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Sharma PK, Sekar A, Amir AP, Prabhu ALR. Parry-Romberg syndrome: A case report and literature review. Radiol Case Rep 2024; 19:2230-2238. [PMID: 38523720 PMCID: PMC10959643 DOI: 10.1016/j.radcr.2024.02.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/09/2024] [Accepted: 02/15/2024] [Indexed: 03/26/2024] Open
Abstract
Parry-Romberg syndrome (PRS) is a rare neurocutaneous and craniofacial disorder characterized by progressive hemifacial wasting and atrophy that predominantly affects children and young adults, with an estimated prevalence of 1 in 700,000 individuals. Despite its rarity, PRS poses significant challenges for patients, their families, and healthcare providers due to its unpredictable course and potential functional and aesthetic impairments. The main aim is to provide a comprehensive overview of PRS, encompassing its clinical features, pathogenesis, and management techniques. We present a case of PRS in a 9-year-old female with pronounced facial asymmetry, with marked wasting and atrophy involving the entire right side of the face. CT scan revealed right sided hypoplasia of maxilla, mandible, and zygomatic arch with enophthalmos of right eye. MRI showed right temporalis, medial and lateral pterygoid, masseter, risorius, buccinator, zygomaticus major and minor, levator labii superioris, levatorangulioris and orbicularis oris muscles atrophy. The clinical presentation of PRS typically involves progressive facial atrophy, predominantly affecting the subcutaneous tissues, muscles and bones. Patients may experience various symptoms as the condition advances, including facial asymmetry, hemifacial pain, dental and ocular abnormalities and neurological manifestations. The exact etiology of PRS remains unknown, although autoimmune, genetic and vascular factors are likely contributors. Treatment of PRS needs a multidisciplinary approach involving dermatologists, plastic surgeons, neurologists, ophthalmologists, and dental specialists. Treatment options aim to alleviate symptoms, improve function and address cosmetic concerns. Surgical interventions such as autologous fat grafting, facial reconstructive procedures and orthognathic surgery have restored facial symmetry and function. Additionally, nonsurgical modalities, including botulinum toxin injections, prosthetic devices and dental interventions, may offer symptomatic relief and enhance overall quality of life.
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Affiliation(s)
- Praveen K. Sharma
- Department of Radio-Diagnosis, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, Tamil Nadu - 602105, India
| | - Aadithiyan Sekar
- Department of Radio-Diagnosis, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, Tamil Nadu - 602105, India
| | - Aashika Parveen Amir
- Department of Radio-Diagnosis, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, Tamil Nadu - 602105, India
| | - Ajay Lucas Rubben Prabhu
- Department of Radio-Diagnosis, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, Tamil Nadu - 602105, India
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Teixeira J, Costa CC, Batista M, Gonçalo M. Morphoea en coup de sabre with Adie's pupil: An exceptional association. J Eur Acad Dermatol Venereol 2023; 37:e1178-e1179. [PMID: 37170937 DOI: 10.1111/jdv.19181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/05/2023] [Indexed: 05/13/2023]
Affiliation(s)
- João Teixeira
- Department of Dermatology and Venereology, Coimbra Hospital and University Center, Coimbra, Portugal
| | - Celso Cabral Costa
- Department of Ophthalmology, Coimbra Hospital and University Center, Coimbra, Portugal
| | - Mariana Batista
- Department of Dermatology and Venereology, Coimbra Hospital and University Center, Coimbra, Portugal
| | - Margarida Gonçalo
- Department of Dermatology and Venereology, Coimbra Hospital and University Center, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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De la Garza-Ramos C, Jain A, Montazeri SA, Okromelidze L, McGeary R, Bhatt AA, Sandhu SJS, Grewal SS, Feyissa A, Sirven JI, Ritaccio AL, Tatum WO, Gupta V, Middlebrooks EH. Brain Abnormalities and Epilepsy in Patients with Parry-Romberg Syndrome. AJNR Am J Neuroradiol 2022; 43:850-856. [PMID: 35672084 DOI: 10.3174/ajnr.a7517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 03/21/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Parry-Romberg syndrome is a rare disorder characterized by progressive hemifacial atrophy. Concomitant brain abnormalities have been reported, frequently resulting in epilepsy, but the frequency and spectrum of brain involvement are not well-established. This study aimed to characterize brain abnormalities in Parry-Romberg syndrome and their association with epilepsy. MATERIALS AND METHODS This is a single-center, retrospective review of patients with a clinical diagnosis of Parry-Romberg syndrome and brain MR imaging. The degree of unilateral hemispheric atrophy, white matter disease, microhemorrhage, and leptomeningeal enhancement was graded as none, mild, moderate, or severe. Other abnormalities were qualitatively reported. Findings were considered potentially Parry-Romberg syndrome-related when occurring asymmetrically on the side affected by Parry-Romberg syndrome. RESULTS Of 80 patients, 48 (60%) had brain abnormalities identified on MR imaging, with 26 (32%) having abnormalities localized to the side of the hemifacial atrophy. Sixteen (20%) had epilepsy. MR imaging brain abnormalities were more common in the epilepsy group (100% versus 48%, P < .001) and were more frequently present ipsilateral to the hemifacial atrophy in patients with epilepsy (81% versus 20%, P < .001). Asymmetric white matter disease was the predominant finding in patients with (88%) and without (23%) epilepsy. White matter disease and hemispheric atrophy had a higher frequency and severity in patients with epilepsy (P < .001). Microhemorrhage was also more frequent in the epilepsy group (P = .015). CONCLUSIONS Ipsilateral MR imaging brain abnormalities are common in patients with Parry-Romberg syndrome, with a higher frequency and greater severity in those with epilepsy. The most common findings in both groups are white matter disease and hemispheric atrophy, both presenting with greater severity in patients with epilepsy.
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Affiliation(s)
- C De la Garza-Ramos
- From the Department of Neuroradiology (C.D.l.G.-R., A.J., S.A.M., L.O., R.M., A.A.B., S.J.S., V.G., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - A Jain
- From the Department of Neuroradiology (C.D.l.G.-R., A.J., S.A.M., L.O., R.M., A.A.B., S.J.S., V.G., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - S A Montazeri
- From the Department of Neuroradiology (C.D.l.G.-R., A.J., S.A.M., L.O., R.M., A.A.B., S.J.S., V.G., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - L Okromelidze
- From the Department of Neuroradiology (C.D.l.G.-R., A.J., S.A.M., L.O., R.M., A.A.B., S.J.S., V.G., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - R McGeary
- From the Department of Neuroradiology (C.D.l.G.-R., A.J., S.A.M., L.O., R.M., A.A.B., S.J.S., V.G., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - A A Bhatt
- From the Department of Neuroradiology (C.D.l.G.-R., A.J., S.A.M., L.O., R.M., A.A.B., S.J.S., V.G., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - S J S Sandhu
- From the Department of Neuroradiology (C.D.l.G.-R., A.J., S.A.M., L.O., R.M., A.A.B., S.J.S., V.G., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - S S Grewal
- Department of Neurologic Surgery (S.S.G.), Mayo Clinic, Jacksonville, Florida
| | - A Feyissa
- Department of Neurology (A.F., J.I.S., A.L.R., W.O.T.), Mayo Clinic, Jacksonville, Florida
| | - J I Sirven
- Department of Neurology (A.F., J.I.S., A.L.R., W.O.T.), Mayo Clinic, Jacksonville, Florida
| | - A L Ritaccio
- Department of Neurology (A.F., J.I.S., A.L.R., W.O.T.), Mayo Clinic, Jacksonville, Florida
| | - W O Tatum
- Department of Neurology (A.F., J.I.S., A.L.R., W.O.T.), Mayo Clinic, Jacksonville, Florida
| | - V Gupta
- From the Department of Neuroradiology (C.D.l.G.-R., A.J., S.A.M., L.O., R.M., A.A.B., S.J.S., V.G., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - E H Middlebrooks
- From the Department of Neuroradiology (C.D.l.G.-R., A.J., S.A.M., L.O., R.M., A.A.B., S.J.S., V.G., E.H.M.), Mayo Clinic, Jacksonville, Florida
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Pueyo-Asensio C, Saint Gerons Trecu M, Rubio Pérez MA, Matheu Fabra A. Holmes-Adie syndrome as an early manifestation of systemic lupus erythematosus. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2021; 96:167-170. [PMID: 32680767 DOI: 10.1016/j.oftal.2020.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/13/2020] [Accepted: 03/17/2020] [Indexed: 06/11/2023]
Abstract
Lupus is an autoimmune disease with multiple manifestations and multiorgan damage. Neuro-ophthalmic disorders are the less common ophthalmological manifestations of lupus. Adie's tonic pupil is mostly idiopathic and may rarely be caused by autoimmune disorders. The combination of abnormal pupil size and a decrease or loss of deep tendon reflexes is usually called Holmes-Adie syndrome. A case is reported of Holmes-Adie syndrome as an early manifestation of systemic lupus erythematosus.
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Affiliation(s)
- C Pueyo-Asensio
- Departamento de Neuroftalmología, Hospitals Universitaris de l'Esperança i del Mar, Parc de Salut Mar, Universitat Autònoma de Barcelona, Universitat Pompeu Fabra, Barcelona, España.
| | - M Saint Gerons Trecu
- Departamento de Neuroftalmología, Hospitals Universitaris de l'Esperança i del Mar, Parc de Salut Mar, Universitat Autònoma de Barcelona, Universitat Pompeu Fabra, Barcelona, España
| | - M A Rubio Pérez
- Departamento de Neurología, Hospitals Universitaris de l'Esperança i del Mar, Parc de Salut Mar, Universitat Autònoma de Barcelona, Universitat Pompeu Fabra, Barcelona, España
| | - A Matheu Fabra
- Departamento de Neuroftalmología, Hospitals Universitaris de l'Esperança i del Mar, Parc de Salut Mar, Universitat Autònoma de Barcelona, Universitat Pompeu Fabra, Barcelona, España
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Liapakis IE, Tzouganakis AC, Paschalis EI, Englander M, Christopoulos A, Gloustianou G, Kontoes P. Parry-Romberg syndrome treatment with fat transfer and a new bleaching formula. J Cosmet Dermatol 2019; 18:1424-1429. [PMID: 30770631 DOI: 10.1111/jocd.12819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 09/18/2018] [Accepted: 10/23/2018] [Indexed: 01/24/2023]
Abstract
Parry-Romberg syndrome is a hemifacial atrophy which can be complicated by melasma. We present two cases of Parry-Romberg syndrome, treated by fat transfer and bleaching of the skin using a modified "Kligman's formula." The atrophy, as well as the skin dyschromia, improved, and the results were stable.
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Affiliation(s)
- Ioannis E Liapakis
- "OpsisClinical", Plastic and Reconstructive Surgery, Heraklion-Crete, Greece
| | | | | | | | | | | | - Paraskevas Kontoes
- ISAPS, Athens, Greece.,DrK Medical Group, Athens, Greece.,Plastic, Aesthetic and Laser Surgery Department, HYGEIA Hospital, Kifisia, Athens, Greece
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6
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Hennocq Q, Facchini A, Kverneland B, Bodemer C, Picard A, Khonsari RH. Craniofacial bone atrophy in Parry Romberg syndrome demonstrated using a Bayesian hierarchical model. J Craniomaxillofac Surg 2019; 47:909-914. [DOI: 10.1016/j.jcms.2019.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 02/05/2019] [Accepted: 03/25/2019] [Indexed: 10/27/2022] Open
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7
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Jiang L, Li M, Liu Q, Liu C, Zhou J. Nummular Headache: 2 Cases With Good Beta Blocker Responses and a Narrative Review. Headache 2019; 59:593-602. [PMID: 30869172 DOI: 10.1111/head.13503] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2019] [Indexed: 01/09/2023]
Affiliation(s)
- Li Jiang
- Department of Neurology The First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Maolin Li
- Department of Neurology The First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Qing Liu
- Department of Neurology The First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Chaoyang Liu
- Department of Neurology The First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Jiying Zhou
- Department of Neurology The First Affiliated Hospital of Chongqing Medical University Chongqing China
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8
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Abstract
INTRODUCTION Cerebral hemiatrophy is an uncommon neuroimaging finding of diverse etiologies, conventionally classified into two broad categories: congenital and acquired. The authors propose an alternative pragmatic clinical approach to cerebral hemiatrophy, classifying its diverse etiologies into a single event insult such as an in utero stroke, or a progressive disorder from an inflammatory or neoplastic process, the latter of which needs urgent intervention and will be the focus of our review paper. Illustrative cases will also be presented to facilitate the understanding of the discussed disorders. CONCLUSION A systematic approach, linking both clinical and neuroimaging features, is important to facilitate the diagnostic workup of cerebral hemiatrophy. This may potentially help avoid large-scale investigations. Determining the underlying aetiology of cerebral hemiatrophy may impact treatment and prognostication as some conditions such as Rasmussen encephalitis and Parry-Romberg syndrome may benefit from timely implementation of immunomodulatory therapy.
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9
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The central nervous system manifestations of localized craniofacial scleroderma: a study of 10 cases and literature review. Pediatr Radiol 2018; 48:1642-1654. [PMID: 29971479 DOI: 10.1007/s00247-018-4177-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 02/07/2018] [Accepted: 06/10/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Localized craniofacial scleroderma is a rare pediatric disease that involves a spectrum of discoloration, fibrosis and hemiatrophy of the face and scalp. Children with localized craniofacial scleroderma may have neurological symptoms, and in this context often undergo diagnostic imaging of the brain. OBJECTIVE To catalogue neuroimaging abnormalities in patients with localized craniofacial scleroderma treated at our institution, review their clinical courses and compare this data with prior studies. MATERIALS AND METHODS Following Institutional Review Board approval, an imaging database search identified 10 patients with localized craniofacial scleroderma and neuroimaging abnormalities treated at our institution. Neuroimaging exams and the electronic medical record were reviewed for each case. RESULTS The most common indications for neuroimaging were headache or seizure (80% of cases). The most common neuroimaging abnormalities were T2-hyperintense, subcortical white matter lesions ipsilateral to the cutaneous lesion (90% of cases) on magnetic resonance imaging (MRI). Calcifications or blood products (50%), cysts (40%) and abnormal enhancement (20%) were also observed. A positron emission tomography (PET) scan obtained for a single case demonstrated diminished 18F-fluorodeoxyglucose (FDG) avidity corresponding to the dominant focus of signal abnormality on MRI. Progressive neuroimaging abnormalities were present in 30% of cases. There was no consistent relationship between changes in neurological symptoms following treatment and neuroimaging findings. CONCLUSION Our results are similar to previously published data. In the absence of new or worsening neurological symptoms, the role of neuroimaging for follow-up of localized craniofacial scleroderma is unclear. Knowledge of intracranial neuroimaging abnormalities that are commonly associated with localized craniofacial scleroderma helps to distinguish these lesions from others that have similar appearance.
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10
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Li E, Kostina Y, Lesser RL. New Ophthalmoplegia and Recurrent Ptosis After Ptosis Repair Surgery. JAMA Ophthalmol 2018; 136:952-953. [PMID: 29879280 DOI: 10.1001/jamaophthalmol.2017.6810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Emily Li
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut
| | - Yania Kostina
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut
| | - Robert L Lesser
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut.,Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
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11
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Laxer RM, Miller S, Pope E. Adie Pupil as the Initial Presentation of Localized En Coup de Sabre Scleroderma. J Rheumatol Suppl 2017; 44:1096-1097. [PMID: 28668815 DOI: 10.3899/jrheum.161442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Ronald M Laxer
- Division of Rheumatology, The Hospital for Sick Children, and Department of Paediatrics, University of Toronto;
| | - Steven Miller
- Division of Neurology, The Hospital for Sick Children, and Department of Paediatrics, University of Toronto
| | - Elena Pope
- Section of Dermatology, The Hospital for Sick Children, and Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
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12
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Adie's Tonic Pupil in Systemic Sclerosis: A Rare Association. Case Rep Ophthalmol Med 2015; 2015:491795. [PMID: 26421204 PMCID: PMC4573426 DOI: 10.1155/2015/491795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 07/27/2015] [Indexed: 11/18/2022] Open
Abstract
We report a rare association of Adie's tonic pupil in a patient with systemic sclerosis who was otherwise systemically stable. This paper is an effort to unravel whether the tonic pupil and systemic sclerosis are an association by chance (which may be the case) or systemic sclerosis is the source of the tonic pupil.
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13
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Zahlane S, Adali N, Kissani N. Parry-Romberg syndrome associated with complete agenesis of the corpus callosum: An uncommon case report. Rev Neurol (Paris) 2015; 171:737-9. [DOI: 10.1016/j.neurol.2015.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 03/21/2015] [Accepted: 04/03/2015] [Indexed: 10/23/2022]
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14
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Fea AM, Aragno V, Briamonte C, Franzone M, Putignano D, Grignolo FM. Parry Romberg syndrome with a wide range of ocular manifestations: a case report. BMC Ophthalmol 2015; 15:119. [PMID: 26340917 PMCID: PMC4560931 DOI: 10.1186/s12886-015-0093-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 07/29/2015] [Indexed: 11/18/2022] Open
Abstract
Background Parry-Romberg syndrome (PRS) is a rare disorder characterized by unilateral facial atrophy affecting the skin, subcutaneous tissue, muscles, and sometimes extending to the osteocartilaginous structures. Ocular involvement is relatively rare. Case presentation We present a case of a 23-year-old female caucasian patient with Parry Romberg syndrome and extensive ocular involvement: enophthalmos, uveitis, iris atrophy. Ultrasound biomicroscopy (UBM) demonstrated hypotrophy of the ciliary body. The ciliary body atrophy has been previously reported just once and can be an explanation for the hypotony, frequently present in these patients. Conclusions Parry Romberg syndrome is a rare multidisciplinary disease. Our case presents a full spectrum of ocular manifestations. The pathogenesis of hypotonia is discussed.
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Affiliation(s)
- Antonio Maria Fea
- Department of Clinical Sciences, Ophthalmology Institute, University of Turin, Via Juvarra 19, 10100, Turin, Italy.
| | - Vittoria Aragno
- Department of Clinical Sciences, Ophthalmology Institute, University of Turin, Via Juvarra 19, 10100, Turin, Italy.
| | - Cristina Briamonte
- Department of Clinical Sciences, Ophthalmology Institute, University of Turin, Via Juvarra 19, 10100, Turin, Italy.
| | - Mauro Franzone
- Department of Clinical Sciences, Ophthalmology Institute, University of Turin, Via Juvarra 19, 10100, Turin, Italy.
| | - Davide Putignano
- Department of Clinical Sciences, Ophthalmology Institute, University of Turin, Via Juvarra 19, 10100, Turin, Italy.
| | - Federico Maria Grignolo
- Department of Clinical Sciences, Ophthalmology Institute, University of Turin, Via Juvarra 19, 10100, Turin, Italy.
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Vix J, Mathis S, Lacoste M, Guillevin R, Neau JP. Neurological Manifestations in Parry-Romberg Syndrome: 2 Case Reports. Medicine (Baltimore) 2015; 94:e1147. [PMID: 26181554 PMCID: PMC4617071 DOI: 10.1097/md.0000000000001147] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Parry-Romberg syndrome (PRS) is a variant of morphea usually characterized by a slowly progressive course. Clinical and radiological involvement of the central nervous system may be observed in PRS. We describe 2 patients with PRS and neurological symptoms (one with trigeminal neuralgia associated with deafness, and the second with hemifacial pain associated with migraine without aura) in conjunction with abnormal cerebral MRI including white matter T2 hyperintensities and enhancement with gadolinium. Despite the absence of specific immunosuppressive treatments, both patients have presented stable imaging during follow-up without any clinical neurologic progression. We have performed a large review of the medical literature on patients with PRS and neurological involvement (total of 129 patients). Central nervous system involvement is frequent among PRS patients and is inconsistently associated with clinical abnormalities. These various neurological manifestations include seizures, headaches, movement disorders, neuropsychological symptoms, and focal symptoms. Cerebral MRI may reveal frequent abnormalities, which can be bilateral or more often homolateral to the skin lesions, localized or so widespread so as to involve the whole hemisphere: T2 hyperintensities, mostly in the subcortical white matter, gadolinium enhancement, brain atrophy, and calcifications. These radiological lesions do not usually progress over time. Steroids or immunosuppressive treatments are controversial since it remains unclear to what extent they are beneficial and there is often no neurological progression.
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Affiliation(s)
- Justine Vix
- From Department of Neurology, CHU Poitiers, University of Poitiers, Poitiers (JV, SM, JPN); Cabinet of Neurology, Niort (ML); and Department of Radiology, CHU Poitiers, University of Poitiers, Poitiers, France (RG)
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16
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Wong M, Phillips CD, Hagiwara M, Shatzkes DR. Parry Romberg Syndrome: 7 Cases and Literature Review. AJNR Am J Neuroradiol 2015; 36:1355-61. [PMID: 26066627 DOI: 10.3174/ajnr.a4297] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 01/11/2015] [Indexed: 11/07/2022]
Abstract
Parry Romberg syndrome is a rare progressive hemiatrophy of the face that typically occurs in children and young adults and has a peculiar progression that ceases without apparent cause after a highly variable period. Only a subset of patients with Parry Romberg syndrome will develop secondary neurologic or ophthalmologic symptoms, and prognosis is highly variable. Inconsistency in the pattern of atrophy and the development of associated symptoms in patients with Parry Romberg syndrome has made it challenging to diagnose, prognosticate, and treat. The precise etiology of this disease remains unknown, but some authors have implicated sympathetic cervical ganglion dysfunction, abnormal embryogenesis, autoimmune and inflammatory mechanisms, or vasculopathy as potential causes. We present 7 cases of Parry Romberg syndrome and their associated clinical and imaging findings with specific attention to the radiographic characteristics of this disease.
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Affiliation(s)
- M Wong
- From the Department of Radiology (M.W., D.R.S.), Lenox Hill Hospital, North Shore Long Island Jewish Health System, New York, New York
| | - C D Phillips
- Department of Radiology (C.D.P.), Division of Neuroradiology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
| | - M Hagiwara
- Department of Radiology (M.H.), New York University Langone Medical Center, New York, New York
| | - D R Shatzkes
- From the Department of Radiology (M.W., D.R.S.), Lenox Hill Hospital, North Shore Long Island Jewish Health System, New York, New York
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Abstract
A variety of neurologic diseases have cutaneous manifestations. These may precede, coincide with, or follow the neurologic findings. An array of autoimmune, genetic, and environmental factors play a role in expression and severity of the neurologic burden in these conditions. This chapter emphasizes congenital and genetic disorders, but we also discuss the pathophysiology and manifestation of various acquired neurocutaneous disorders with an emphasis Behcet's disease, dermatomyositis, Sjögren's syndrome, systemic lupus erythematosus, scleroderma, Parry-Romberg syndrome and Degos disease.
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Affiliation(s)
- Amre Nouh
- Department of Neurology, Hartford Hospital - University of Connecticut, Hartford CT, USA
| | - Jodi Speiser
- Section of Dermatopathology, Department of Pathology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - José Biller
- Department of Neurology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA.
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18
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Chronologic presentation of a severe case of progressive hemifacial atrophy (parry-romberg syndrome) with the loss of an eye. Case Rep Otolaryngol 2014; 2014:703017. [PMID: 25506017 PMCID: PMC4251878 DOI: 10.1155/2014/703017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 10/30/2014] [Indexed: 11/17/2022] Open
Abstract
Progressive hemifacial atrophy, also known as Parry-Romberg syndrome, is a slowly advancing degenerative disease that mostly affects the cutaneous, subcutaneous fatty tissue, muscle tissue, and bone structures on one side of the face. We describe the chronological progression of this very rare syndrome from early childhood until adulthood in a patient who developed severe atrophy and lost one eye. We also discuss the aetiology and pathophysiology of this syndrome.
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Moloney G, Lehman A, Shojania K, Ross M, McCarthy M. Corneal findings in Parry–Romberg syndrome. Can J Ophthalmol 2014; 49:e2-5. [DOI: 10.1016/j.jcjo.2013.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 09/04/2013] [Accepted: 09/15/2013] [Indexed: 10/25/2022]
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Chiu YE, Vora S, Kwon EKM, Maheshwari M. A significant proportion of children with morphea en coup de sabre and Parry-Romberg syndrome have neuroimaging findings. Pediatr Dermatol 2012; 29:738-48. [PMID: 23106674 PMCID: PMC3490222 DOI: 10.1111/pde.12001] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
En coup de sabre (ECDS) and Parry-Romberg syndrome (PRS) are variants of linear morphea on the head and neck that can be associated with neurologic manifestations. Intracranial abnormalities on computed tomography (CT) and magnetic resonance imaging (MRI) are present in a significant proportion of individuals with these conditions. We describe 32 children from our institution with ECDS or PRS; neuroimaging was performed in 21 cases. We also review 51 additional cases from the literature. Nineteen percent of the children at our institution with ECDS or PRS had intracranial abnormalities on MRI, half of whom were asymptomatic. Hyperintensities on T2-weighted sequences were the most common finding, present in all children with intracranial abnormalities on MRI. Seizures (13%) and headaches (9%) were the most common neurologic symptom. Neurologic symptoms were not correlated with neuroimaging abnormalities, with two asymptomatic children having marked MRI findings and only two of nine symptomatic children having an abnormal MRI. Similarly the severity of the superficial disease did not predict neurologic involvement; a child with subtle skin involvement had striking MRI findings and seizures, whereas another with a bony defect had no brain parenchymal involvement. Neurologic symptoms and neuroimaging abnormalities are found in a surprisingly substantial percentage of children with ECDS and PRS. Early recognition of neurologic involvement is necessary because it affects treatment choices. Because clinical predictors of intracranial abnormalities are poor, strong consideration should be given to obtaining an MRI before treatment initiation to assist in management decisions and establish a baseline examination.
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Affiliation(s)
- Yvonne E Chiu
- Division of Pediatric Dermatology, Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA.
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21
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El-Kehdy J, Abbas O, Rubeiz N. A review of Parry-Romberg syndrome. J Am Acad Dermatol 2012; 67:769-84. [PMID: 22405645 DOI: 10.1016/j.jaad.2012.01.019] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Revised: 01/19/2012] [Accepted: 01/27/2012] [Indexed: 11/15/2022]
Abstract
Parry-Romberg syndrome, also known as progressive hemifacial atrophy, is a rare disorder characterized by unilateral facial atrophy affecting the skin, subcutaneous tissue, muscles, and sometimes extending to the osteocartilaginous structures. It has been associated with various systemic manifestations, particularly neurologic, ophthalmologic and maxillofacial. In this article, we review Parry-Romberg syndrome with its associated findings (neurologic, ophthalmologic, cardiac, rheumatologic, endocrinologic, infectious, orthodontic and maxillofacial, and autoimmune), underlying cause, differential diagnoses (en coup de sabre, scleroderma, and Rasmussen encephalitis), and therapeutic options.
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22
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Sharma M, Bharatha A, Antonyshyn OM, Aviv RI, Symons SP. Case 178: Parry-Romberg Syndrome. Radiology 2012; 262:721-5. [DOI: 10.1148/radiol.11092104] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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23
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Blitstein MK, Vecchione MJ, Tung GA. Parry-Romberg syndrome. APPLIED RADIOLOGY 2011. [DOI: 10.37549/ar1797] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Bosman T, Van Bei Jnum J, Van Walderveen MAA, Brouwer PA. Giant intracranial aneurysm in a ten-year-old boy with parry romberg syndrome. A case report and literature review. Interv Neuroradiol 2009; 15:165-73. [PMID: 20465894 DOI: 10.1177/159101990901500205] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2009] [Accepted: 04/19/2009] [Indexed: 11/17/2022] Open
Abstract
SUMMARY Parry-Romberg syndrome (PRS) is a rare acquired syndrome consisting of progressive hemiatrophy of the face.We present a child with PRS and progressive neurological deficit caused by a giant intracranial aneurysm and reviewed the literature concerning all intracranial abnormalities in patients with PRS.A literature search identified 27 articles reporting on 88 patients ith PRS and intracranial abnormalities. Ipsilateral brain calcification and hemiatrophy are the most prominent features on CT scan and hyperintense white matter lesions are most frequently seen on T2-weighted MRI. Although lacking precise prevalence data, intracranial abnormalities are not uncommon in patients with PRS. We found three other PRS patients with intracranial aneurysms. Our case and literature search suggests a possible association between PRS and intracranial aneurysms. We consider this association important for clinical practice and recommend including intracranial vascular diseases in the differential diagnosis when dealing with a PRS patient with neurological symptoms.
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Affiliation(s)
- T Bosman
- Department of Neurology, Leiden University Medical Centre; Leiden, The Netherlands -
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Bergler-Czop B, Lis-Swiety A, Brzezińska-Wcisło L. Scleroderma linearis: hemiatrophia faciei progressiva (Parry-Romberg syndrom) without any changes in CNS and linear scleroderma "en coup de sabre" with CNS tumor. BMC Neurol 2009; 9:39. [PMID: 19635150 PMCID: PMC2723072 DOI: 10.1186/1471-2377-9-39] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Accepted: 07/27/2009] [Indexed: 11/17/2022] Open
Abstract
Background Hemifacial atrophy (Parry-Romberg syndrome) is a relatively rare disease. The etiology of the disease is not clear. Some authors postulate its relation with limited scleroderma linearis. Linear scleroderma "en coup de sabre" is characterized by clinical presence of most commonly one-sided linear syndrome. In a number of patients, neurological affection is the medium of the disease. The treatment of both scleroderma varieties is similar to the treatment of limited systemic sclerosis. Case presentation We present two cases of a disease: a case of a 49-year-old woman with a typical image of hemifacial atrophy, without any changes of the nervous system and a case of a 33-year-old patient with an "en coup de sabre" scleroderma and with CNS tumor. Conclusion We described typical cases of a rare diseases, hemifacial atrophy and "en coup de sabre" scleroderma. In the patient diagnosed with Parry-Romberg syndrome, with Borrelia burgdoferi infection and with minor neurological symptoms, despite a four-year case history, there was a lack of proper diagnosis and treatment. In the second patient only skin changes without any neurological symptoms could be observed and only a precise neurological diagnosis revealed the presence of CNS tumor.
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Affiliation(s)
- Beata Bergler-Czop
- Department of Dermatology Silesian Medical University in Katowice, Francuska Street 20/24, 40-027 Katowice, Poland.
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26
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Kee C, Hwang JM. Parry-Romberg syndrome presenting with recurrent exotropia and torticollis. J Pediatr Ophthalmol Strabismus 2008; 45:368-70. [PMID: 19043950 DOI: 10.3928/01913913-20081101-10] [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] [Indexed: 11/20/2022]
Abstract
Parry-Romberg syndrome, or progressive facial hemiatrophy, is a unilateral, slowly progressive atrophy that affects skin, subcutaneous tissues, muscles, and bones. The authors describe an 8-year-old girl with Parry-Romberg syndrome, amblyopia, recurrent exotropia, and torticollis, and stress that the association between this syndrome and amblyopia, recurrent exotropia, and torticollis should be recognized.
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Affiliation(s)
- Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea
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27
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Sarikaya B, Sarikaya S. Dyke-Davidoff-Masson syndrome revisited: a didactic case with interesting imaging findings. ACTA ACUST UNITED AC 2007; 51 Spec No.:B10-3. [PMID: 17875125 DOI: 10.1111/j.1440-1673.2007.01834.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We present an adult female patient with Dyke-Davidoff-Masson syndrome with distinct features, and discuss neuroimaging findings some of which are unique to this syndrome.
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Affiliation(s)
- B Sarikaya
- Gaziosmanpasa University, School of Medicine, Radiology Department, Tokat, Turkey.
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28
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Korkmaz C. Linear scleroderma 'en coup de sabre' associated with cerebral and ocular vasculitis. Scand J Rheumatol 2007; 36:159-60; author reply 160. [PMID: 17476628 DOI: 10.1080/03009740601179639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Schnitzler E, Reinhardt F, Tomandl B, Gusek-Schneider G. Kranielle Bildgebung und Serologie bei Pupillotonie nicht hilfreich. Ophthalmologe 2005; 102:1083-9. [PMID: 15889260 DOI: 10.1007/s00347-005-1224-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Tonic pupil (TP) is a common disorder of parasympathetic innervation. In contrast to textbook recommendations, cranial imaging is still being performed in most of the patients with TP. The intention of the present study is to show that cranial imaging is of no benefit. PATIENTS AND METHODS The medical records of 33 patients with TP were analyzed retrospectively. All patients had undergone a complete ophthalmological, orthoptic, and neurological investigation. Cranial imaging was performed by computed tomography or magnetic resonance imaging. Serology tests were carried out in some of the patients. RESULTS Diagnostic imaging provided no additional data revealing the underlying cause of TP. CONCLUSIONS Cranial imaging in isolated tonic pupil is not helpful. Because of therapeutic implications, diagnostic evaluation can be recommended only in patients older than 50 years to exclude giant cell arteritis and syphilis.
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Affiliation(s)
- E Schnitzler
- Augenklinik mit Poliklinik, Friedrich-Alexander-Universität Erlangen-Nürnberg
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Gonul M, Dogan B, Izci Y, Varol G. Parry-Romberg syndrome in association with anti-dsDNA antibodies: a case report. J Eur Acad Dermatol Venereol 2005; 19:740-2. [PMID: 16268883 DOI: 10.1111/j.1468-3083.2005.01290.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Parry-Romberg syndrome (PRS) is a rare and puzzling disorder that is characterized by progressive hemifacial atrophy. It involves mainly some or all tissues of one side of the face. A case of 21-year-old Caucasian man with hemifacial atrophy in the right facial region is reported. Serological studies with anti-single-stranded DNA (anti-ssDNA), anti-double-stranded DNA (anti-dsDNA), anticentromere (ACA) and antinuclear (ANA) antibodies were done. Anti-dsDNA antibodies was found positive, but the others were negative. Rheumatoid factor (RF) was also negative. Since PRS is rare and its association with anti-dsDNA antibodies was not reported before, this case appears to be the first report.
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Affiliation(s)
- M Gonul
- Department of Dermatology, Numune Research and Training Hospital, Ankara, Turkey
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31
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Korkmaz C, Adapinar B, Uysal S. Beneficial Effect of Immunosuppressive Drugs on Parry-Romberg Syndrome: A Case Report and Review of the Literature. South Med J 2005; 98:940-2. [PMID: 16217992 DOI: 10.1097/01.smj.0000177355.43001.ff] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Progressive facial hemiatrophy, also known as Parry-Romberg syndrome (PRS), is characterized by slowly progressive atrophy of one side of the face, primarily involving the subcutaneous tissues and fat. Involvement of the central nervous system with impairment of neurologic function occurs infrequently. At present, there is no agreement as to whether PRS is a distinct entity or a clinical variant of linear scleroderma en coup de sabre. The exact reason for PRS has not yet been determined; therefore, no suitable treatment exists. We observed beneficial effects of immunosuppressive agents on neurologic lesions in particular in a patient with PRS who presented with immunoinflammatory findings and neurologic involvement, apart from cutaneous manifestations.
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Affiliation(s)
- Cengiz Korkmaz
- Division of Rheumatology, Department of Internal Medicine, Osmangazi University Medical Faculty, Eskişehir, Turkey.
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Chbicheb M, Gelot A, Rivier F, Roubertie A, Humbertclaude V, Coubes P, Echenne B. Syndrome de Parry-Romberg et épilepsie. Rev Neurol (Paris) 2005; 161:92-7. [PMID: 15678008 DOI: 10.1016/s0035-3787(05)84980-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Parry-Romberg's syndrome or progressive facial hemiatrophy is a rare disorder of unknown etiology which may be accompanied by neurological complications, frequently epilepsy, usually focal refractory epilepsy. The associated brain lesions are located on the same side as the half face atrophy and may progress. OBSERVATION We report the cases of two patients with Parry-Romberg's syndrome and epilepsy. Neurosurgery was performed in one patient, enabling a histological study. CONCLUSION The link between Parry-Romberg's syndrome and epilepsy is discussed and the neurodevelopmental theory with vascular dysgenesis is suggested.
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Affiliation(s)
- M Chbicheb
- Service de Médecine C, Unité de Neurologie, Centre Hospitalier, Narbonne
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Grosso S, Fioravanti A, Biasi G, Conversano E, Marcolongo R, Morgese G, Balestri P. Linear scleroderma associated with progressive brain atrophy. Brain Dev 2003; 25:57-61. [PMID: 12536035 DOI: 10.1016/s0387-7604(02)00147-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Linear scleroderma (LS) is characterized by scleroatrophic lesions affecting limbs and legs, unilaterally. Neurological involvement may be associated with ipsilateral facial and skull involvement in disorders referred to clinically as LS 'en coup de sabre', and Parry-Romberg syndrome. We report a child with LS presenting with a severe neurological disorder characterized by epilepsy, progressive mental deterioration and a rapid process of atrophy involving the ipsilateral cerebral hemisphere, but not associated with an overlying facial structure involvement. Functional brain studies showed a reduction in the diameter of the left internal carotid and of the left middle cerebral artery. Our observations suggest that neuroimaging studies should be considered in all patients with linear scleroderma, and such studies become necessary when neurological symptoms occur.
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Affiliation(s)
- Salvatore Grosso
- Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Viale M. Bracci - Le scotte, 53100 Siena, Italy
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