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I Kh Almadhoun MK, Hattab AW, Alazzeh NN, Aladwan ST, Ta'amneh O. Diagnosis and Treatment of Dandy-Walker Syndrome With Two Types of Ventriculoperitoneal (VP) Shunts: A Case Report. Cureus 2023; 15:e46564. [PMID: 37933337 PMCID: PMC10625663 DOI: 10.7759/cureus.46564] [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] [Accepted: 10/05/2023] [Indexed: 11/08/2023] Open
Abstract
Dandy-Walker Syndrome (DWS) is a rare congenital neurological condition characterized by cerebellar and posterior fossa malformations, often presenting a variable clinical spectrum. Common complications include hydrocephalus, necessitating interventions like ventriculoperitoneal (VP) shunts, and endoscopic third ventriculostomy (ETV). We describe the case of a five-month-old infant conceived through in vitro fertilization (IVF), initially presenting with cold-like symptoms, later diagnosed with DWS. The patient underwent VP shunt placement for hydrocephalus management, with subsequent complications requiring shunt revisions and ETV. Vigilant monitoring and timely interventions were crucial for a favorable outcome, highlighting the challenges in diagnosing and managing DWS and the importance of tailored treatment strategies.
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Affiliation(s)
| | | | | | | | - Osamah Ta'amneh
- General Practice, National Center for Diabetes, Endocrinology and Genetic Diseases, Irbid, JOR
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Fu F, Chen C, Du K, Li LS, Li R, Lei TY, Deng Q, Wang D, Yu QX, Yang X, Han J, Pan M, Zhen L, Zhang LN, Li J, Li FT, Zhang YL, Jing XY, Li FC, Li DZ, Liao C. Ndufa4 Regulates the Proliferation and Apoptosis of Neurons via miR-145a-5p/Homer1/Ccnd2. Mol Neurobiol 2023; 60:2986-3003. [PMID: 36763283 PMCID: PMC10122635 DOI: 10.1007/s12035-023-03239-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 01/09/2023] [Indexed: 02/11/2023]
Abstract
The Dandy-Walker malformation (DWM) is characterized by neuron dysregulation in embryonic development; however, the regulatory mechanisms associated with it are unclear. This study aimed to investigate the role of NADH dehydrogenase 1 alpha subcomplex 4 (NDUFA4) in regulating downstream signaling cascades and neuronal proliferation and apoptosis. Ndufa4 overexpression promoted the proliferation of neurons and inhibited their apoptosis in vitro, which underwent reverse regulation by the Ndufa4 short hairpin RNAs. Ndufa4-knockout (KO) mice showed abnormal histological alterations in the brain tissue, in addition to impaired spatial learning capacity and exploratory activity. Ndufa4 depletion altered the microRNA expressional profiles of the cerebellum: Ndufa4 inhibited miR-145a-5p expression both in the cerebellum and neurons. miR-145a-5p inhibited the proliferation of neurons and promoted their apoptosis. Ndufa4 promoted and miR-145a-5p inhibited the expression of human homer protein homolog 1 and cyclin D2 in neurons. Thus, Ndufa4 promotes the proliferation of neurons and inhibits their apoptosis by inhibiting miR-145a-5p, which directly targets and inhibits the untranslated regions of Homer1 and Ccnd2 expression.
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Affiliation(s)
- Fang Fu
- Department of Prenatal Diagnostic Centre, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 of Jinsui Road of Guangzhou, Guangzhou, 510623, Guangdong, China
| | - Chen Chen
- Department of Respirator, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Kun Du
- Department of Prenatal Diagnostic Centre, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 of Jinsui Road of Guangzhou, Guangzhou, 510623, Guangdong, China
| | - Lu-Shan Li
- Department of Prenatal Diagnostic Centre, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 of Jinsui Road of Guangzhou, Guangzhou, 510623, Guangdong, China
| | - Ru Li
- Department of Prenatal Diagnostic Centre, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 of Jinsui Road of Guangzhou, Guangzhou, 510623, Guangdong, China
| | - Ting-Ying Lei
- Department of Prenatal Diagnostic Centre, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 of Jinsui Road of Guangzhou, Guangzhou, 510623, Guangdong, China
| | - Qiong Deng
- Department of Prenatal Diagnostic Centre, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 of Jinsui Road of Guangzhou, Guangzhou, 510623, Guangdong, China
| | - Dan Wang
- Department of Prenatal Diagnostic Centre, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 of Jinsui Road of Guangzhou, Guangzhou, 510623, Guangdong, China
| | - Qiu-Xia Yu
- Department of Prenatal Diagnostic Centre, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 of Jinsui Road of Guangzhou, Guangzhou, 510623, Guangdong, China
| | - Xin Yang
- Department of Prenatal Diagnostic Centre, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 of Jinsui Road of Guangzhou, Guangzhou, 510623, Guangdong, China
| | - Jin Han
- Department of Prenatal Diagnostic Centre, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 of Jinsui Road of Guangzhou, Guangzhou, 510623, Guangdong, China
| | - Min Pan
- Department of Prenatal Diagnostic Centre, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 of Jinsui Road of Guangzhou, Guangzhou, 510623, Guangdong, China
| | - Li Zhen
- Department of Prenatal Diagnostic Centre, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 of Jinsui Road of Guangzhou, Guangzhou, 510623, Guangdong, China
| | - Li-Na Zhang
- Department of Prenatal Diagnostic Centre, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 of Jinsui Road of Guangzhou, Guangzhou, 510623, Guangdong, China
| | - Jian Li
- Department of Prenatal Diagnostic Centre, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 of Jinsui Road of Guangzhou, Guangzhou, 510623, Guangdong, China
| | - Fa-Tao Li
- Department of Prenatal Diagnostic Centre, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 of Jinsui Road of Guangzhou, Guangzhou, 510623, Guangdong, China
| | - Yong-Ling Zhang
- Department of Prenatal Diagnostic Centre, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 of Jinsui Road of Guangzhou, Guangzhou, 510623, Guangdong, China
| | - Xiang-Yi Jing
- Department of Prenatal Diagnostic Centre, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 of Jinsui Road of Guangzhou, Guangzhou, 510623, Guangdong, China
| | - Fu-Cheng Li
- Department of Prenatal Diagnostic Centre, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 of Jinsui Road of Guangzhou, Guangzhou, 510623, Guangdong, China
| | - Dong-Zhi Li
- Department of Prenatal Diagnostic Centre, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 of Jinsui Road of Guangzhou, Guangzhou, 510623, Guangdong, China
| | - Can Liao
- Department of Prenatal Diagnostic Centre, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 of Jinsui Road of Guangzhou, Guangzhou, 510623, Guangdong, China.
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Abstract
ABSTRACT Dandy-Walker malformation is a rare congenital anomaly affecting the posterior fossa, occurring in one in 30,000 births. Its hallmark characteristics include hypoplasia of the vermis, dilation of the fourth ventricle, and an enlarged posterior fossa. This case study describes a finding of Dandy-Walker malformation during a workup of encephalopathy in a patient on veno-venous extracorporeal membrane oxygenation for acute respiratory distress syndrome.
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Affiliation(s)
- Eric Hochberg
- Eric Hochberg and Erin Niles practice in the Lung Rescue Unit, an adult veno-venous extracorporeal membrane oxygenation unit at the University of Maryland's R Adams Cowley Shock Trauma Center in Baltimore, Md. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Belser-Ehrlich J, Adrian Lafo J, Mangal P, Bradley M, Wicklund M, Bowers D. Neurocognitive profile of a man with Dandy-Walker malformation: Evidence of subtle cerebellar cognitive affective syndrome. Clin Neuropsychol 2019; 34:591-610. [PMID: 30821610 DOI: 10.1080/13854046.2019.1569724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background: The Dandy-Walker Malformation (DWM) is a congenital birth malformation that is characterized by a triad of features: cerebellar dysgenesis, cystic dilation of the fourth ventricle, and an enlarged posterior fossa that displaces the dural sinuses and the tentorium. Despite this defining triad, clinical presentation can be highly heterogeneous in part due to severity of structural changes. To date, there been limited consideration of cognitive-behavioral symptoms of DWM in relation to nonmotor functions of the cerebellum, specifically cerebellar cognitive affective syndrome (CCAS).Method: In this case study, we describe the neuropsychological and behavioral profile of a 48-year-old man with DWM who was seen due to concerns, expressed solely by the patient's father, about his son's atypical housing, employment and social skills.Results: Neuropsychological test findings revealed high average intellect on standard intellectual measures (WAIS-IV), with stronger verbal (superior) than perceptual reasoning (average) skills. Across all cognitive domains, performance was generally within expectations, although bilateral fine motor skills were impaired. In contrast, he exhibited weaknesses on nontraditional neuropsychological measures assessing orbitofrontal-limbic circuitry, including reward sensitivity decision making and indices of threat-related emotional physiology.Conclusions: Through the use of traditional and nontraditional neuropsychological measures, subtle cognitive weaknesses in fronto-executive and affective regulation were illuminated and likely explain the patient's functional difficulties. Etiologically, these findings are consistent with the nonmotor functions of the cerebellum as described by CCAS.
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Affiliation(s)
- Janna Belser-Ehrlich
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Jacob Adrian Lafo
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Paul Mangal
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Margaret Bradley
- Department of Psychology, University of Florida, Gainesville, FL, USA
| | - Meredith Wicklund
- Department of Neurology, University of Florida, Gainesville, FL, USA
| | - Dawn Bowers
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA.,Department of Neurology, University of Florida, Gainesville, FL, USA
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Dandy-Walker Syndrome: A Review of New Diagnosis and Management in Children. JOURNAL OF PEDIATRICS REVIEW 2018. [DOI: 10.5812/jpr.63486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Batmaz M, Balçik ZE, Özer Ü, Hamurişçi Yalçin B, Özen Ş. Dandy-Walker Malformation Presenting with Affective Symptoms. ACTA ACUST UNITED AC 2017; 54:277-281. [PMID: 29033643 DOI: 10.5152/npa.2017.18114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 06/29/2016] [Indexed: 11/22/2022]
Abstract
Dandy-Walker malformation is defined by enlarged posterior fossa, cystic dilatation of the fourth ventricle, and cerebellar hypoplasia. Although developmental delay and mental retardation are common in Dandy-Walker malformation cases, other comorbid psychiatric conditions have been rarely reported. There are limited numbers of case reports about comorbidity of bipolar disorder with Dandy-Walker malformation in the literature. Herein, a Dandy-Walker malformation case presenting affective symptoms is reported, and psychiatric symptoms which might be seen in this rare malformation are discussed along with diagnosis, treatment, and follow-up processes. A 27-year-old male patient, hospitalized for compulsory treatment, had been diagnosed with Dandy-Walker malformation in childhood. First complaints were attention deficiency, behavioral problems, learning difficulties; and manic and depressive episodes have occurred during follow-ups. He recently complained of decreased need for sleep, irritability, and increased speed of thought, and psychiatric examination was consistent with manic episode. Cranial computed tomography (CT) revealed bilateral ventriculomegaly, enlarged third and fourth ventricles with posterior fossa cyst, and cerebellar hypoplasia. His treatment included 30 mg/day aripiprazole, 1000 mg/day valproic acid, 200 mg/day quetiapine, 4 mg/day biperiden, and 100 mg/month paliperidone palmitate. Beside its traditional role in the regulation of coordination and motor functions, cerebellum is increasingly emphasized for its involvement in the mood regulation. Thus, as seen in Dandy-Walker malformation, cerebellar anomalies are suggested to play a role in the pathophysiology of mood disorders. Further studies are needed to better understand the relationship between mood disorders and cerebellum. Moreover, treatment options should be considered carefully in terms of resistance to treatment and potential side effects, for psychiatric disorders occurring in these cases; and detailed examinations, including cranial imaging, would be beneficial in bipolar cases with early onset, unresponsiveness to treatment, presenting atypical symptoms, mental retardation, and developmental delay as well as neurological symptoms and signs.
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Affiliation(s)
- Mert Batmaz
- Department of Psychiatry, Bakırköy Prof. Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital, İstanbul, Turkey
| | - Zeynep Ezgi Balçik
- Department of Neurology, Bakırköy Prof. Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital, İstanbul, Turkey
| | - Ürün Özer
- Department of Psychiatry, Bakırköy Prof. Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital, İstanbul, Turkey
| | - Burcu Hamurişçi Yalçin
- Department of Psychiatry, Bakırköy Prof. Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital, İstanbul, Turkey
| | - Şakir Özen
- Department of Psychiatry, Bakırköy Prof. Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital, İstanbul, Turkey
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McClelland S, Passias PG, Errico TJ, Bess RS, Protopsaltis TS. Inpatient versus Outpatient Anterior Cervical Discectomy and Fusion: A Perioperative Complication Analysis of 259,414 Patients From the Healthcare Cost and Utilization Project Databases. Int J Spine Surg 2017; 11:11. [PMID: 28765795 DOI: 10.14444/4011] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Anterior cervical discectomy and fusion (ACDF) is one of the most common operations utilized to address pathology of the cervical spine. Few reports have attempted to compare complications associated with inpatient versus outpatient ACDF. METHODS The Nationwide Inpatient Sample (NIS) from 2001-2012 and the State Ambulatory Services Database (SASD) for New Jersey (NJ) from 2003-2012 were used for analysis. Patients receiving ACDF (defined as anterior cervical fusion (ICD-0 code=81.02) + excision of intervertebral disc (80.51)) were segmented into an inpatient group derived from the NIS, and an outpatient group derived from the NJ SASD. Patients receiving > 2 levels fused (ICD-9 codes 81.63-81.64), or surgery for cancer (ICD-9 codes 140-239), or trauma (ICD-9 codes=805.0-806.9) were excluded. Propensity score matching (PSM) was used to adjust the analysis for patient age, race, sex, primary payer for care, and number of medical diagnoses. RESULTS Of the 94,492,438 inpatients comprising the NIS from 2001-2012, 257,398 received ACDF. Of the 4,194,207 outpatients comprising the NJ SASD, 2,016 received ACDF. PSM of 10,080 patients (all 2,016 SASD and 8,064 from NIS) was performed, and subsequent analysis revealed that durotomy (P=0.001;OR=0.81), paraplegia, postoperative infection, hematoma/seroma (OR=0.14), respiratory complications, acute posthemorrhagic anemia and red blood cell transfusion (all P<0.001) were less frequent in outpatient versus inpatient ACDF (p<0.05). These results were similar to an unmatched analysis involving all of the NIS patients. CONCLUSION Accepting the limitations of the NIS and SASD (inability to distinguish between one and two-level fusions, no long-term follow-up, potential selection bias, disparities between inpatient and outpatient ACDF populations), these findings indicate that for 1-2 level ACDF, perioperative complications, including durotomy, paraplegia, hematoma, and acute posthemorrhagic anemia were more commonly reported following inpatient ACDF. Future studies involving outpatient analysis of several states will be necessary to determine whether these results of outpatient ACDF are applicable nationwide.
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Affiliation(s)
- Shearwood McClelland
- Division of Spine Surgery, Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY
| | - Peter G Passias
- Division of Spine Surgery, Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY
| | - Thomas J Errico
- Division of Spine Surgery, Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY
| | - R Shay Bess
- Division of Spine Surgery, Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY
| | - Themistocles S Protopsaltis
- Division of Spine Surgery, Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY
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McClelland S, Ukwuoma OI, Lunos S, Okuyemi KS. Mortality of Dandy-Walker syndrome in the United States: Analysis by race, gender, and insurance status. J Neurosci Rural Pract 2015; 6:182-5. [PMID: 25883477 PMCID: PMC4387808 DOI: 10.4103/0976-3147.153224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Dandy-Walker syndrome (DWS) is a congenital disorder often diagnosed in early childhood. Typically manifesting with signs/symptoms of increased intracranial pressure, DWS is catastrophic unless timely neurosurgical care can be administered via cerebrospinal fluid (CSF) drainage. The rates of mortality, adverse discharge disposition (ADD), and CSF drainage in DWS may not be uniform regardless of race, gender or insurance status; such differences could reflect disparities in access to neurosurgical care. This study examines these issues on a nationwide level. MATERIALS AND METHODS The Kids' Inpatient Database spanning 1997-2003 was used for analysis. Only patients admitted for DWS (ICD-9-CM = 742.3) were included. Multivariate analysis was adjusted for several variables, including patient age, race, sex, admission type, primary payer, income, and hospital volume. RESULTS More than 14,000 DWS patients were included. Increasing age predicted reduced mortality (OR = 0.87; P < 0.05), ADD (OR = 0.96; P < 0.05), and decreased likelihood of receiving CSF drainage (OR = 0.86; P < 0.0001). Elective admission type predicted reduced mortality (OR = 0.29; P = 0.0008), ADD (OR = 0.68; P < 0.05), and increased CSF drainage (OR = 2.02; P < 0.0001). African-American race (OR = 1.20; P < 0.05) and private insurance (OR = 1.18; P < 0.05) each predicted increased likelihood of receiving CSF drainage, but were not predictors of mortality or ADD. Gender, income, and hospital volume were not significant predictors of DWS outcome. CONCLUSION Increasing age and elective admissions each decrease mortality and ADD associated with DWS. African-American race and private insurance status increase access to CSF drainage. These findings contradict previous literature citing African-American race as a risk factor for mortality in DWS, and emphasize the role of private insurance in obtaining access to potentially lifesaving operative care.
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Affiliation(s)
- Shearwood McClelland
- Program in Health Disparities Research, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Onyinyechi I Ukwuoma
- Department of Pediatrics, Brookdale University Hospital and Medical Center, New York, USA
| | - Scott Lunos
- Biostatistics Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Kolawole S Okuyemi
- Program in Health Disparities Research, University of Minnesota Medical School, Minneapolis, Minnesota, USA ; Department of Family Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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