |
Collapse
|
19
|
Mavinkurve GG, Sciubba D, Amundson E, Jallo GI. Familial Chiari type I malformation with syringomyelia in two siblings: case report and review of the literature. Childs Nerv Syst 2005; 21:955-9. [PMID: 15821947 DOI: 10.1007/s00381-005-1146-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2004] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Familial cases of Chiari malformation with syringomyelia are rare. The majority of the reported series and case reports detail sporadic cases. The authors report two siblings who presented with Chiari type I malformation and syringomyelia (CMI+S). CLINICAL PRESENTATION We report two sisters who each presented with scoliosis on routine school physicals. Their clinical examination was unremarkable; however, imaging studies demonstrated a Chiari malformation with syringomyelia. Both underwent cervicomedullary decompression, and follow-up imaging studies revealed resolution of the syringomyelia. CONCLUSION A review of the literature reveals fewer than ten previous reports of familial CMI+S in the past 30 years. Although rare, the existence of familial cases of CMI+S suggests a genetic component to the pathogenesis of this condition in at least a proportion of patients. Neurosurgeons should be aware of the familial aggregation of CMI+S.
Collapse
Affiliation(s)
- Gaurav G Mavinkurve
- Division of Pediatric Neurosurgery, Johns Hopkins Hospital, Harvey 811, Baltimore, MD 21287, USA
| | | | | | | |
Collapse
|