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da Fonseca IO, Luvizutto GJ, Souza IP, Trindade AP, de Freitas CCM, Bazan R, Modolo GP. Neurofibromatosis type 1, fibromuscular dysplasia, and ischemic stroke: an association lost in time? A case report. J Vasc Bras 2023; 22:e20220118. [PMID: 37312835 PMCID: PMC10259178 DOI: 10.1590/1677-5449.202201182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 03/27/2023] [Indexed: 06/15/2023] Open
Abstract
Neurofibromatosis Type 1 (NF1) is a rare cause of ischemic stroke (IS) in the general population. We report a case of a young patient with NF1 in whom IS was caused by fibromuscular dysplasia. An angiographic study demonstrated occlusion in the right internal carotid artery (ICA), just after its origin, and the left ICA, just before the intracranial portion, and brain magnetic resonance imaging showed the limits of an area of brain infarction in the right frontoparietal region. Despite these concomitant neuroimaging findings, this association is rare, and it is difficult to establish the contribution to the outcome made by each of these diseases, which treatment is the best to implement, or what prognosis is.
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Affiliation(s)
| | | | | | - André Petean Trindade
- Universidade Estadual Paulista – UNESP, São Paulo, SP, Brasil.
- Instituto de Diagnóstico Sorocaba, Sorocaba, SP, Brasil.
| | | | - Rodrigo Bazan
- Academia Brasileira de Neurologia – ABN, Departamento Científico em Reabilitação Neurológica, São Paulo, SP, Brasil.
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Brosius SN, Vossough A, Fisher MJ, Lang SS, Beslow LA, George BJ, Ichord R. Characteristics of Moyamoya Syndrome in Pediatric Patients With Neurofibromatosis Type 1. Pediatr Neurol 2022; 134:85-92. [PMID: 35849956 DOI: 10.1016/j.pediatrneurol.2022.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/09/2022] [Accepted: 05/30/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Moyamoya syndrome (MMS) is a progressive cerebral arteriopathy with increased incidence in children with neurofibromatosis type 1 (NF1). Despite the potential for significant neurological morbidity including stroke, little is known about the natural history, and no guidelines exist for screening and management of NF1-associated MMS. METHODS We identified 152 literature cases of children aged ≤18 years with NF1-associated MMS. A meta-analysis was performed evaluating clinical and neuroimaging findings and patient outcomes. Data from 19 patients with NF1-associated MMS from our center treated from January 1995 to July 2020 were abstracted via chart review and similarly analyzed for clinical and neuroimaging features. RESULTS Meta-analysis of literature cases showed a median age of MMS diagnosis of 6 years (interquartile range 3 to 10.8 years). Optic pathway gliomas were more common in patients with MMS (42%) compared with historical prevalence. Stroke or transient ischemic attack (TIA) was present at diagnosis in 46%. TIA and stroke were more common in patients with bilateral versus unilateral MMS (62% vs 34%, P = 0.001) and in children aged <4 years versus those aged ≥4 years (61% vs 40%, P = 0.02). Compared with the literature cases, our cohort was more frequently asymptomatic (42% vs 25%) and less likely to present with TIA or stroke (32% vs 46%) at diagnosis. CONCLUSIONS These data suggest there is an aggressive form of MMS in children with NF1 <4 years of age. Therefore, early screening should be considered to facilitate early detection and treatment of cerebral arteriopathy.
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Affiliation(s)
- Stephanie N Brosius
- Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | - Arastoo Vossough
- Department of Radiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania; Division of Neuroradiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Michael J Fisher
- Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Shih-Shan Lang
- Department of Neurosurgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania; Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lauren A Beslow
- Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Neurology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania; Division of Child Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Brandon J George
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania; Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Rebecca Ichord
- Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Neurology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania; Division of Child Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Vargiami E, Sapountzi E, Samakovitis D, Batzios S, Kyriazi M, Anastasiou A, Zafeiriou DI. Moyamoya syndrome and neurofibromatosis type 1. Ital J Pediatr 2014; 40:59. [PMID: 24952383 PMCID: PMC4104827 DOI: 10.1186/1824-7288-40-59] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 04/13/2014] [Indexed: 11/10/2022] Open
Abstract
Neurofibromatosis type 1 (NF1) is the most prevalent autosomal dominant genetic disorder among humans. NF1 vasculopathy is a significant but underrecognized complication of the disease, affecting both arterial and venous blood vessels of all sizes. Moyamoya syndrome is a cerebral vasculopathy that is only rarely observed in association with NF1, particularly in the pediatric age range. Herein, we report of a 5-year-old female with NF1 and moyamoya syndrome and we briefly review the existing literature.
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Affiliation(s)
- Euthymia Vargiami
- 1st Department of Pediatrics, Aristotle University of Thessaloniki, Egnatia St. 106, Thessaloniki 54622, Greece
| | - Evdoxia Sapountzi
- 1st Department of Pediatrics, Aristotle University of Thessaloniki, Egnatia St. 106, Thessaloniki 54622, Greece
| | - Dimitris Samakovitis
- 1st Department of Pediatrics, Aristotle University of Thessaloniki, Egnatia St. 106, Thessaloniki 54622, Greece
| | - Spyros Batzios
- 1st Department of Pediatrics, Aristotle University of Thessaloniki, Egnatia St. 106, Thessaloniki 54622, Greece
| | - Maria Kyriazi
- 1st Department of Pediatrics, Aristotle University of Thessaloniki, Egnatia St. 106, Thessaloniki 54622, Greece
| | | | - Dimitrios I Zafeiriou
- 1st Department of Pediatrics, Aristotle University of Thessaloniki, Egnatia St. 106, Thessaloniki 54622, Greece
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Cerebrovascular stenosis in neurofibromatosis type 1 and utility of magnetic resonance angiography: our experience and literature review. Radiol Med 2013; 119:415-21. [PMID: 24297593 DOI: 10.1007/s11547-013-0358-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 05/13/2013] [Indexed: 12/25/2022]
Abstract
PURPOSE Neurofibromatosis type 1 (NF1) is a multisystem autosomal dominant disorder that primarily involves the skin and the nervous system. Development of cerebral arterial stenosis is a potentially deadly complication of NF1, which is frequently underestimated. The aim of our paper is to report the frequency of this cerebrovascular disease in a series of patients affected by NF1, using magnetic resonance angiography (MRA). A review of the literature was also performed, focused on the usefulness of MRA in NF1 patients. MATERIALS AND METHODS Among 125 patients with NF1 (clinical diagnosis according to the standard National Institutes of Health criteria), 81 (65%) were studied with brain MRI (magnetic resonance imaging) and MRA using a 1.5 T magnet. RESULTS Multiple intracranial arterial stenoses were found in six patients (7.4%). In our study, MRA proved to be critical, especially for the detection of stenoses in the branches of the Circle of Willis. CONCLUSION Few case series have investigated the incidence of vascular complications of NF1, and most of them have used MRI. We suggest adding MRA to the brain imaging of all these patients, as stenoses of the branches of the Circle of Willis are often undetectable by MRI only.
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Smith M, Heran MKS, Connolly MB, Heran HK, Friedman JM, Jett K, Lyons CJ, Steinbok P, Armstrong L. Cerebrovasculopathy in NF1 associated with ocular and scalp defects. Am J Med Genet A 2010; 155A:380-5. [PMID: 21271658 DOI: 10.1002/ajmg.a.33788] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Accepted: 10/03/2010] [Indexed: 11/09/2022]
Abstract
Vascular lesions are uncommon in children with neurofibromatosis 1 (NF1) but can cause serious complications. We report on a child with NF1 who presented at 18 months of age with symptomatic stenosis of the left middle cerebral artery and its branches, and associated moyamoya disease. She also had bilateral posterior embryotoxon, left corneal opacity (Peters anomaly), and cutis aplasia of the left scalp. All of these defects may have occurred as a result of disruption of the blood supply caused by NF1 vasculopathy prenatally. This constellation of vascular anomalies has not been previously reported in a patient with NF1.
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Affiliation(s)
- Matt Smith
- Provincial Medical Genetics Programme, University of British Columbia, Vancouver, British Columbia, Canada
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Millichap JG. CVA with Neurofibromatosis Type I. Pediatr Neurol Briefs 1992. [DOI: 10.15844/pedneurbriefs-6-7-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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