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Serpieri V, D’Abrusco F, Dempsey JC, Cheng YHH, Arrigoni F, Baker J, Battini R, Bertini ES, Borgatti R, Christman AK, Curry C, D'Arrigo S, Fluss J, Freilinger M, Gana S, Ishak GE, Leuzzi V, Loucks H, Manti F, Mendelsohn N, Merlini L, Miller CV, Muhammad A, Nuovo S, Romaniello R, Schmidt W, Signorini S, Siliquini S, Szczałuba K, Vasco G, Wilson M, Zanni G, Boltshauser E, Doherty D, Valente EM. SUFU haploinsufficiency causes a recognisable neurodevelopmental phenotype at the mild end of the Joubert syndrome spectrum. J Med Genet 2022; 59:888-894. [PMID: 34675124 PMCID: PMC9411896 DOI: 10.1136/jmedgenet-2021-108114] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/29/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Joubert syndrome (JS) is a recessively inherited ciliopathy characterised by congenital ocular motor apraxia (COMA), developmental delay (DD), intellectual disability, ataxia, multiorgan involvement, and a unique cerebellar and brainstem malformation. Over 40 JS-associated genes are known with a diagnostic yield of 60%-75%.In 2018, we reported homozygous hypomorphic missense variants of the SUFU gene in two families with mild JS. Recently, heterozygous truncating SUFU variants were identified in families with dominantly inherited COMA, occasionally associated with mild DD and subtle cerebellar anomalies. METHODS We reanalysed next generation sequencing (NGS) data in two cohorts comprising 1097 probands referred for genetic testing of JS genes. RESULTS Heterozygous truncating and splice-site SUFU variants were detected in 22 patients from 17 families (1.5%) with strong male prevalence (86%), and in 8 asymptomatic parents. Patients presented with COMA, hypotonia, ataxia and mild DD, and only a third manifested intellectual disability of variable severity. Brain MRI showed consistent findings characterised by vermis hypoplasia, superior cerebellar dysplasia and subtle-to-mild abnormalities of the superior cerebellar peduncles. The same pattern was observed in two out of three tested asymptomatic parents. CONCLUSION Heterozygous truncating or splice-site SUFU variants cause a novel neurodevelopmental syndrome encompassing COMA and mild JS, which likely represent overlapping entities. Variants can arise de novo or be inherited from a healthy parent, representing the first cause of JS with dominant inheritance and reduced penetrance. Awareness of this condition will increase the diagnostic yield of JS genetic testing, and allow appropriate counselling about prognosis, medical monitoring and recurrence risk.
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Affiliation(s)
| | - Fulvio D’Abrusco
- Department of Molecular Medicine, University of Pavia, Pavia, Lombardia, Italy
| | - Jennifer C Dempsey
- Department of Pediatrics, University of Washington Center for Mendelian Genomics, WashingtonUSA
| | - Yong-Han Hank Cheng
- Department of Pediatrics, University of Washington Center for Mendelian Genomics, WashingtonUSA
| | - Filippo Arrigoni
- Neuroimaging Lab, Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
| | - Janice Baker
- Genomics and Genetic Medicine Department, Children's Minnesota, Minneapolis, Minnesota, USA
| | - Roberta Battini
- Unit of Child Neuropsychiatry, IRCCS Foundation Stella Maris, Calambrone, Toscana, Italy,Department of Clinical ad Experimental Medicine, University of Pisa, Pisa, Italy
| | - Enrico Silvio Bertini
- Laboratory of Molecular Medicine, Unit of Muscular and Neurodegenerative Diseases, Department of Neuroscience, Bambino Gesu Children's Hospital, IRCCS, Rome, Italy
| | - Renato Borgatti
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy,Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Angela K Christman
- Department of Pediatrics, University of Washington Center for Mendelian Genomics, WashingtonUSA
| | - Cynthia Curry
- Department of Pediatrics, Stanford University, Stanford, California, USA,Division of Medical Genetics, Department of Pediatrics, University of California San Francisco, Fresno, California, USA,University Pediatric Specialists, Fresno, California, USA
| | - Stefano D'Arrigo
- Department of Developmental Neurology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Joel Fluss
- Department of Women, Children and Adolescents, Geneva University Hospitals, Geneva, Switzerland
| | - Michael Freilinger
- Department of Paediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Simone Gana
- Neurogenetics Research Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Gisele E Ishak
- Department of Neuroradiology, University of Washington School of Medicine, Seattle, Washington, USA,Pediatric Radiology, Seattle Children’s Hospital, Seattle, Washington, USA
| | - Vincenzo Leuzzi
- Department of Human Neuroscience, University of Rome La Sapienza, Roma, Lazio, Italy
| | - Hailey Loucks
- Department of Pediatrics, University of Washington Center for Mendelian Genomics, WashingtonUSA
| | - Filippo Manti
- Department of Human Neuroscience, University of Rome La Sapienza, Roma, Lazio, Italy
| | - Nancy Mendelsohn
- Complex Health Solutions, United Healthcare, Minneapolis, Minnesota, USA
| | - Laura Merlini
- Department of Pediatric Radiology, Geneva University Hospitals Children's Hospital, Geneva, Switzerland
| | - Caitlin V Miller
- Department of Pediatrics, University of Washington Center for Mendelian Genomics, WashingtonUSA
| | - Ansar Muhammad
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland,Depatment of Ophtalmology, University of Lausanne, Jules Gonin Eye Hospital, Lausanne, Switzerland,Department of Genetic Medicine and Development, University of Geneva, Geneva, Switzerland
| | - Sara Nuovo
- Department of Experimental Medicine, University of Rome La Sapienza, Rome, Lazio, Italy
| | - Romina Romaniello
- Neuropsychiatry and Neurorehabilitation Unit, Scientific Institute, IRCCS Eugenio Medea, Lecco, Italy
| | - Wolfgang Schmidt
- Center for Anatomy and Cell Biology, Neuromuscular Research Department, Medical University of Vienna, Vienna, Austria
| | - Sabrina Signorini
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Sabrina Siliquini
- Child Neuropsychiatry Unit, Paediatric Hospital G Salesi, Ancona, Italy
| | - Krzysztof Szczałuba
- Department of Medical Genetics, Warszawski Uniwersytet Medyczny, Warszawa, Poland
| | - Gessica Vasco
- Unit of Neurorehabilitation, Department of Neurosciences, IRCCS Bambino Gesù Children's Hospital, Roma, Italy
| | - Meredith Wilson
- Department of Clinical Genetics, Children’s Hospital at Westmead, Sydney, New South Wales, Australia,Discipline of Genomic Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Ginevra Zanni
- Laboratory of Molecular Medicine, Unit of Muscular and Neurodegenerative Diseases, Department of Neuroscience, Bambino Gesu Children's Hospital, IRCCS, Rome, Italy
| | - Eugen Boltshauser
- Department of Pediatric Neurology (Emeritus), University Children's Hospital Zürich, Zurich, Zürich, Switzerland
| | - Dan Doherty
- Department of Pediatrics, University of Washington Center for Mendelian Genomics, WashingtonUSA,Center for Integrative Brain Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Enza Maria Valente
- Neurogenetics Research Centre, IRCCS Mondino Foundation, Pavia, Italy,Department of Molecular Medicine, University of Pavia, Pavia, Lombardia, Italy
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Abstract
Neuroblastoma is the most common neoplasm associated with pediatric Horner syndrome. The laboratory and imaging evaluation of isolated pediatric Horner syndrome is controversial. We review the literature published in the last several decades and present the rationale for the imaging work-up in this patient cohort.
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Affiliation(s)
- Hedieh Khalatbari
- Department of Radiology, University of Washington School of Medicine, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
| | - Gisele E Ishak
- Department of Radiology, University of Washington School of Medicine, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
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3
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Mak CCY, Doherty D, Lin AE, Vegas N, Cho MT, Viot G, Dimartino C, Weisfeld-Adams JD, Lessel D, Joss S, Li C, Gonzaga-Jauregui C, Zarate YA, Ehmke N, Horn D, Troyer C, Kant SG, Lee Y, Ishak GE, Leung G, Barone Pritchard A, Yang S, Bend EG, Filippini F, Roadhouse C, Lebrun N, Mehaffey MG, Martin PM, Apple B, Millan F, Puk O, Hoffer MJV, Henderson LB, McGowan R, Wentzensen IM, Pei S, Zahir FR, Yu M, Gibson WT, Seman A, Steeves M, Murrell JR, Luettgen S, Francisco E, Strom TM, Amlie-Wolf L, Kaindl AM, Wilson WG, Halbach S, Basel-Salmon L, Lev-El N, Denecke J, Vissers LELM, Radtke K, Chelly J, Zackai E, Friedman JM, Bamshad MJ, Nickerson DA, Reid RR, Devriendt K, Chae JH, Stolerman E, McDougall C, Powis Z, Bienvenu T, Tan TY, Orenstein N, Dobyns WB, Shieh JT, Choi M, Waggoner D, Gripp KW, Parker MJ, Stoler J, Lyonnet S, Cormier-Daire V, Viskochil D, Hoffman TL, Amiel J, Chung BHY, Gordon CT. MN1 C-terminal truncation syndrome is a novel neurodevelopmental and craniofacial disorder with partial rhombencephalosynapsis. Brain 2020; 143:55-68. [PMID: 31834374 DOI: 10.1093/brain/awz379] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 10/02/2019] [Accepted: 10/15/2019] [Indexed: 11/12/2022] Open
Abstract
MN1 encodes a transcriptional co-regulator without homology to other proteins, previously implicated in acute myeloid leukaemia and development of the palate. Large deletions encompassing MN1 have been reported in individuals with variable neurodevelopmental anomalies and non-specific facial features. We identified a cluster of de novo truncating mutations in MN1 in a cohort of 23 individuals with strikingly similar dysmorphic facial features, especially midface hypoplasia, and intellectual disability with severe expressive language delay. Imaging revealed an atypical form of rhombencephalosynapsis, a distinctive brain malformation characterized by partial or complete loss of the cerebellar vermis with fusion of the cerebellar hemispheres, in 8/10 individuals. Rhombencephalosynapsis has no previously known definitive genetic or environmental causes. Other frequent features included perisylvian polymicrogyria, abnormal posterior clinoid processes and persistent trigeminal artery. MN1 is encoded by only two exons. All mutations, including the recurrent variant p.Arg1295* observed in 8/21 probands, fall in the terminal exon or the extreme 3' region of exon 1, and are therefore predicted to result in escape from nonsense-mediated mRNA decay. This was confirmed in fibroblasts from three individuals. We propose that the condition described here, MN1 C-terminal truncation (MCTT) syndrome, is not due to MN1 haploinsufficiency but rather is the result of dominantly acting C-terminally truncated MN1 protein. Our data show that MN1 plays a critical role in human craniofacial and brain development, and opens the door to understanding the biological mechanisms underlying rhombencephalosynapsis.
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Affiliation(s)
- Christopher C Y Mak
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Dan Doherty
- Department of Pediatrics, University of Washington, Seattle, WA, USA.,Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Angela E Lin
- Medical Genetics, MassGeneral Hospital for Children, Boston, MA, USA
| | - Nancy Vegas
- Laboratory of Embryology and Genetics of Human Malformation, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1163, Institut Imagine, Paris, France.,Paris Descartes-Sorbonne Paris Cité University, Institut Imagine, Paris, France
| | | | - Géraldine Viot
- Gynécologie Obstétrique, Hôpital Cochin, Hôpitaux Universitaires Paris Centre (HUPC), Assistance Publique Hôpitaux de Paris (AP-HP), Paris, France
| | - Clémantine Dimartino
- Laboratory of Embryology and Genetics of Human Malformation, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1163, Institut Imagine, Paris, France.,Paris Descartes-Sorbonne Paris Cité University, Institut Imagine, Paris, France
| | - James D Weisfeld-Adams
- Section of Clinical Genetics and Metabolism, Department of Pediatrics, University of Colorado-Denver School of Medicine, Aurora, CO, USA
| | - Davor Lessel
- Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Shelagh Joss
- West of Scotland Regional Genetics Service, Queen Elizabeth University Hospital, Glasgow, UK
| | - Chumei Li
- McMaster University Medical Center, Hamilton, Ontario, Canada
| | | | - Yuri A Zarate
- Section of Genetics and Metabolism, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, USA
| | - Nadja Ehmke
- Institute for Medical Genetics and Human Genetics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Denise Horn
- Institute for Medical Genetics and Human Genetics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Caitlin Troyer
- Pediatrics and Medical Genetics, University of Virginia Health System, Charlottesville, VA, USA
| | - Sarina G Kant
- Department of Clinical Genetics, Leiden University Medical Center, RC Leiden, The Netherlands
| | - Youngha Lee
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Gisele E Ishak
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA, USA.,Department of Radiology, University of Washington, Seattle, WA, USA
| | - Gordon Leung
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | | | | | - Eric G Bend
- Greenwood Genetic Center, Greenwood, SC, USA.,PreventionGenetics, Marshfield, WI, USA
| | - Francesca Filippini
- Laboratory of Embryology and Genetics of Human Malformation, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1163, Institut Imagine, Paris, France.,Paris Descartes-Sorbonne Paris Cité University, Institut Imagine, Paris, France
| | | | - Nicolas Lebrun
- Institut Cochin, INSERM U1016, CNRS UMR, Paris Descartes University, Paris, France
| | | | - Pierre-Marie Martin
- Institute for Human Genetics, University of California San Francisco, San Francisco, CA, USA.,Division of Medical Genetics, Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Benjamin Apple
- Section of Clinical Genetics and Metabolism, Department of Pediatrics, University of Colorado-Denver School of Medicine, Aurora, CO, USA
| | | | - Oliver Puk
- Praxis für Humangenetik Tübingen, Tübingen, Germany
| | - Mariette J V Hoffer
- Department of Clinical Genetics, Leiden University Medical Center, RC Leiden, The Netherlands
| | | | - Ruth McGowan
- West of Scotland Regional Genetics Service, Queen Elizabeth University Hospital, Glasgow, UK
| | | | - Steven Pei
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Farah R Zahir
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Mullin Yu
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - William T Gibson
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Ann Seman
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA, USA
| | - Marcie Steeves
- Medical Genetics, MassGeneral Hospital for Children, Boston, MA, USA
| | - Jill R Murrell
- Division of Genomic Diagnostics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sabine Luettgen
- Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Tim M Strom
- Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany.,Institute of Human Genetics, Technische Universität München, Munich, Germany
| | - Louise Amlie-Wolf
- Division of Medical Genetics, A I duPont Hospital for Children/Nemours, Wilmington, DE, USA
| | - Angela M Kaindl
- Charité - Universitätsmedizin Berlin, Institute of Neuroanatomy and Cell Biology, Department of Pediatric Neurology and Center for Chronically Sick Children, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - William G Wilson
- Pediatrics and Medical Genetics, University of Virginia Health System, Charlottesville, VA, USA
| | - Sara Halbach
- Department of Human Genetics, University of Chicago, Chicago, IL, USA
| | - Lina Basel-Salmon
- Raphael Recanati Genetic Institute, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel.,Pediatric Genetics Clinic, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Felsenstein Medical Research Center, Petach Tikva, Israel
| | - Noa Lev-El
- Raphael Recanati Genetic Institute, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
| | - Jonas Denecke
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Lisenka E L M Vissers
- Department of Human Genetics, Donders Centre for Neuroscience, Radboud University Medical Center, HB Nijmegen, The Netherlands
| | - Kelly Radtke
- Clinical Genomics Department, Ambry Genetics, Aliso Viejo, CA, USA
| | - Jamel Chelly
- Laboratoire de Diagnostic Génétique, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France.,Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, 67000 Strasbourg, France.,Institut de Génétique et de Biologie Moléculaire et Cellulaire, INSERM U964, CNRS UMR7104, Université de Strasbourg, 67404 Illkirch, France
| | - Elaine Zackai
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jan M Friedman
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Michael J Bamshad
- Department of Pediatrics, University of Washington, Seattle, WA, USA.,Department of Genome Sciences, University of Washington, Seattle, WA, USA.,University of Washington Center for Mendelian Genomics, Seattle, WA, USA
| | - Deborah A Nickerson
- Department of Genome Sciences, University of Washington, Seattle, WA, USA.,University of Washington Center for Mendelian Genomics, Seattle, WA, USA
| | | | - Russell R Reid
- Department of Surgery, Section of Plastic Surgery, University of Chicago, Chicago, IL, USA
| | - Koenraad Devriendt
- Department of Human Genetics, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
| | - Jong-Hee Chae
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | | | - Carey McDougall
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Zöe Powis
- Clinical Genomics Department, Ambry Genetics, Aliso Viejo, CA, USA
| | - Thierry Bienvenu
- Institut Cochin, INSERM U1016, CNRS UMR, Paris Descartes University, Paris, France.,Laboratoire de Génétique et Biologie Moléculaires, Hôpital Cochin, HUPC, AP-HP, 75014 Paris, France
| | - Tiong Y Tan
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Department of Paediatrics, University of Melbourne, Melbourne, 3052, Australia
| | - Naama Orenstein
- Pediatric Genetics Clinic, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - William B Dobyns
- Department of Pediatrics, University of Washington, Seattle, WA, USA.,Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA, USA.,Department of Neurology, University of Washington, Seattle, WA, USA
| | - Joseph T Shieh
- Institute for Human Genetics, University of California San Francisco, San Francisco, CA, USA.,Division of Medical Genetics, Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Murim Choi
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Darrel Waggoner
- Department of Human Genetics, University of Chicago, Chicago, IL, USA
| | - Karen W Gripp
- Division of Medical Genetics, A I duPont Hospital for Children/Nemours, Wilmington, DE, USA
| | - Michael J Parker
- Sheffield Clinical Genetics Service, Sheffield Children's Hospital, Sheffield S10 2TH, UK
| | - Joan Stoler
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA, USA
| | - Stanislas Lyonnet
- Laboratory of Embryology and Genetics of Human Malformation, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1163, Institut Imagine, Paris, France.,Paris Descartes-Sorbonne Paris Cité University, Institut Imagine, Paris, France.,Département de Génétique, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Valérie Cormier-Daire
- Paris Descartes-Sorbonne Paris Cité University, Institut Imagine, Paris, France.,Département de Génétique, Hôpital Necker-Enfants Malades, AP-HP, Paris, France.,Laboratory of Molecular and Physiopathological Bases of Osteochondrodysplasia, INSERM UMR 1163, Institut Imagine, 75015 Paris, France
| | - David Viskochil
- Division of Medical Genetics, University of Utah, Salt Lake City, UT, USA
| | - Trevor L Hoffman
- Southern California Kaiser Permanente Medical Group, Anaheim, CA, USA
| | - Jeanne Amiel
- Laboratory of Embryology and Genetics of Human Malformation, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1163, Institut Imagine, Paris, France.,Paris Descartes-Sorbonne Paris Cité University, Institut Imagine, Paris, France.,Département de Génétique, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Brian H Y Chung
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Christopher T Gordon
- Laboratory of Embryology and Genetics of Human Malformation, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1163, Institut Imagine, Paris, France.,Paris Descartes-Sorbonne Paris Cité University, Institut Imagine, Paris, France
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4
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Wright JN, Feyma TJ, Ishak GE, Abeshaus S, Metz JB, Brown ECB, Friedman SD, Browd SR, Feldman KW. Correction to: Subdural hemorrhage rebleeding in abused children: frequency, associations and clinical presentation. Pediatr Radiol 2020; 50:1161. [PMID: 32444953 DOI: 10.1007/s00247-020-04687-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The original article included a statement which is not fully accurate. This correction clarifies the original statement.
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Affiliation(s)
- Jason N Wright
- Department of Radiology, Seattle Children's Hospital, Harborview Medical Center, Seattle, WA, USA.,University of Washington, Seattle, WA, USA
| | - Timothy J Feyma
- Department of Neurology, Gillette Children's Specialty Health Care, St. Paul, MN, USA
| | - Gisele E Ishak
- Department of Radiology, Seattle Children's Hospital, Harborview Medical Center, Seattle, WA, USA.,University of Washington, Seattle, WA, USA
| | - Sergey Abeshaus
- Department of Neurosurgery, Rambam Health Care Campus, Haifa, Israel
| | - James B Metz
- Department of Pediatrics, University of Vermont School of Medicine, Burlington, VT, USA
| | - Emily C B Brown
- University of Washington, Seattle, WA, USA.,Department of Pediatrics, Children's Protection Program, M/S SB-250, Seattle Children's Hospital, Harborview Medical Center, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Seth D Friedman
- Department of Radiology, Seattle Children's Hospital, Harborview Medical Center, Seattle, WA, USA.,University of Washington, Seattle, WA, USA
| | - Samuel R Browd
- University of Washington, Seattle, WA, USA.,Department of Neurological Surgery, Seattle Children's Hospital, Harborview Medical Center, Seattle, WA, USA
| | - Kenneth W Feldman
- University of Washington, Seattle, WA, USA. .,Department of Pediatrics, Children's Protection Program, M/S SB-250, Seattle Children's Hospital, Harborview Medical Center, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
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5
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Affiliation(s)
- J Gust
- Seattle Children's Division of Pediatric Neurology Department of Neurology University of Washington Seattle, Washington.,Center for Integrative Brain Research Seattle Children's Research Institute Seattle, Washington
| | - G E Ishak
- Seattle Children's Division of Radiology Department of Radiology University of Washington Seattle, Washington
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6
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Aldinger KA, Timms AE, Thomson Z, Mirzaa GM, Bennett JT, Rosenberg AB, Roco CM, Hirano M, Abidi F, Haldipur P, Cheng CV, Collins S, Park K, Zeiger J, Overmann LM, Alkuraya FS, Biesecker LG, Braddock SR, Cathey S, Cho MT, Chung BHY, Everman DB, Zarate YA, Jones JR, Schwartz CE, Goldstein A, Hopkin RJ, Krantz ID, Ladda RL, Leppig KA, McGillivray BC, Sell S, Wusik K, Gleeson JG, Nickerson DA, Bamshad MJ, Gerrelli D, Lisgo SN, Seelig G, Ishak GE, Barkovich AJ, Curry CJ, Glass IA, Millen KJ, Doherty D, Dobyns WB. Redefining the Etiologic Landscape of Cerebellar Malformations. Am J Hum Genet 2019; 105:606-615. [PMID: 31474318 DOI: 10.1016/j.ajhg.2019.07.019] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 07/26/2019] [Indexed: 11/15/2022] Open
Abstract
Cerebellar malformations are diverse congenital anomalies frequently associated with developmental disability. Although genetic and prenatal non-genetic causes have been described, no systematic analysis has been performed. Here, we present a large-exome sequencing study of Dandy-Walker malformation (DWM) and cerebellar hypoplasia (CBLH). We performed exome sequencing in 282 individuals from 100 families with DWM or CBLH, and we established a molecular diagnosis in 36 of 100 families, with a significantly higher yield for CBLH (51%) than for DWM (16%). The 41 variants impact 27 neurodevelopmental-disorder-associated genes, thus demonstrating that CBLH and DWM are often features of monogenic neurodevelopmental disorders. Though only seven monogenic causes (19%) were identified in more than one individual, neuroimaging review of 131 additional individuals confirmed cerebellar abnormalities in 23 of 27 genetic disorders (85%). Prenatal risk factors were frequently found among individuals without a genetic diagnosis (30 of 64 individuals [47%]). Single-cell RNA sequencing of prenatal human cerebellar tissue revealed gene enrichment in neuronal and vascular cell types; this suggests that defective vasculogenesis may disrupt cerebellar development. Further, de novo gain-of-function variants in PDGFRB, a tyrosine kinase receptor essential for vascular progenitor signaling, were associated with CBLH, and this discovery links genetic and non-genetic etiologies. Our results suggest that genetic defects impact specific cerebellar cell types and implicate abnormal vascular development as a mechanism for cerebellar malformations. We also confirmed a major contribution for non-genetic prenatal factors in individuals with cerebellar abnormalities, substantially influencing diagnostic evaluation and counseling regarding recurrence risk and prognosis.
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Affiliation(s)
- Kimberly A Aldinger
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA 98101, USA
| | - Andrew E Timms
- Center for Developmental Biology and Regenerative Medicine, Seattle Children's Research Institute, Seattle, WA 98101, USA
| | - Zachary Thomson
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA 98101, USA
| | - Ghayda M Mirzaa
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA 98101, USA; Department of Pediatrics, University of Washington, Seattle, WA 98105, USA
| | - James T Bennett
- Center for Developmental Biology and Regenerative Medicine, Seattle Children's Research Institute, Seattle, WA 98101, USA; Department of Pediatrics, University of Washington, Seattle, WA 98105, USA
| | - Alexander B Rosenberg
- Department of Electrical Engineering, University of Washington, Seattle, WA 98105, USA
| | - Charles M Roco
- Department of Bioengineering, University of Washington, Seattle, WA 98105, USA
| | - Matthew Hirano
- Department of Electrical Engineering, University of Washington, Seattle, WA 98105, USA
| | - Fatima Abidi
- Greenwood Genetic Center, Greenwood, SC 29646, USA
| | - Parthiv Haldipur
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA 98101, USA
| | - Chi V Cheng
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA 98101, USA
| | - Sarah Collins
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA 98101, USA
| | - Kaylee Park
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA 98101, USA
| | - Jordan Zeiger
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA 98101, USA
| | - Lynne M Overmann
- Institute of Genetic Medicine, Newcastle University, International Centre for life, Central Parkway, Newcastle upon Tyne NE1 3BZ, UK
| | - Fowzan S Alkuraya
- Department of Genetics, King Faisal Specialist Hospital Research Center, Riyadh, 11211, Saudi Arabia
| | - Leslie G Biesecker
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, 20892 USA
| | - Stephen R Braddock
- Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, MO 63104, USA
| | - Sara Cathey
- Greenwood Genetic Center, Greenwood, SC 29646, USA
| | | | - Brian H Y Chung
- Department of Pediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | | | - Yuri A Zarate
- Section of Genetics and Metabolism, University of Arkansas for Medical Sciences, Little Rock, AR, 72202, USA
| | | | | | - Amy Goldstein
- Mitochondrial Medicine Frontier Program, Division of Human Genetics, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA; The Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Robert J Hopkin
- Division of Human Genetics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Ian D Krantz
- The Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA; Division of Human Genetics and Molecular Biology, The Children's Hospital of Philadelphia, Philadelphia, PA, 19104 USA
| | - Roger L Ladda
- Department of Pediatrics, Milton S Hershey Medical Center, Hershey, PA 17033, USA; Departments of Pathology, Milton S Hershey Medical Center, Hershey, PA 17033, USA
| | - Kathleen A Leppig
- Genetic Services, Kaiser Permanente Washington, Seattle, WA 98112, USA
| | - Barbara C McGillivray
- Department of Medical Genetics, Children's and Women's Health Centre of British Columbia, Vancouver, BC V6H 3N1, Canada
| | - Susan Sell
- Department of Pediatrics, Milton S Hershey Medical Center, Hershey, PA 17033, USA
| | - Katherine Wusik
- Division of Human Genetics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Joseph G Gleeson
- Department of Neurosciences, Howard Hughes Medical Institute, University of California, San Diego, La Jolla, CA 92093, USA
| | - Deborah A Nickerson
- Department of Genome Sciences, University of Washington, Seattle, WA 98195, USA; University of Washington Center for Mendelian Genomics, Seattle, WA 98195, USA
| | - Michael J Bamshad
- Department of Pediatrics, University of Washington, Seattle, WA 98105, USA; Department of Genome Sciences, University of Washington, Seattle, WA 98195, USA; University of Washington Center for Mendelian Genomics, Seattle, WA 98195, USA
| | - Dianne Gerrelli
- University College London Institute of Child Health, London WC1N 1EH, UK
| | - Steven N Lisgo
- Institute of Genetic Medicine, Newcastle University, International Centre for life, Central Parkway, Newcastle upon Tyne NE1 3BZ, UK
| | - Georg Seelig
- Department of Electrical Engineering, University of Washington, Seattle, WA 98105, USA; Paul G. Allen School of Computer Science & Engineering, University of Washington, Seattle, WA 98195, USA
| | - Gisele E Ishak
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA 98101, USA; Department of Radiology, University of Washington, Seattle, WA 98195, USA
| | - A James Barkovich
- Departments of Radiology, Neurology, Pediatrics, and Neurosurgery, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Cynthia J Curry
- Genetic Medicine, Department of Pediatrics, University of California San Francisco, Fresno, CA, 93701, USA
| | - Ian A Glass
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA 98101, USA; Department of Pediatrics, University of Washington, Seattle, WA 98105, USA
| | - Kathleen J Millen
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA 98101, USA; Department of Pediatrics, University of Washington, Seattle, WA 98105, USA
| | - Dan Doherty
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA 98101, USA; Department of Pediatrics, University of Washington, Seattle, WA 98105, USA
| | - William B Dobyns
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA 98101, USA; Department of Pediatrics, University of Washington, Seattle, WA 98105, USA; Department of Neurology, University of Washington, Seattle, WA 98105, USA.
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7
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Dines JN, Liu YJ, Neufeld-Kaiser W, Sawyer T, Ishak GE, Tully HM, Racobaldo M, Sanchez-Valle A, Disteche CM, Juusola J, Torti E, McWalter K, Doherty D, Dipple KM. Expanding phenotype with severe midline brain anomalies and missense variant supports a causal role for FOXA2 in 20p11.2 deletion syndrome. Am J Med Genet A 2019; 179:1783-1790. [PMID: 31294511 DOI: 10.1002/ajmg.a.61281] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/30/2019] [Accepted: 06/05/2019] [Indexed: 12/11/2022]
Abstract
Rare individuals with 20p11.2 proximal deletions have been previously reported, with a variable phenotype that includes heterotaxy, biliary atresia, midline brain defects associated with panhypopituitarism, intellectual disability, scoliosis, and seizures. Deletions have ranged in size from 277 kb to 11.96 Mb. We describe a newborn with a de novo 2.7 Mb deletion of 20p11.22p11.21 that partially overlaps previously reported deletions and encompasses FOXA2. Her clinical findings further expand the 20p11.2 deletion phenotype to include severe midline cranial and intracranial defects such as aqueductal stenosis with hydrocephalus, mesencephalosynapsis with diencephalic-mesencephalic junction dysplasia, and pyriform aperture stenosis. We also report one individual with a missense variant in FOXA2 who had abnormal glucose homeostasis, panhypopituitarism, and endodermal organ dysfunction. Together, these findings support the critical role of FOXA2 in panhypopituitarism and midline defects.
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Affiliation(s)
- Jennifer N Dines
- Department of Medicine, Division of Medical Genetics, University of Washington, Seattle, Washington
- Department of Pediatrics, Division of Genetic Medicine, University of Washington/Seattle Children's Hospital, Seattle, Washington
| | - Yajuan J Liu
- Department of Pathology, University of Washington School of Medicine, Seattle, Washington
| | - Whitney Neufeld-Kaiser
- Department of Pathology, University of Washington School of Medicine, Seattle, Washington
| | - Taylor Sawyer
- Department of Pediatrics, Division of Neonatology, University of Washington, Seattle, Washington
| | - Gisele E Ishak
- Department of Radiology, University of Washington, Seattle Children's Hospital, Seattle, Washington
| | - Hannah M Tully
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington
- Division of Pediatric Neurology, Seattle Children's Hospital, Seattle, Washington
| | - Melissa Racobaldo
- Division of Genetics and Metabolism, University of South Florida, Tampa, Florida
| | | | - Christine M Disteche
- Department of Medicine, Division of Medical Genetics, University of Washington, Seattle, Washington
- Department of Pathology, University of Washington School of Medicine, Seattle, Washington
| | | | | | | | - Dan Doherty
- Department of Pediatrics, Division of Genetic Medicine, University of Washington/Seattle Children's Hospital, Seattle, Washington
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington
| | - Katrina M Dipple
- Department of Pediatrics, Division of Genetic Medicine, University of Washington/Seattle Children's Hospital, Seattle, Washington
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington
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8
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Gust J, Finney OC, Li D, Brakke HM, Hicks RM, Futrell RB, Gamble DN, Rawlings-Rhea SD, Khalatbari HK, Ishak GE, Duncan VE, Hevner RF, Jensen MC, Park JR, Gardner RA. Glial injury in neurotoxicity after pediatric CD19-directed chimeric antigen receptor T cell therapy. Ann Neurol 2019; 86:42-54. [PMID: 31074527 DOI: 10.1002/ana.25502] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 05/06/2019] [Accepted: 05/06/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To test whether systemic cytokine release is associated with central nervous system inflammatory responses and glial injury in immune effector cell-associated neurotoxicity syndrome (ICANS) after chimeric antigen receptor (CAR)-T cell therapy in children and young adults. METHODS We performed a prospective cohort study of clinical manifestations as well as imaging, pathology, CSF, and blood biomarkers on 43 subjects ages 1 to 25 who received CD19-directed CAR/T cells for acute lymphoblastic leukemia (ALL). RESULTS Neurotoxicity occurred in 19 of 43 (44%) subjects. Nine subjects (21%) had CTCAE grade 3 or 4 neurological symptoms, with no neurotoxicity-related deaths. Reversible delirium, headache, decreased level of consciousness, tremor, and seizures were most commonly observed. Cornell Assessment of Pediatric Delirium (CAPD) scores ≥9 had 94% sensitivity and 33% specificity for grade ≥3 neurotoxicity, and 91% sensitivity and 72% specificity for grade ≥2 neurotoxicity. Neurotoxicity correlated with severity of cytokine release syndrome, abnormal past brain magnetic resonance imaging (MRI), and higher peak CAR-T cell numbers in blood, but not cerebrospinal fluid (CSF). CSF levels of S100 calcium-binding protein B and glial fibrillary acidic protein increased during neurotoxicity, indicating astrocyte injury. There were concomitant increases in CSF white blood cells, protein, interferon-γ (IFNγ), interleukin (IL)-6, IL-10, and granzyme B (GzB), with concurrent elevation of serum IFNγ IL-10, GzB, granulocyte macrophage colony-stimulating factor, macrophage inflammatory protein 1 alpha, and tumor necrosis factor alpha, but not IL-6. We did not find direct evidence of endothelial activation. INTERPRETATION Our data are most consistent with ICANS as a syndrome of systemic inflammation, which affects the brain through compromise of the neurovascular unit and astrocyte injury. ANN NEUROL 2019.
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Affiliation(s)
- Juliane Gust
- Seattle Children's Division of Pediatric Neurology, Department of Neurology, University of Washington, Seattle, WA.,Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA
| | - Olivia C Finney
- Seattle Children's Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, WA
| | | | - Hannah M Brakke
- Seattle Children's Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, WA
| | - Roxana M Hicks
- Seattle Children's Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, WA
| | - Robert B Futrell
- Seattle Children's Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, WA
| | - Danielle N Gamble
- Seattle Children's Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, WA
| | - Stephanie D Rawlings-Rhea
- Seattle Children's Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, WA
| | | | | | | | - Robert F Hevner
- Department of Pathology, University of California San Diego, San Diego, CA
| | - Michael C Jensen
- Seattle Children's Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, WA.,Seattle Children's Division of Hematology-Oncology, Seattle, WA
| | - Julie R Park
- Seattle Children's Division of Hematology-Oncology, Seattle, WA
| | - Rebecca A Gardner
- Seattle Children's Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, WA.,Seattle Children's Division of Hematology-Oncology, Seattle, WA
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9
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Dobyns WB, Aldinger KA, Ishak GE, Mirzaa GM, Timms AE, Grout ME, Dremmen MH, Schot R, Vandervore L, van Slegtenhorst MA, Wilke M, Kasteleijn E, Lee AS, Barry BJ, Chao KR, Szczałuba K, Kobori J, Hanson-Kahn A, Bernstein JA, Carr L, D’Arco F, Miyana K, Okazaki T, Saito Y, Sasaki M, Das S, Wheeler MM, Bamshad MJ, Nickerson DA, Engle EC, Verheijen FW, Doherty D, Mancini GM, Doherty D, Mancini GMS. MACF1 Mutations Encoding Highly Conserved Zinc-Binding Residues of the GAR Domain Cause Defects in Neuronal Migration and Axon Guidance. Am J Hum Genet 2018; 103:1009-1021. [PMID: 30471716 DOI: 10.1016/j.ajhg.2018.10.019] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 10/22/2018] [Indexed: 01/08/2023] Open
Abstract
To date, mutations in 15 actin- or microtubule-associated genes have been associated with the cortical malformation lissencephaly and variable brainstem hypoplasia. During a multicenter review, we recognized a rare lissencephaly variant with a complex brainstem malformation in three unrelated children. We searched our large brain-malformation databases and found another five children with this malformation (as well as one with a less severe variant), analyzed available whole-exome or -genome sequencing data, and tested ciliogenesis in two affected individuals. The brain malformation comprised posterior predominant lissencephaly and midline crossing defects consisting of absent anterior commissure and a striking W-shaped brainstem malformation caused by small or absent pontine crossing fibers. We discovered heterozygous de novo missense variants or an in-frame deletion involving highly conserved zinc-binding residues within the GAR domain of MACF1 in the first eight subjects. We studied cilium formation and found a higher proportion of mutant cells with short cilia than of control cells with short cilia. A ninth child had similar lissencephaly but only subtle brainstem dysplasia associated with a heterozygous de novo missense variant in the spectrin repeat domain of MACF1. Thus, we report variants of the microtubule-binding GAR domain of MACF1 as the cause of a distinctive and most likely pathognomonic brain malformation. A gain-of-function or dominant-negative mechanism appears likely given that many heterozygous mutations leading to protein truncation are included in the ExAC Browser. However, three de novo variants in MACF1 have been observed in large schizophrenia cohorts.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Dan Doherty
- Department of Pediatrics, University of Washington, Seattle, WA 98195, USA; Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA 98101, USA
| | - Grazia M S Mancini
- Department of Clinical Genetics, Erasmus MC University Medical Center, Rotterdam 3015 CN, the Netherlands.
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10
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D'Arco F, Alves CA, Raybaud C, Chong WKK, Ishak GE, Ramji S, Grima M, Barkovich AJ, Ganesan V. Expanding the Distinctive Neuroimaging Phenotype of ACTA2 Mutations. AJNR Am J Neuroradiol 2018; 39:2126-2131. [PMID: 30262641 DOI: 10.3174/ajnr.a5823] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 08/16/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Arg179His mutations in ACTA2 are associated with a distinctive neurovascular phenotype characterized by a straight course of intracranial arteries, absent basal Moyamoya collaterals, dilation of the proximal internal carotid arteries, and occlusive disease of the terminal internal carotid arteries. We now add to the distinctive neuroimaging features in these patients by describing their unique constellation of brain malformative findings that could flag the diagnosis in cases in which targeted cerebrovascular imaging has not been performed. MATERIALS AND METHODS Neuroimaging studies from 13 patients with heterozygous Arg179His mutations in ACTA2 and 1 patient with pathognomonic clinicoradiologic findings for ACTA2 mutation were retrospectively reviewed. The presence and localization of brain malformations and other abnormal brain MR imaging findings are reported. RESULTS Characteristics bending and hypoplasia of the anterior corpus callosum, apparent absence of the anterior gyrus cinguli, and radial frontal gyration were present in 100% of the patients; flattening of the pons on the midline and multiple indentations in the lateral surface of the pons were demonstrated in 93% of the patients; and apparent "squeezing" of the cerebral peduncles in 85% of the patients. CONCLUSIONS Because α-actin is not expressed in the brain parenchyma, only in vascular tissue, we speculate that rather than a true malformative process, these findings represent a deformation of the brain during development related to the mechanical interaction with rigid arteries during the embryogenesis.
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Affiliation(s)
- F D'Arco
- From the Departments of Radiology (F.D'A., W.K.K.C.)
| | - C A Alves
- Radiology Department (C.A.A.), Hospital Das Clinicas, Sao Paulo, Brazil
| | - C Raybaud
- Department of Diagnostic Imaging (C.R.), Hospital for Sick Children, Toronto, Ontario, Canada
| | - W K K Chong
- From the Departments of Radiology (F.D'A., W.K.K.C.)
| | - G E Ishak
- Department of Radiology (G.E.I.), Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - S Ramji
- Department of Radiology (S.R.), Imperial College Healthcare National Health Service Trust, London, UK
| | - M Grima
- Department of Radiology (M.G.), University Hospital of North Staffordshire National Health Service Trust, Stoke-on-Trent, UK
| | - A J Barkovich
- Department of Radiology and Diagnostic Imaging (A.J.B.), University of California, San Francisco, San Francisco, California
| | - V Ganesan
- Neurology (V.G.), Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, UK
- Neuroscience Unit (V.G.), UCL Great Ormond Street Institute of Child Health, London, UK
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11
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Chapman T, Menashe SJ, Zare M, Alessio AM, Ishak GE. Establishment of normative values for the fetal posterior fossa by magnetic resonance imaging. Prenat Diagn 2018; 38:1035-1041. [PMID: 30280395 DOI: 10.1002/pd.5367] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 09/23/2018] [Accepted: 09/27/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Suspected Dandy-Walker continuum anomalies constitute a significant percentage of prenatal cases evaluated by magnetic resonance imaging (MRI). To unify the description of posterior fossa malformations, we sought to establish objective measurements for the posterior fossa in normal fetuses between 18 and 37 weeks gestation. METHODS T2-weighted images of normal fetal brains in sagittal projection were obtained from fetal magnetic resonance (MR) studies of normal brains performed from 2009 to 2017.121 fetal brains were included in the analysis. Three radiologists reviewed images and recorded the following for each case: superior posterior fossa angle (SPFA), posterior fossa perimeter, and tegmento-vermian angle (TVA). RESULTS For each feature, the mean of the measurements, the percentage of absolute difference of the reader measurement compared with mean measurement, and the interclass correlation (ICC) were calculated. Values are reported as mean ± standard deviation. Perimeter increases linearly with age, whereas the SPFA and the TVA are independent of gestational age. For all included cases, the SPFA averaged 100.9° ± 8° and the TVA averaged 2.5° ± 2.3°. CONCLUSION The superior posterior fossa angle, a novel measurement, and the posterior fossa perimeter can be used for establishing the expected size of the posterior fossa in second- and third-trimester fetuses by MRI.
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Affiliation(s)
- Teresa Chapman
- Department of Radiology, Seattle Children's Hospital, Seattle, Washington.,Department of Radiology, University of Washington School of Medicine, Seattle, Washington
| | - Sarah J Menashe
- Department of Radiology, Seattle Children's Hospital, Seattle, Washington.,Department of Radiology, University of Washington School of Medicine, Seattle, Washington
| | - Megan Zare
- Department of Radiology, Seattle Children's Hospital, Seattle, Washington.,Department of Radiology, University of Washington School of Medicine, Seattle, Washington
| | - Adam M Alessio
- Department of Radiology, Seattle Children's Hospital, Seattle, Washington.,Department of Radiology, University of Washington School of Medicine, Seattle, Washington
| | - Gisele E Ishak
- Department of Radiology, Seattle Children's Hospital, Seattle, Washington.,Department of Radiology, University of Washington School of Medicine, Seattle, Washington
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12
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Bayart CB, Ishak GE, Finn LS, Lee A, Baran F, Sun A, Gupta D, Vitanza NA. Pilocytic astrocytoma with leptomeningeal spread in a patient with incontinentia pigmenti presenting with unilateral nystagmus. Pediatr Blood Cancer 2018; 65. [PMID: 29171168 DOI: 10.1002/pbc.26886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 08/28/2017] [Accepted: 10/10/2017] [Indexed: 01/26/2023]
Abstract
Incontinentia pigmenti (IP) is a genetic disorder caused by mutations in IKBKG, leading to functional loss of nuclear factor kappa B (NF-ĸB). We report the case of a 6-month-old female child with IP who presented with unilateral nystagmus and was found to have a pilocytic astrocytoma with leptomeningeal spread. Enhanced understanding of the relationship between NF-ĸB, along with its upstream regulators, and tumorigenesis may shed light on whether a subset of patients with IP may be at increased risk for neoplasia.
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Affiliation(s)
- Cheryl B Bayart
- Division of Dermatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Gisele E Ishak
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Laura S Finn
- Division of Pathology, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Amy Lee
- Department of Neurological Surgery, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Francine Baran
- Division of Ophthalmology, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Angela Sun
- Division of Biochemical Genetics, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Deepti Gupta
- Division of Dermatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Nicholas A Vitanza
- Division of Hematology/Oncology, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Fred Hutchinson Cancer Research Center, Seattle, Washington
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13
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Abstract
Cystic dysraphism of the cervical and upper thoracic spine is very rare. It differs from the much more common lumbosacral dysraphism in appearance and structure, and usually portends a better prognosis due to lack of functional neurological tissue in the dysraphic sac and absent or less severe intracranial anomalies. There is ambiguity in the literature regarding terminology because of the paucity of cases. We present cases of the most common type of cervicothoracic cystic dysraphism and emphasize differences from lumbosacral myelomeningocele. Patient outcome depends on the presence of associated anomalies and whether complete surgical resection is performed. Imaging plays a critical role in surgical planning, screening the central nervous system for additional anomalies, and in the postoperative setting for evaluation of retethering.
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Affiliation(s)
- Natalie S Valeur
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
| | - Ramesh S Iyer
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Gisele E Ishak
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
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14
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Chapman T, Perez FA, Ishak GE, Doherty D. Prenatal diagnosis of Chudley-McCullough syndrome. Am J Med Genet A 2016; 170:2426-30. [PMID: 27312216 DOI: 10.1002/ajmg.a.37806] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 05/29/2016] [Indexed: 11/07/2022]
Abstract
Chudley-McCullough syndrome (CMS) is an autosomal-recessive disorder characterized by a complex brain malformation and profound congenital sensorineural hearing loss. Postnatal brain imaging findings include ventriculomegaly, partial agenesis of corpus callosum, inferior cerebellar dysplasia, arachnoid cysts, and malformations of cortical development including frontal subcortical heterotopia and polymicrogyria. Prenatal diagnosis of CMS is important due to the markedly less severe neurodevelopmental prognosis compared to disorders with similar brain imaging findings. We report prenatal imaging features that help distinguish CMS from other disorders, including slit-like frontal horns, agenesis of the corpus callosum, frontal subcortical heterotopia, arachnoid cysts, and cerebellar dysplasia. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Teresa Chapman
- Department of Radiology, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Francisco A Perez
- Department of Radiology, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Gisele E Ishak
- Department of Radiology, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Dan Doherty
- Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington
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15
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Abstract
Cervical dysraphism is rare, and the 3 recognized subtypes manifest as cystic, skin-covered masses. To our knowledge, no case of cervical lipomyelocele has been reported in the literature so far. We present a case of surgically and pathologically confirmed cervical lipomyelocele in a patient with spondylocostal dysostosis and multiple other congenital anomalies and a brief review of the literature. In this case, magnetic resonance imaging demonstrates fat extension into a dysraphic cervical spinal canal, allowing for preoperative diagnosis. Computed tomography using 3-dimensional reconstruction serves to more clearly characterize the extensive spine malsegmentation characteristic of spondylocostal dysostosis. The use of this technique is suggested to benefit the orthopedic or neurologic surgeon confronted with such complex malformations.
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Affiliation(s)
- Natalie S Valeur
- Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA
| | - Ramesh S Iyer
- Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA
| | - Gisele E Ishak
- Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA
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16
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Tully HM, Ishak GE, Rue TC, Dempsey JC, Browd SR, Millen KJ, Doherty D, Dobyns WB. Two Hundred Thirty-Six Children With Developmental Hydrocephalus: Causes and Clinical Consequences. J Child Neurol 2016; 31:309-20. [PMID: 26184484 PMCID: PMC4990005 DOI: 10.1177/0883073815592222] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 05/23/2015] [Indexed: 11/15/2022]
Abstract
Few systematic assessments of developmental forms of hydrocephalus exist. We reviewed magnetic resonance images (MRIs) and clinical records of patients with infancy-onset hydrocephalus. Among 411 infants, 236 had hydrocephalus with no recognizable extrinsic cause. These children were assigned to 1 of 5 subtypes and compared on the basis of clinical characteristics and developmental and surgical outcomes. At an average age of 5.3 years, 72% of children were walking independently and 87% could eat by mouth; in addition, 18% had epilepsy. Distinct patterns of associated malformations and syndromes were observed within each subtype. On average, children with aqueductal obstruction, cysts, and encephaloceles had worse clinical outcomes than those with other forms of developmental hydrocephalus. Overall, 53% of surgically treated patients experienced at least 1 shunt failure, but hydrocephalus associated with posterior fossa crowding required fewer shunt revisions. We conclude that each subtype of developmental hydrocephalus is associated with distinct clinical characteristics, syndromology, and outcomes, suggesting differences in underlying mechanisms.
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Affiliation(s)
- Hannah M Tully
- Department of Neurology, University of Washington, Seattle, WA, USA Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Gisele E Ishak
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Tessa C Rue
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | | | - Samuel R Browd
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Kathleen J Millen
- Department of Pediatrics, University of Washington, Seattle, WA, USA Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Dan Doherty
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - William B Dobyns
- Department of Neurology, University of Washington, Seattle, WA, USA Department of Pediatrics, University of Washington, Seattle, WA, USA Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA, USA
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Kelly JP, Ishak GE, Phillips JO, Nguyen H, Weiss AH. Visual sensory and ocular motor function in children with polymicrogyria: relationship to magnetic resonance imaging. J AAPOS 2016; 20:37-43. [PMID: 26917070 DOI: 10.1016/j.jaapos.2015.10.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 10/28/2015] [Accepted: 10/29/2015] [Indexed: 01/23/2023]
Abstract
PURPOSE To assess visual and ocular motor function in children with polymicrogyria (PMG). METHODS The medical records of 15 children (0.4-4 years of age) with PMG documented by magnetic resonance imaging (MRI) and with age-corrected visual acuity measured by Teller acuity cards were reviewed retrospectively. Cortical function was assessed by pattern visually evoked potentials (VEP). Ocular motor function was assessed by video-oculography or clinical assessment. Results were compared to age-matched controls. RESULTS Extent of PMG involvement varied from bilateral fronto-parietal to bilateral-diffuse. Nine children had involvement of the occipital lobe. Visual acuity at presentation was normal in 5 children (≥20/40 Snellen equivalent for age) and subnormal in 10 (average 20/200 equivalent). Visual acuity was similar in children with or without involvement of the occipital lobe (P = 0.4). Follow-up visual acuity was available for 9 children; 3 improved and 6 failed to improve (5 of whom had seizures). PMG involving the occipital lobe significantly reduced VEP amplitude and signal-to-noise ratios. Three infants without visually-guided behaviors had VEP responses. All 3 children with cytomegalovirus-related PMG without retinal disease had preserved visual function despite generalized MRI abnormalities. CONCLUSIONS All children with PMG had recordable visual function either by visual acuity or VEP testing, however the majority did not show longitudinal improvement in acuity. Seizures may impose limits on visual acuity development. Children with cytomegalovirus-related PMG, microcephaly, and developmental delay can have normal visual acuity. Children with a recordable VEP but without visually guided behaviors may have a defect in sensorimotor transformation.
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Affiliation(s)
- John P Kelly
- Roger H. Johnson Vision Lab, Division of Ophthalmology, Seattle Children's Hospital, Seattle, Washington; Department of Ophthalmology, University of Washington Medical Center, Seattle
| | - Gisele E Ishak
- Division of Radiology, Seattle Children's Hospital, Seattle, Washington; Department of Radiology, University of Washington Medical Center, Seattle
| | - James O Phillips
- Roger H. Johnson Vision Lab, Division of Ophthalmology, Seattle Children's Hospital, Seattle, Washington; Department of Otolaryngology, University of Washington Medical Center, Seattle
| | - Ho Nguyen
- Division of Radiology, Seattle Children's Hospital, Seattle, Washington
| | - Avery H Weiss
- Roger H. Johnson Vision Lab, Division of Ophthalmology, Seattle Children's Hospital, Seattle, Washington; Department of Ophthalmology, University of Washington Medical Center, Seattle.
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Poliachik SL, Friedman SD, Poliakov AV, Budech CB, Ishak GE, Shaw DWW, Gospe SM. Corpus Callosum Diffusion and Connectivity Features in High Functioning Subjects With Pyridoxine-Dependent Epilepsy. Pediatr Neurol 2016; 54:43-8. [PMID: 26547255 DOI: 10.1016/j.pediatrneurol.2015.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 08/31/2015] [Accepted: 09/04/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND In this observational study, white matter structure, functional magnetic resonance imaging (fMRI) task-based responses, and functional connectivity were assessed in four subjects with high functioning pyridoxine-dependent epilepsy and age-matched control subjects. METHODS Four male subjects with pyridoxine-dependent epilepsy (mean age 31 years 8 months, standard deviation 12 years 3 months) and age-matched control subjects (32 years 4 months, standard deviation 13 years) were recruited to participate in the study. Diffusion tensor data were collected and postprocessed in Functional Magnetic Resonance Imaging of the Brain Software Library to quantify corpus callosum tracts as a means to assess white matter structure. Task-based fMRI data were collected and Functional Magnetic Resonance Imaging of the Brain Software Library used to assess task response. The fMRI resting-state data were analyzed with the functional connectivity toolbox Conn to determine functional connectivity. RESULTS Subjects with high functioning pyridoxine-dependent epilepsy retained structural white matter connectivity compared with control subjects, despite morphologic differences in the posterior corpus callosum. fMRI task-based results did not differ between subjects with pyridoxine-dependent epilepsy and control subjects; functional connectivity as measured with resting-state fMRI was lower in subjects with pyridoxine-dependent epilepsy for several systems (memory, somatosensory, auditory). CONCLUSION Although corpus callosum morphology is diminished in the posterior portions, structural connectivity was retained in subjects with pyridoxine-dependent epilepsy, while functional connectivity was diminished for memory, somatosensory, and auditory systems.
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Affiliation(s)
- Sandra L Poliachik
- Department of Radiology, Seattle Children's Hospital, Seattle Washington
| | - Seth D Friedman
- Department of Radiology, Seattle Children's Hospital, Seattle Washington
| | - Andrew V Poliakov
- Department of Radiology, Seattle Children's Hospital, Seattle Washington
| | | | - Gisele E Ishak
- Department of Radiology, Seattle Children's Hospital, Seattle Washington; Department of Radiology, University of Washington, Seattle Washington
| | - Dennis W W Shaw
- Department of Radiology, Seattle Children's Hospital, Seattle Washington; Department of Radiology, University of Washington, Seattle Washington
| | - Sidney M Gospe
- Departments of Neurology and Pediatrics, University of Washington, Division of Neurology, Seattle Children's Hospital, Seattle Washington.
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Nixon JN, Dempsey JC, Doherty D, Ishak GE. Temporal bone and cranial nerve findings in pontine tegmental cap dysplasia. Neuroradiology 2015; 58:179-87. [DOI: 10.1007/s00234-015-1604-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 09/29/2015] [Indexed: 11/28/2022]
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20
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Bachmann-Gagescu R, Phelps IG, Dempsey JC, Sharma VA, Ishak GE, Boyle EA, Wilson M, Lourenço CM, Arslan M, Shendure J, Doherty D. KIAA0586 is Mutated in Joubert Syndrome. Hum Mutat 2015; 36:831-5. [PMID: 26096313 PMCID: PMC4537327 DOI: 10.1002/humu.22821] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 06/08/2015] [Indexed: 12/26/2022]
Abstract
Joubert syndrome (JS) is a recessive neurodevelopmental disorder characterized by a distinctive mid-hindbrain malformation. JS is part of a group of disorders called ciliopathies based on their overlapping phenotypes and common underlying pathophysiology linked to primary cilium dysfunction. Biallelic mutations in one of 28 genes, all encoding proteins localizing to the primary cilium or basal body, can cause JS. Despite this large number of genes, the genetic cause can currently be determined in about 62% of individuals with JS. To identify novel JS genes, we performed whole exome sequencing on 35 individuals with JS and found biallelic rare deleterious variants (RDVs) in KIAA0586, encoding a centrosomal protein required for ciliogenesis, in one individual. Targeted next-generation sequencing in a large JS cohort identified biallelic RDVs in eight additional families for an estimated prevalence of 2.5% (9/366 JS families). All affected individuals displayed JS phenotypes toward the mild end of the spectrum.
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Affiliation(s)
- Ruxandra Bachmann-Gagescu
- Institute of Molecular Life Sciences, University of Zurich, 8057 Zurich, Switzerland
- Institute of Medical Genetics, University of Zurich, 8603 Zurich, Switzerland
| | - Ian G. Phelps
- Dept. of Pediatrics, University of Washington, Seattle, WA
| | | | | | - Gisele E. Ishak
- Department of Radiology, University of Washington, Seattle Children’s Hospital, Seattle, WA
| | - Evan A Boyle
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
- Department of Genetics, Stanford University, Stanford, CA, USA
| | - Meredith Wilson
- Department of Clinical Genetics, Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Charles Marques Lourenço
- Department of Neurosciences and Behavior Neurosciences, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Mutluay Arslan
- Gulhane Military Medical School, Division of Child Neurology, Ankara, Turkey
| | | | - Jay Shendure
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Dan Doherty
- Dept. of Pediatrics, University of Washington, Seattle, WA
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21
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Bachmann-Gagescu R, Dempsey JC, Phelps IG, O'Roak BJ, Knutzen DM, Rue TC, Ishak GE, Isabella CR, Gorden N, Adkins J, Boyle EA, de Lacy N, O'Day D, Alswaid A, Ramadevi A R, Lingappa L, Lourenço C, Martorell L, Garcia-Cazorla À, Ozyürek H, Haliloğlu G, Tuysuz B, Topçu M, Chance P, Parisi MA, Glass IA, Shendure J, Doherty D. Joubert syndrome: a model for untangling recessive disorders with extreme genetic heterogeneity. J Med Genet 2015; 52:514-22. [PMID: 26092869 PMCID: PMC5082428 DOI: 10.1136/jmedgenet-2015-103087] [Citation(s) in RCA: 190] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 06/01/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND Joubert syndrome (JS) is a recessive neurodevelopmental disorder characterised by hypotonia, ataxia, cognitive impairment, abnormal eye movements, respiratory control disturbances and a distinctive mid-hindbrain malformation. JS demonstrates substantial phenotypic variability and genetic heterogeneity. This study provides a comprehensive view of the current genetic basis, phenotypic range and gene-phenotype associations in JS. METHODS We sequenced 27 JS-associated genes in 440 affected individuals (375 families) from a cohort of 532 individuals (440 families) with JS, using molecular inversion probe-based targeted capture and next-generation sequencing. Variant pathogenicity was defined using the Combined Annotation Dependent Depletion algorithm with an optimised score cut-off. RESULTS We identified presumed causal variants in 62% of pedigrees, including the first B9D2 mutations associated with JS. 253 different mutations in 23 genes highlight the extreme genetic heterogeneity of JS. Phenotypic analysis revealed that only 34% of individuals have a 'pure JS' phenotype. Retinal disease is present in 30% of individuals, renal disease in 25%, coloboma in 17%, polydactyly in 15%, liver fibrosis in 14% and encephalocele in 8%. Loss of CEP290 function is associated with retinal dystrophy, while loss of TMEM67 function is associated with liver fibrosis and coloboma, but we observe no clear-cut distinction between JS subtypes. CONCLUSIONS This work illustrates how combining advanced sequencing techniques with phenotypic data addresses extreme genetic heterogeneity to provide diagnostic and carrier testing, guide medical monitoring for progressive complications, facilitate interpretation of genome-wide sequencing results in individuals with a variety of phenotypes and enable gene-specific treatments in the future.
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Affiliation(s)
- R Bachmann-Gagescu
- Institute for Molecular Life Sciences and Institute of Medical Genetics, University of Zurich, Zurich, Switzerland
| | - J C Dempsey
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - I G Phelps
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - B J O'Roak
- Molecular and Medical Genetics, Oregon Health and Science University, Portland, Oregon, USA
| | - D M Knutzen
- Department of Oncology, Franciscan Health System, Tacoma, Washington, USA
| | - T C Rue
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - G E Ishak
- Department of Radiology, University of Washington, Seattle Children's Hospital, Seattle, Washington, USA
| | - C R Isabella
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - N Gorden
- Department of Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - J Adkins
- Division of Integrated Cancer Genomics, Translational Genomics Research Institute, Phoenix, Arizona, USA
| | - E A Boyle
- Department of Genome Sciences, University of Washington, Seattle, Washington, USA
| | - N de Lacy
- Department of Psychiatry, University of Washington, Seattle, Washington, USA
| | - D O'Day
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - A Alswaid
- Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | | | - L Lingappa
- Department of Child Neurology, Rainbow Children Hospital, Hyderabad, India
| | - C Lourenço
- Department of Neurosciences and Behavior Neurosciences, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - L Martorell
- Department of Genetica Molecular, Hospital Sant Joan de Deu, Barcelona, Spain
| | - À Garcia-Cazorla
- Department of Neurology, Neurometabolic Unit, Hospital Sant Joan de Déu and CIBERER, ISCIII, Barcelona, Spain
| | - H Ozyürek
- Department of Pediatric Neurology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - G Haliloğlu
- Department of Pediatric Neurology, Hacettepe University Children's Hospital, Ankara, Turkey
| | - B Tuysuz
- Department of Pediatric Genetics, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
| | - M Topçu
- Department of Pediatric Neurology, Hacettepe University Children's Hospital, Ankara, Turkey
| | - P Chance
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - M A Parisi
- National Institute of Child Health and Human Development, NIH, Bethesda, Maryland, USA
| | - I A Glass
- Department of Pediatrics, University of Washington, Seattle, Washington, USA Seattle Children's Research Institute, Seattle, Washington, USA
| | - J Shendure
- Department of Genome Sciences, University of Washington, Seattle, Washington, USA
| | - D Doherty
- Department of Pediatrics, University of Washington, Seattle, Washington, USA Seattle Children's Research Institute, Seattle, Washington, USA
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22
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Oegema R, Cushion TD, Phelps IG, Chung SK, Dempsey JC, Collins S, Mullins JGL, Dudding T, Gill H, Green AJ, Dobyns WB, Ishak GE, Rees MI, Doherty D. Recognizable cerebellar dysplasia associated with mutations in multiple tubulin genes. Hum Mol Genet 2015; 24:5313-25. [PMID: 26130693 DOI: 10.1093/hmg/ddv250] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 06/24/2015] [Indexed: 01/06/2023] Open
Abstract
Mutations in alpha- and beta-tubulins are increasingly recognized as a major cause of malformations of cortical development (MCD), typically lissencephaly, pachygyria and polymicrogyria; however, sequencing tubulin genes in large cohorts of MCD patients has detected tubulin mutations in only 1-13%. We identified patients with a highly characteristic cerebellar dysplasia but without lissencephaly, pachygyria and polymicrogyria typically associated with tubulin mutations. Remarkably, in seven of nine patients (78%), targeted sequencing revealed mutations in three different tubulin genes (TUBA1A, TUBB2B and TUBB3), occurring de novo or inherited from a mosaic parent. Careful re-review of the cortical phenotype on brain imaging revealed only an irregular pattern of gyri and sulci, for which we propose the term tubulinopathy-related dysgyria. Basal ganglia (100%) and brainstem dysplasia (80%) were common features. On the basis of in silico structural predictions, the mutations affect amino acids in diverse regions of the alpha-/beta-tubulin heterodimer, including the nucleotide binding pocket. Cell-based assays of tubulin dynamics reveal various effects of the mutations on incorporation into microtubules: TUBB3 p.Glu288Lys and p.Pro357Leu do not incorporate into microtubules at all, whereas TUBB2B p.Gly13Ala shows reduced incorporation and TUBA1A p.Arg214His incorporates fully, but at a slower rate than wild-type. The broad range of effects on microtubule incorporation is at odds with the highly stereotypical clinical phenotype, supporting differential roles for the three tubulin genes involved. Identifying this highly characteristic phenotype is important due to the low recurrence risk compared with the other (recessive) cerebellar dysplasias and the apparent lack of non-neurological medical issues.
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Affiliation(s)
- Renske Oegema
- Department of Clinical Genetics, Erasmus MC University Medical Center, Rotterdam, The Netherlands,
| | | | | | - Seo-Kyung Chung
- Institute of Life Science, College of Medicine and Wales Epilepsy Research Network (WERN), College of Medicine, Swansea University, Swansea SA2 8PP, UK
| | | | - Sarah Collins
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA 98101, USA
| | | | - Tracy Dudding
- Hunter Genetics, Waratah, New South Wales, Australia, University of Newcastle, Callaghan, New South Wales, Australia
| | - Harinder Gill
- National Centre for Medical Genetics, Our Lady's Children's Hospital, Dublin 12, Ireland and
| | - Andrew J Green
- National Centre for Medical Genetics, Our Lady's Children's Hospital, Dublin 12, Ireland and School of Medicine and Medical Science, University College Dublin, Dublin 4, Ireland
| | - William B Dobyns
- Department of Pediatrics, Department of Neurology and Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA 98101, USA
| | - Gisele E Ishak
- Department of Radiology, Seattle Children's Hospital and University of Washington, Seattle, WA 98195, USA
| | - Mark I Rees
- Institute of Life Science, College of Medicine and Wales Epilepsy Research Network (WERN), College of Medicine, Swansea University, Swansea SA2 8PP, UK
| | - Dan Doherty
- Department of Pediatrics, Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA 98101, USA,
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23
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Jansen LA, Mirzaa GM, Ishak GE, O'Roak BJ, Hiatt JB, Roden WH, Gunter SA, Christian SL, Collins S, Adams C, Rivière JB, St-Onge J, Ojemann JG, Shendure J, Hevner RF, Dobyns WB. PI3K/AKT pathway mutations cause a spectrum of brain malformations from megalencephaly to focal cortical dysplasia. Brain 2015; 138:1613-28. [PMID: 25722288 DOI: 10.1093/brain/awv045] [Citation(s) in RCA: 231] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 12/22/2014] [Indexed: 11/15/2022] Open
Abstract
Malformations of cortical development containing dysplastic neuronal and glial elements, including hemimegalencephaly and focal cortical dysplasia, are common causes of intractable paediatric epilepsy. In this study we performed multiplex targeted sequencing of 10 genes in the PI3K/AKT pathway on brain tissue from 33 children who underwent surgical resection of dysplastic cortex for the treatment of intractable epilepsy. Sequencing results were correlated with clinical, imaging, pathological and immunohistological phenotypes. We identified mosaic activating mutations in PIK3CA and AKT3 in this cohort, including cancer-associated hotspot PIK3CA mutations in dysplastic megalencephaly, hemimegalencephaly, and focal cortical dysplasia type IIa. In addition, a germline PTEN mutation was identified in a male with hemimegalencephaly but no peripheral manifestations of the PTEN hamartoma tumour syndrome. A spectrum of clinical, imaging and pathological abnormalities was found in this cohort. While patients with more severe brain imaging abnormalities and systemic manifestations were more likely to have detected mutations, routine histopathological studies did not predict mutation status. In addition, elevated levels of phosphorylated S6 ribosomal protein were identified in both neurons and astrocytes of all hemimegalencephaly and focal cortical dysplasia type II specimens, regardless of the presence or absence of detected PI3K/AKT pathway mutations. In contrast, expression patterns of the T308 and S473 phosphorylated forms of AKT and in vitro AKT kinase activities discriminated between mutation-positive dysplasia cortex, mutation-negative dysplasia cortex, and non-dysplasia epilepsy cortex. Our findings identify PI3K/AKT pathway mutations as an important cause of epileptogenic brain malformations and establish megalencephaly, hemimegalencephaly, and focal cortical dysplasia as part of a single pathogenic spectrum.
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Affiliation(s)
- Laura A Jansen
- 1 University of Virginia, Neurology, Charlottesville, VA, USA 2 Seattle Children's Research Institute, Centre for Integrative Brain Research, Seattle, WA, USA
| | - Ghayda M Mirzaa
- 2 Seattle Children's Research Institute, Centre for Integrative Brain Research, Seattle, WA, USA 3 University of Washington, Paediatrics, Seattle, WA, USA
| | - Gisele E Ishak
- 4 Seattle Children's Hospital, Radiology, Seattle, WA, USA
| | - Brian J O'Roak
- 5 University of Washington, Genome Sciences, Seattle, WA, USA 6 Oregon Health and Science University, Molecular and Medical Genetics, Portland, OR, USA
| | - Joseph B Hiatt
- 5 University of Washington, Genome Sciences, Seattle, WA, USA
| | - William H Roden
- 2 Seattle Children's Research Institute, Centre for Integrative Brain Research, Seattle, WA, USA
| | - Sonya A Gunter
- 1 University of Virginia, Neurology, Charlottesville, VA, USA
| | - Susan L Christian
- 2 Seattle Children's Research Institute, Centre for Integrative Brain Research, Seattle, WA, USA
| | - Sarah Collins
- 2 Seattle Children's Research Institute, Centre for Integrative Brain Research, Seattle, WA, USA
| | - Carissa Adams
- 2 Seattle Children's Research Institute, Centre for Integrative Brain Research, Seattle, WA, USA
| | - Jean-Baptiste Rivière
- 2 Seattle Children's Research Institute, Centre for Integrative Brain Research, Seattle, WA, USA 7 Université de Bourgogne, Equipe Génétique des Anomalies du Développement, Dijon, France
| | - Judith St-Onge
- 2 Seattle Children's Research Institute, Centre for Integrative Brain Research, Seattle, WA, USA 7 Université de Bourgogne, Equipe Génétique des Anomalies du Développement, Dijon, France
| | | | - Jay Shendure
- 5 University of Washington, Genome Sciences, Seattle, WA, USA
| | - Robert F Hevner
- 2 Seattle Children's Research Institute, Centre for Integrative Brain Research, Seattle, WA, USA 8 University of Washington, Neurosurgery, Seattle, WA, USA
| | - William B Dobyns
- 2 Seattle Children's Research Institute, Centre for Integrative Brain Research, Seattle, WA, USA 3 University of Washington, Paediatrics, Seattle, WA, USA
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Chapman T, Mahalingam S, Ishak GE, Nixon JN, Siebert J, Dighe MK. Diagnostic imaging of posterior fossa anomalies in the fetus and neonate: Part 1, normal anatomy and classification of anomalies. Clin Imaging 2015; 39:1-8. [DOI: 10.1016/j.clinimag.2014.10.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 10/01/2014] [Accepted: 10/16/2014] [Indexed: 10/24/2022]
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25
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Friedman SD, Ishak GE, Poliachik SL, Poliakov AV, Otto RK, Shaw DWW, Willemsen MA, Bok LA, Gospe SM. Callosal alterations in pyridoxine-dependent epilepsy. Dev Med Child Neurol 2014; 56:1106-10. [PMID: 24942048 DOI: 10.1111/dmcn.12511] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2014] [Indexed: 11/30/2022]
Abstract
AIM While there have been isolated reports of callosal morphology differences in pyridoxine-dependent epilepsy (PDE), a rare autosomal disorder caused by ALDH7A1 gene mutations, no study has systematically evaluated callosal features in a large sample of patients. This study sought to overcome this knowledge gap. METHOD Spanning a wide age range from birth to 48 years, corpus callosum morphology and cross-sectional cerebral area were measured in 30 individuals with PDE (12 males, 18 females, median age 3.92y; 25th centile 0.27, 75th centile 15.25) compared to 30 age-matched comparison individuals (11 males, 19 females, median age 3.85y; 25th centile 0.26, 75th centile 16.00). Individuals with PDE were also divided into age groups to evaluate findings across development. As delay to treatment may modulate clinical severity, groups were stratified by treatment delay (less than or greater than 2wks from birth). RESULTS Markedly reduced callosal area expressed as a ratio of mid-sagittal cerebral area was observed for the entire group with PDE (p<0.001). Stratifying by age (<1y, 1-10y, >10y) demonstrated posterior abnormalities to be a consistent feature, with anterior regions increasingly involved across the developmental trajectory. Splitting the PDE group by treatment lag did not reveal overall or sub-region callosal differences. INTERPRETATION Callosal abnormalities are a common feature of PDE not explained by treatment lag. Future work utilizing tract-based approaches to understand inter- and intra-hemispheric connectivity patterns will help in the better understanding the structural aspects of this disease.
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Affiliation(s)
- Seth D Friedman
- Department of Radiology, Seattle Children's Hospital, Seattle, WA, USA
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26
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Chapman T, Mahalingam S, Ishak GE, Nixon JN, Siebert J, Dighe MK. Diagnostic imaging of posterior fossa anomalies in the fetus and neonate: part 2, Posterior fossa disorders. Clin Imaging 2014; 39:167-75. [PMID: 25457569 DOI: 10.1016/j.clinimag.2014.10.012] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 10/16/2014] [Accepted: 10/20/2014] [Indexed: 01/15/2023]
Abstract
This second portion of a two-part review illustrates examples of posterior fossa disorders detectable on prenatal ultrasound and MRI, with postnatal or pathology correlation where available. These disorders are discussed in the context of an anatomic classification scheme described in Part 1 of this posterior fossa anomaly review. Assessment of the size and formation of the cerebellar hemispheres and vermis is critical. Diagnoses discussed here include arachnoid cyst, Blake's pouch cyst, Dandy-Walker malformation, vermian agenesis, Joubert syndrome, rhombencephalosynapsis, Chiari II malformation, ischemia, and tumors.
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Affiliation(s)
- Teresa Chapman
- Department of Radiology, Seattle Children's Hospital, MA.7.220, 4800 Sand Point Way NE, Seattle, WA, 98105; Department of Radiology, University of Washington Medical Center, Box 357115, 1959 NE Pacific Street, Seattle, WA 98195-7117.
| | - Sowmya Mahalingam
- Department of Radiology, University of Washington Medical Center, Box 357115, 1959 NE Pacific Street, Seattle, WA 98195-7117
| | - Gisele E Ishak
- Department of Radiology, Seattle Children's Hospital, MA.7.220, 4800 Sand Point Way NE, Seattle, WA, 98105; Department of Radiology, University of Washington Medical Center, Box 357115, 1959 NE Pacific Street, Seattle, WA 98195-7117
| | - Jason N Nixon
- Department of Radiology, Seattle Children's Hospital, MA.7.220, 4800 Sand Point Way NE, Seattle, WA, 98105; Department of Radiology, University of Washington Medical Center, Box 357115, 1959 NE Pacific Street, Seattle, WA 98195-7117
| | - Joseph Siebert
- Department of Pathology, Seattle Children's Hospital, PC.8.720, 4800 Sand Point Way NE, Seattle, WA, 98105
| | - Manjiri K Dighe
- Department of Radiology, University of Washington Medical Center, Box 357115, 1959 NE Pacific Street, Seattle, WA 98195-7117
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Tse R, Nixon JN, Iyer RS, Kuhlman-Wood KA, Ishak GE. The diagnostic value of CT myelography, MR myelography, and both in neonatal brachial plexus palsy. AJNR Am J Neuroradiol 2014; 35:1425-32. [PMID: 24676008 DOI: 10.3174/ajnr.a3878] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Although most infants with brachial plexus palsy recover function spontaneously, approximately 10-30% benefit from surgical treatment. Pre-operative screening for nerve root avulsions is helpful in planning reconstruction. Our aim was to compare the diagnostic value of CT myelography, MR myelography, and both against a surgical criterion standard for detection of complete nerve root avulsions in birth brachial plexus palsy. MATERIALS AND METHODS Nineteen patients who underwent a preoperative CT and/or MR myelography and subsequent brachial plexus exploration were included. Imaging studies were analyzed for the presence of abnormalities potentially predictive of nerve root avulsion. Findings of nerve root avulsion on surgical exploration were used as the criterion standard to assess the predictive value of imaging findings. RESULTS Ninety-five root levels were examined. When the presence of any pseudomeningocele was used as a predictor, the sensitivity was 0.73 for CT and 0.68 for MR imaging and the specificity was 0.96 for CT and 0.97 for MR imaging. When presence of pseudomeningocele with absent rootlets was used as the predictor, the sensitivity was 0.68 for CT and 0.68 for MR imaging and the specificity was 0.96 for CT and 0.97 for MR imaging. The use of both CT and MR imaging did not increase diagnostic accuracy. Rootlet findings in the absence of pseudomeningocele were not helpful in predicting complete nerve root avulsion. CONCLUSIONS Findings of CT and MR myelography were highly correlated. Given the advantages of MR myelography, it is now the single technique for preoperative evaluation of nerve root avulsion at our institution.
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Affiliation(s)
- R Tse
- the Division of Plastic Surgery, Department of Surgery (R.T., K.A.K.-W.), the Seattle Children's Hospital, University of Washington, Seattle, Washington.
| | - J N Nixon
- From the Department of Radiology (J.N.N., R.S.L., G.E.I.)
| | - R S Iyer
- From the Department of Radiology (J.N.N., R.S.L., G.E.I.)
| | - K A Kuhlman-Wood
- the Division of Plastic Surgery, Department of Surgery (R.T., K.A.K.-W.), the Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - G E Ishak
- From the Department of Radiology (J.N.N., R.S.L., G.E.I.)
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Tuz K, Bachmann-Gagescu R, O'Day DR, Hua K, Isabella CR, Phelps IG, Stolarski AE, O'Roak BJ, Dempsey JC, Lourenco C, Alswaid A, Bönnemann CG, Medne L, Nampoothiri S, Stark Z, Leventer RJ, Topçu M, Cansu A, Jagadeesh S, Done S, Ishak GE, Glass IA, Shendure J, Neuhauss SCF, Haldeman-Englert CR, Doherty D, Ferland RJ. Mutations in CSPP1 cause primary cilia abnormalities and Joubert syndrome with or without Jeune asphyxiating thoracic dystrophy. Am J Hum Genet 2014; 94:62-72. [PMID: 24360808 DOI: 10.1016/j.ajhg.2013.11.019] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 11/13/2013] [Indexed: 12/26/2022] Open
Abstract
Joubert syndrome (JBTS) is a recessive ciliopathy in which a subset of affected individuals also have the skeletal dysplasia Jeune asphyxiating thoracic dystrophy (JATD). Here, we have identified biallelic truncating CSPP1 (centrosome and spindle pole associated protein 1) mutations in 19 JBTS-affected individuals, four of whom also have features of JATD. CSPP1 mutations explain ∼5% of JBTS in our cohort, and despite truncating mutations in all affected individuals, the range of phenotypic severity is broad. Morpholino knockdown of cspp1 in zebrafish caused phenotypes reported in other zebrafish models of JBTS (curved body shape, pronephric cysts, and cerebellar abnormalities) and reduced ciliary localization of Arl13b, further supporting loss of CSPP1 function as a cause of JBTS. Fibroblasts from affected individuals with CSPP1 mutations showed reduced numbers of primary cilia and/or short primary cilia, as well as reduced axonemal localization of ciliary proteins ARL13B and adenylyl cyclase III. In summary, CSPP1 mutations are a major cause of the Joubert-Jeune phenotype in humans; however, the mechanism by which these mutations lead to both JBTS and JATD remains unknown.
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Affiliation(s)
- Karina Tuz
- Center for Neuropharmacology and Neuroscience, Albany Medical College, Albany, NY 12208, USA
| | - Ruxandra Bachmann-Gagescu
- Institute of Molecular Life Sciences, University of Zurich, 8057 Zurich, Switzerland; Institute of Medical Genetics, University of Zurich, 8603 Zurich, Switzerland
| | - Diana R O'Day
- Divisions of Genetic Medicine and Developmental Medicine, Department of Pediatrics, University of Washington, Seattle, WA 98195, USA
| | - Kiet Hua
- Center for Neuropharmacology and Neuroscience, Albany Medical College, Albany, NY 12208, USA
| | - Christine R Isabella
- Divisions of Genetic Medicine and Developmental Medicine, Department of Pediatrics, University of Washington, Seattle, WA 98195, USA
| | - Ian G Phelps
- Divisions of Genetic Medicine and Developmental Medicine, Department of Pediatrics, University of Washington, Seattle, WA 98195, USA
| | - Allan E Stolarski
- Center for Neuropharmacology and Neuroscience, Albany Medical College, Albany, NY 12208, USA
| | - Brian J O'Roak
- Department of Molecular & Medical Genetics, Oregon Health Sciences University, Portland, OR 97239, USA
| | - Jennifer C Dempsey
- Divisions of Genetic Medicine and Developmental Medicine, Department of Pediatrics, University of Washington, Seattle, WA 98195, USA
| | - Charles Lourenco
- Neurogenetics Division, Clinics Hospital, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo 14049-900, Brazil
| | - Abdulrahman Alswaid
- Department of Pediatrics, King Abdulaziz Medical City, Riyadh 11426, Saudi Arabia
| | - Carsten G Bönnemann
- Neuromuscular and Neurogenetic Disorders of Childhood Section, John Edward Porter Neuroscience Research Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Livija Medne
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Sheela Nampoothiri
- Department of Pediatric Genetics, Amrita Institute of Medical Sciences and Research Center, AIMS Ponekkara Post Office, Kochi, Kerala 682041, India
| | - Zornitza Stark
- Victorian Clinical Genetics Services, Murdoch Childrens Research Institute, Parkville, VIC 3052, Australia
| | - Richard J Leventer
- Departments of Neurology and Pediatrics, Murdoch Childrens Research Institute, Royal Children's Hospital and University of Melbourne, Parkville, VIC 3052, Australia
| | - Meral Topçu
- Department of Child Neurology, Hacettepe University Medical Faculty, Ihsan Dogramacı Children's Hospital, Ankara 06100, Turkey
| | - Ali Cansu
- Pediatric Neurology Unit, De Karadeniz Technical University, Trabzon 61080, Turkey
| | | | - Stephen Done
- Department of Radiology, University of Washington and Seattle Children's Hospital, Seattle, WA 98105, USA
| | - Gisele E Ishak
- Department of Radiology, University of Washington and Seattle Children's Hospital, Seattle, WA 98105, USA
| | - Ian A Glass
- Divisions of Genetic Medicine and Developmental Medicine, Department of Pediatrics, University of Washington, Seattle, WA 98195, USA; Center for Integrative Brain Research, Seattle Children's Hospital Research Institute, Seattle, WA 98105, USA
| | - Jay Shendure
- Department of Genome Sciences, University of Washington, Seattle, WA 98195, USA
| | - Stephan C F Neuhauss
- Institute of Molecular Life Sciences, University of Zurich, 8057 Zurich, Switzerland
| | - Chad R Haldeman-Englert
- Department of Pediatrics, Section on Medical Genetics, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Dan Doherty
- Divisions of Genetic Medicine and Developmental Medicine, Department of Pediatrics, University of Washington, Seattle, WA 98195, USA; Center for Integrative Brain Research, Seattle Children's Hospital Research Institute, Seattle, WA 98105, USA.
| | - Russell J Ferland
- Center for Neuropharmacology and Neuroscience, Albany Medical College, Albany, NY 12208, USA; Department of Neurology, Albany Medical College, Albany, NY 12208, USA.
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Ojemann JG, Partridge SC, Poliakov AV, Niazi TN, Shaw DW, Ishak GE, Lee A, Browd SR, Geyer JR, Ellenbogen RG. Diffusion tensor imaging of the superior cerebellar peduncle identifies patients with posterior fossa syndrome. Childs Nerv Syst 2013; 29:2071-7. [PMID: 23817992 DOI: 10.1007/s00381-013-2205-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Accepted: 06/11/2013] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Posterior fossa tumors are the most common brain tumor of children. Aggressive resection correlates with long-term survival. A high incidence of posterior fossa syndrome (PFS), impairing the quality of life in many survivors, has been attributed to damage to bilateral dentate nucleus or to cerebellar output pathways. Using diffusion tensor imaging (DTI), we examined the involvement of the dentothalamic tracts, specifically the superior cerebellar peduncle (SCP), in patients with posterior fossa tumors and the association with PFS. METHODS DTI studies were performed postoperatively in patients with midline (n = 12), lateral cerebellar tumors (n = 4), and controls. The location and visibility of the SCP were determined. The postoperative course was recorded, especially with regard to PFS, cranial nerve deficits, and oculomotor function. RESULTS The SCP travels immediately adjacent to the lateral wall of the fourth ventricle and just medial to the middle cerebellar peduncle. Patients with midline tumors that still had observable SCP did not develop posterior fossa syndrome (N = 7). SCPs were absent, on either preoperative (N = 1, no postoperative study available) or postoperative studies (N = 4), in the five patients who developed PFS. Oculomotor deficits of tracking were observed in patients independent of PFS or SCP involvement. CONCLUSION PFS can occur with bilateral injury to the outflow from dentate nuclei. In children with PFS, this may occur due to bilateral injury to the superior cerebellar peduncle. These tracts sit immediately adjacent to the wall of the ventricle and are highly vulnerable when an aggressive resection for these tumors is performed.
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Tully HM, Dempsey JC, Ishak GE, Adam MP, Mink JW, Dobyns WB, Gospe SM, Weiss A, Phillips JO, Doherty D. Persistent figure-eight and side-to-side head shaking is a marker for rhombencephalosynapsis. Mov Disord 2013; 28:2019-23. [PMID: 24105968 DOI: 10.1002/mds.25634] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 06/11/2013] [Accepted: 07/14/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Head-shaking stereotypies have been described in patients with neurological impairment. We noted an unusual preponderance of head shaking in patients with rhombencephalosynapsis (RES). We sought to delineate the movements further and determine whether oculomotor and vestibular testing could reveal their cause. METHODS Information was collected from direct observation, video review and parental questionnaire from 59 patients with RES. Oculomotor and vestibular testing was performed in 4 children. RESULTS Of 59 patients, 50 had persistent head shaking that was often observed years before RES was recognized. Three affected children demonstrated abnormal central vestibular processing. CONCLUSIONS Head-shaking is common in RES. These characteristic movements may provide input to a defective vestibular system or may represent a motor pattern that is usually suppressed by vestibular feedback. Persistent head shaking should alert clinicians to the possible presence of a congenital hindbrain abnormality that affects the vestibulocerebellum, particularly RES.
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Affiliation(s)
- Hannah M Tully
- Department of Neurology, University of Washington, Seattle, Washington, USA
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Stanescu L, Ishak GE, Khanna PC, Biyyam DR, Shaw DW, Parisi MT. FDG PET of the Brain in Pediatric Patients: Imaging Spectrum with MR Imaging Correlation. Radiographics 2013; 33:1279-303. [DOI: 10.1148/rg.335125152] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Badve CA, K MM, Iyer RS, Ishak GE, Khanna PC. Craniosynostosis: imaging review and primer on computed tomography. Pediatr Radiol 2013; 43:728-42; quiz 725-7. [PMID: 23636536 DOI: 10.1007/s00247-013-2673-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 02/05/2013] [Accepted: 02/07/2013] [Indexed: 12/29/2022]
Abstract
Craniosynostosis is encountered in the pediatric population in isolated or syndromic forms. The resulting deformity depends on the number and type of sutures involved and, in multi-sutural synostosis, the order of suture fusion. Primary craniosynostosis needs to be differentiated from the secondary variety and positional or deformational mimics. Syndromic craniosynostoses are associated with other craniofacial deformities. Evaluation with 3-D CT plays an important role in accurate diagnosis and management; however, implementation of appropriate CT techniques is essential to limit the radiation burden in these children. In this article, the authors briefly review the classification, embryopathogenesis and epidemiology and describe in detail the radiologic appearance and differential diagnoses of craniosynostosis.
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Affiliation(s)
- Chaitra A Badve
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA.
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Tully HM, Dempsey JC, Ishak GE, Adam MP, Curry CJR, Sanchez-Lara P, Hunter A, Gripp KW, Allanson J, Cunniff C, Glass I, Millen KJ, Doherty D, Dobyns WB. Beyond Gómez-López-Hernández syndrome: recurring phenotypic themes in rhombencephalosynapsis. Am J Med Genet A 2012; 158A:2393-406. [PMID: 22965664 PMCID: PMC3448816 DOI: 10.1002/ajmg.a.35561] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 06/20/2012] [Indexed: 11/07/2022]
Abstract
Rhombencephalosynapsis (RES) is an uncommon cerebellar malformation characterized by fusion of the hemispheres without an intervening vermis. Frequently described in association with Gómez-López-Hernández syndrome, RES also occurs in conjunction with VACTERL features and with holoprosencephaly (HPE). We sought to determine the full phenotypic spectrum of RES in a large cohort of patients. Information was obtained through database review, patient questionnaire, radiographic, and morphologic assessment, and statistical analysis. We assessed 53 patients. Thirty-three had alopecia, 3 had trigeminal anesthesia, 14 had VACTERL features, and 2 had HPE with aventriculy. Specific craniofacial features were seen throughout the cohort, but were more common in patients with alopecia. We noted substantial overlap between groups. We conclude that although some distinct subgroups can be delineated, the overlapping features seen in our cohort suggest an underlying spectrum of RES-associated malformations rather than a collection of discrete syndromes.
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Affiliation(s)
- Hannah M Tully
- Division of Pediatric Neurology, Department of Neurology, University of Washington, Seattle, USA.
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Ishak GE, Poliakov AV, Poliachik SL, Saneto RP, Novotny EJ, McDaniel S, Ojemann JG, Shaw DWW, Friedman SD. Tract-based spatial statistical analysis of diffusion tensor imaging in pediatric patients with mitochondrial disease: widespread reduction in fractional anisotropy of white matter tracts. AJNR Am J Neuroradiol 2012; 33:1726-30. [PMID: 22499843 DOI: 10.3174/ajnr.a3045] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Often diagnosed at birth or in early childhood, mitochondrial disease presents with a variety of clinical symptoms, particularly in organs and tissues that require high energetic demand such as brain, heart, liver, and skeletal muscles. In a group of pediatric patients identified as having complex I or I/III deficits on muscle biopsy but with white matter tissue appearing qualitatively normal for age, we hypothesized that quantitative DTI analyses might unmask disturbance in microstructural integrity. MATERIALS AND METHODS In a retrospective study, DTI and structural MR brain imaging data from 10 pediatric patients with confirmed mitochondrial disease and 10 clinical control subjects were matched for age, sex, scanning parameters, and date of examination. Paired TBSS was performed to evaluate differences in FA, MD, and the separate diffusion direction terms (λr and λa). RESULTS In patients with mitochondrial disease, significant widespread reductions in FA values were shown in white matter tracts. Mean diffusivity values were significantly increased in patients, having a sparser distribution of affected regions compared with FA. Separate diffusion maps showed significant increase in λr and no significant changes in λa. CONCLUSIONS Despite qualitatively normal-appearing white matter tissues, patients with complex I or I/III deficiency have widespread microstructural changes measurable with quantitative DTI.
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Affiliation(s)
- G E Ishak
- Seattle Children's Hospital, Department of Radiology, 4800 Sandpoint Way, M/S R-5417, Seattle, Washington 98105, USA.
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Levitt MR, O'Neill BR, Ishak GE, Khanna PC, Temkin NR, Ellenbogen RG, Ojemann JG, Browd SR. Image-guided cerebrospinal fluid shunting in children: catheter accuracy and shunt survival. J Neurosurg Pediatr 2012; 10:112-7. [PMID: 22747090 DOI: 10.3171/2012.3.peds122] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Cerebrospinal fluid shunt placement has a high failure rate, especially in patients with small ventricles. Frameless stereotactic electromagnetic image guidance can assist ventricular catheter placement. The authors studied the effects of image guidance on catheter accuracy and shunt survival in children. METHODS Pediatric patients who underwent placement or revision of a frontal ventricular CSF shunt were retrospectively evaluated. Catheters were placed using either anatomical landmarks or image guidance. Preoperative ventricular size and postoperative catheter accuracy were quantified. Outcomes of standard and image-guided groups were compared. RESULTS Eighty-nine patients underwent 102 shunt surgeries (58 initial, 44 revision). Image guidance was used in the placement of 56 shunts and the standard technique in 46. Shunt failure rates were not significantly different between the standard (22%) and image-guided (25%) techniques (p = 0.21, log-rank test). Ventricular size was significantly smaller in patients in the image-guided group (p < 0.02, Student t-test) and in the surgery revision group (p < 0.01). Small ventricular size did not affect shunt failure rate, even when controlling for shunt insertion technique. Despite smaller average ventricular size, the accuracy of catheter placement was significantly improved with image guidance (p < 0.01). Shunt accuracy did not affect shunt survival. CONCLUSIONS The use of image guidance improved catheter tip accuracy compared with a standard technique, despite smaller ventricular size. Failure rates were not dependent on shunt insertion technique, but an observed selection bias toward using image guidance for more at-risk catheter placements showed failure rates similar to initial surgeries.
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Affiliation(s)
- Michael R Levitt
- Seattle Children's Hospital, Department of Neurological Surgery, 4800 Sand Point Way NE, Seattle, Washington 98105, USA
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Bachmann-Gagescu R, Ishak GE, Dempsey JC, Adkins J, O'Day D, Phelps IG, Gunay-Aygun M, Kline AD, Szczaluba K, Martorell L, Alswaid A, Alrasheed S, Pai S, Izatt L, Ronan A, Parisi MA, Mefford H, Glass I, Doherty D. Genotype-phenotype correlation in CC2D2A-related Joubert syndrome reveals an association with ventriculomegaly and seizures. J Med Genet 2012; 49:126-37. [PMID: 22241855 DOI: 10.1136/jmedgenet-2011-100552] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Joubert syndrome (JS) is a ciliopathy characterised by a distinctive brain malformation (the 'molar tooth sign'), developmental delay, abnormal eye movements and abnormal breathing pattern. Retinal dystrophy, cystic kidney disease, liver fibrosis and polydactyly are variably present, resulting in significant phenotypic heterogeneity and overlap with other ciliopathies. JS is also genetically heterogeneous, resulting from mutations in 13 genes. These factors render clinical/molecular diagnosis and management challenging. CC2D2A mutations are a relatively common cause of JS and also cause Meckel syndrome. The clinical consequences of CC2D2A mutations in patients with JS have been incompletely reported. METHODS Subjects with JS from 209 families were evaluated to identify mutations in CC2D2A. Clinical and imaging features in subjects with CC2D2A mutations were compared with those in subjects without CC2D2A mutations and reports in the literature. RESULTS 10 novel CC2D2A mutations in 20 subjects were identified; a summary is provided of all published CC2D2A mutations. Subjects with CC2D2A-related JS were more likely to have ventriculomegaly (p<0.0001) and seizures (p=0.024) than subjects without CC2D2A mutations. No mutation-specific genotype-phenotype correlations could be identified, but the findings confirm the observation that mutations that cause CC2D2A-related JS are predicted to be less deleterious than mutations that cause CC2D2A-related Meckel syndrome. Missense variants in the coiled-coil and C2 domains, as well as the C-terminal region, identify these regions as important for the biological mechanisms underlying JS. CONCLUSIONS CC2D2A testing should be prioritised in patients with JS and ventriculomegaly and/or seizures. Patients with CC2D2A-related JS should be monitored for hydrocephalus and seizures.
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Affiliation(s)
- Ruxandra Bachmann-Gagescu
- Division of Genetic Medicine, Department of Pediatrics, University of Washington, Seattle, Washington 98195-6320, USA
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Ishak GE, Dempsey JC, Shaw DWW, Tully H, Adam MP, Sanchez-Lara PA, Glass I, Rue TC, Millen KJ, Dobyns WB, Doherty D. Rhombencephalosynapsis: a hindbrain malformation associated with incomplete separation of midbrain and forebrain, hydrocephalus and a broad spectrum of severity. Brain 2012; 135:1370-86. [PMID: 22451504 PMCID: PMC3338925 DOI: 10.1093/brain/aws065] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Revised: 01/28/2012] [Accepted: 01/29/2012] [Indexed: 12/11/2022] Open
Abstract
Rhombencephalosynapsis is a midline brain malformation characterized by missing cerebellar vermis with apparent fusion of the cerebellar hemispheres. Rhombencephalosynapsis can be seen in isolation or together with other central nervous system and extra-central nervous system malformations. Gómez-López-Hernández syndrome combines rhombencephalosynapsis with parietal/temporal alopecia and sometimes trigeminal anaesthesia, towering skull shape and dysmorphic features. Rhombencephalosynapsis can also be seen in patients with features of vertebral anomalies, anal atresia, cardiovascular anomalies, trachea-oesophageal fistula, renal anomalies, limb defects (VACTERL) association. Based on a comprehensive evaluation of neuroimaging findings in 42 patients with rhombencephalosynapsis, we propose a spectrum of severity, ranging from mild (the partial absence of nodulus, anterior and posterior vermis), to moderate (the absence of posterior vermis with some anterior vermis and nodulus present), to severe (the absence of posterior and anterior vermis with some nodulus present), to complete (the absence of the entire vermis including nodulus). We demonstrate that the severity of rhombencephalosynapsis correlates with fusion of the tonsils, as well as midbrain abnormalities including aqueductal stenosis and midline fusion of the tectum. Rhombencephalosynapsis is also associated with multiple forebrain abnormalities including absent olfactory bulbs, dysgenesis of the corpus callosum, absent septum pellucidum and, in rare patients, atypical forms of holoprosencephaly. The frequent association between rhombencephalosynapsis and aqueductal stenosis prompted us to evaluate brain magnetic resonance images in other patients with aqueductal stenosis at our institution, and remarkably, we identified rhombencephalosynapsis in 9%. Strikingly, subjects with more severe rhombencephalosynapsis have more severely abnormal neurodevelopmental outcome, as do subjects with holoprosencephaly and patients with VACTERL features. In summary, our data provide improved diagnostic and prognostic information, and support disruption of dorsal-ventral patterning as a mechanism underlying rhombencephalosynapsis.
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Affiliation(s)
- Gisele E. Ishak
- 1 Department of Radiology, University of Washington, Seattle Children’s Hospital, Seattle, WA 98105, USA
| | - Jennifer C. Dempsey
- 2 Division of Genetic Medicine, Department of Paediatrics, University of Washington, Seattle, WA 98195, USA
| | - Dennis W. W. Shaw
- 1 Department of Radiology, University of Washington, Seattle Children’s Hospital, Seattle, WA 98105, USA
- 3 Centre for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA 98101, USA
| | - Hannah Tully
- 3 Centre for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA 98101, USA
- 4 Department of Neurology, University of Washington, Seattle, WA 98195, USA
| | - Margaret P. Adam
- 2 Division of Genetic Medicine, Department of Paediatrics, University of Washington, Seattle, WA 98195, USA
| | - Pedro A. Sanchez-Lara
- 5 Department of Paediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
- 6 Children's Hospital Los Angeles, Los Angeles, CA 90027, USA
| | - Ian Glass
- 2 Division of Genetic Medicine, Department of Paediatrics, University of Washington, Seattle, WA 98195, USA
| | - Tessa C. Rue
- 7 Department of Biostatistics, University of Washington, Seattle, WA 98195, USA
| | - Kathleen J. Millen
- 2 Division of Genetic Medicine, Department of Paediatrics, University of Washington, Seattle, WA 98195, USA
- 3 Centre for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA 98101, USA
| | - William B. Dobyns
- 2 Division of Genetic Medicine, Department of Paediatrics, University of Washington, Seattle, WA 98195, USA
- 3 Centre for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA 98101, USA
| | - Dan Doherty
- 2 Division of Genetic Medicine, Department of Paediatrics, University of Washington, Seattle, WA 98195, USA
- 3 Centre for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA 98101, USA
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Abstract
We present a pictorial review of MRI features of various closed spinal dysraphisms based on previously described clinicoradiological classification of spinal dysraphisms proposed. The defining imaging features of each dysraphism type are highlighted and a diagnostic algorithm for closed spinal dysraphisms is suggested.
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Affiliation(s)
- Chaitra A Badve
- Department of Radiology, Seattle Children's Hospital and University of Washington Medical Center, 4800 Sand Point Way NE, Seattle, WA 98105, USA
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Rafiq MA, Kuss AW, Puettmann L, Noor A, Ramiah A, Ali G, Hu H, Kerio NA, Xiang Y, Garshasbi M, Khan MA, Ishak GE, Weksberg R, Ullmann R, Tzschach A, Kahrizi K, Mahmood K, Naeem F, Ayub M, Moremen KW, Vincent JB, Ropers HH, Ansar M, Najmabadi H. Mutations in the alpha 1,2-mannosidase gene, MAN1B1, cause autosomal-recessive intellectual disability. Am J Hum Genet 2011; 89:176-82. [PMID: 21763484 DOI: 10.1016/j.ajhg.2011.06.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 05/19/2011] [Accepted: 06/07/2011] [Indexed: 11/15/2022] Open
Abstract
We have used genome-wide genotyping to identify an overlapping homozygosity-by-descent locus on chromosome 9q34.3 (MRT15) in four consanguineous families affected by nonsyndromic autosomal-recessive intellectual disability (NS-ARID) and one in which the patients show additional clinical features. Four of the families are from Pakistan, and one is from Iran. Using a combination of next-generation sequencing and Sanger sequencing, we have identified mutations in the gene MAN1B1, encoding a mannosyl oligosaccharide, alpha 1,2-mannosidase. In one Pakistani family, MR43, a homozygous nonsense mutation (RefSeq number NM_016219.3: c.1418G>A [p.Trp473*]), segregated with intellectual disability and additional dysmorphic features. We also identified the missense mutation c. 1189G>A (p.Glu397Lys; RefSeq number NM_016219.3), which segregates with NS-ARID in three families who come from the same village and probably have shared inheritance. In the Iranian family, the missense mutation c.1000C>T (p.Arg334Cys; RefSeq number NM_016219.3) also segregates with NS-ARID. Both missense mutations are at amino acid residues that are conserved across the animal kingdom, and they either reduce k(cat) by ∼1300-fold or disrupt stable protein expression in mammalian cells. MAN1B1 is one of the few NS-ARID genes with an elevated mutation frequency in patients with NS-ARID from different populations.
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Affiliation(s)
- Muhammad Arshad Rafiq
- Molecular Neuropsychiatry and Development Lab, Neurogenetics Section, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Affiliation(s)
- Jessica Y Leung
- Department of Radiology, University of Washington Medical Center, 4800 Sand Point Way NE, Seattle, WA 98105, USA.
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Affiliation(s)
- Kathleen R Fink
- Department of Radiology, Seattle Children's Hospital and University of Washington, Seattle, USA
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Mir A, Kaufman L, Noor A, Motazacker MM, Jamil T, Azam M, Kahrizi K, Rafiq MA, Weksberg R, Nasr T, Naeem F, Tzschach A, Kuss AW, Ishak GE, Doherty D, Ropers HH, Barkovich AJ, Najmabadi H, Ayub M, Vincent JB. Identification of mutations in TRAPPC9, which encodes the NIK- and IKK-beta-binding protein, in nonsyndromic autosomal-recessive mental retardation. Am J Hum Genet 2009; 85:909-15. [PMID: 20004765 PMCID: PMC2790571 DOI: 10.1016/j.ajhg.2009.11.009] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Revised: 11/04/2009] [Accepted: 11/09/2009] [Indexed: 11/25/2022] Open
Abstract
Mental retardation/intellectual disability is a devastating neurodevelopmental disorder with serious impact on affected individuals and their families, as well as on health and social services. It occurs with a prevalence of approximately 2%, is an etiologically heterogeneous condition, and is frequently the result of genetic aberrations. Autosomal-recessive forms of nonsyndromic MR (NS-ARMR) are believed to be common, yet only five genes have been identified. We have used homozygosity mapping to search for the gene responsible for NS-ARMR in a large Pakistani pedigree. Using Affymetrix 5.0 single nucleotide polymorphism (SNP) microarrays, we identified a 3.2 Mb region on 8q24 with a continuous run of 606 homozygous SNPs shared among all affected members of the family. Additional genotype data from microsatellite markers verified this, allowing us to calculate a two-point LOD score of 5.18. Within this region, we identified a truncating homozygous mutation, R475X, in exon 7 of the gene TRAPPC9. In a second large NS-ARMR/ID family, previously linked to 8q24 in a study of Iranian families, we identified a 4 bp deletion within exon 14 of TRAPPC9, also segregating with the phenotype and truncating the protein. This gene encodes NIK- and IKK-beta-binding protein (NIBP), which is involved in the NF-kappaB signaling pathway and directly interacts with IKK-beta and MAP3K14. Brain magnetic resonance imaging of affected individuals indicates the presence of mild cerebral white matter hypoplasia. Microcephaly is present in some but not all affected individuals. Thus, to our knowledge, this is the sixth gene for NS-ARMR to be discovered.
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Affiliation(s)
- Asif Mir
- Department of Bioscience, COMSATS Institute of Information Technology, Islamabad, Pakistan
| | - Liana Kaufman
- Neuropsychiatry and Development Lab, Neurogenetics Section, Centre for Addiction and Mental Health, Toronto, ON M5T 1R8, Canada
| | - Abdul Noor
- Neuropsychiatry and Development Lab, Neurogenetics Section, Centre for Addiction and Mental Health, Toronto, ON M5T 1R8, Canada
| | | | - Talal Jamil
- Department of Bioscience, COMSATS Institute of Information Technology, Islamabad, Pakistan
| | - Matloob Azam
- Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Kimia Kahrizi
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Muhammad Arshad Rafiq
- Neuropsychiatry and Development Lab, Neurogenetics Section, Centre for Addiction and Mental Health, Toronto, ON M5T 1R8, Canada
| | - Rosanna Weksberg
- Program in Genetics and Genomic Biology, The Hospital for Sick Children, Toronto, ON M5G 1L7, Canada
| | - Tanveer Nasr
- Mayo Hospital, Lahore 54000, Pakistan
- Chaudhry Hospital, Gujranwala 52250, Pakistan
| | - Farooq Naeem
- Community Clinical Sciences, School of Medicine, Southampton University, Southampton SO16 5ST, UK
- Lahore Institute of Research and Development, Lahore 54000, Pakistan
| | - Andreas Tzschach
- Max Planck Institute for Molecular Genetics, 14195 Berlin, Germany
| | - Andreas W. Kuss
- Max Planck Institute for Molecular Genetics, 14195 Berlin, Germany
| | - Gisele E. Ishak
- Department of Radiology, Seattle Children's Hospital, University of Washington, Seattle, WA 98105, USA
| | - Dan Doherty
- Division of Genetics and Developmental Medicine, Seattle Children's Hospital, University of Washington, Seattle, WA 98105, USA
| | - H. Hilger Ropers
- Max Planck Institute for Molecular Genetics, 14195 Berlin, Germany
| | - A. James Barkovich
- Department of Radiology, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Hossein Najmabadi
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Muhammad Ayub
- Mayo Hospital, Lahore 54000, Pakistan
- St. Luke's Hospital, Middlesborough TS4 3AF, UK
| | - John B. Vincent
- Neuropsychiatry and Development Lab, Neurogenetics Section, Centre for Addiction and Mental Health, Toronto, ON M5T 1R8, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
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Ishak GE, Khoury NJ, Birjawi GA, El-Zein YR, Naffaa LN, Haddad MC. Imaging findings of familial Mediterranean fever. Clin Imaging 2006; 30:153-9. [PMID: 16632148 DOI: 10.1016/j.clinimag.2005.07.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2005] [Revised: 05/25/2005] [Accepted: 06/10/2005] [Indexed: 11/18/2022]
Abstract
PURPOSE The aim of this study was to study the imaging findings of familial Mediterranean fever (FMF). MATERIALS AND METHODS We performed a retrospective review of the medical records and imaging studies of 38 patients with proven FMF, diagnosed between 1992 and 2002. RESULTS The most common clinical manifestation was recurrent peritoneal attacks with abdominal pain (76.3%) and fever (42.1%). Abdominal imaging findings included ileus (n=12), splenomegaly (n=5), hepatomegaly (n=2), ascitis (n=2), focal peritonitis (n=2), mesenteric streaking (n=1), and enlarged mesenteric lymph node (n=1). One patient developed fatal peritoneal mesothelioma, and 13.1% of the patients developed amyloidosis with sonographic findings of renal parenchymal disease or cardiomyopathy. Arthritis was second in frequency, occurring in 34.2% of patients; radiographs were normal (n=4) or showed joint effusion and periarticular soft tissue swelling (n=4) due to synovitis. One patient developed seronegative destructive arthropathy. Skin lesions were noted in 23.6% of patients. Pleuritis was encountered in 13.1% and pericarditis in 5.2%. Polyarteritis nodosa (PAN) was present in two patients, multiple sclerosis in one, and autoimmune hemolytic anemia in one patient. CONCLUSION FMF predominantly involves abdominal viscera but can affect other organs. The majority of patients have nonspecific imaging findings, and the radiologic diagnosis is rarely considered. Amyloidosis, mesothelioma, and destructive arthropathy are potential serious complications of FMF. PAN, multiple sclerosis, and autoimmune hemolytic anemia are probably rare associations or rather than coincident with FMF.
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Affiliation(s)
- Gisele E Ishak
- Department of Diagnostic Radiology, American University of Beirut Medical Center, P.O. Box 11-0236, Beirut, Lebanon
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Naffaa LN, Ishak GE, Haddad MC. The value of contrast-enhanced helical CT scan with rectal contrast enema in the diagnosis of acute appendicitis. Clin Imaging 2005; 29:255-8. [PMID: 15967316 DOI: 10.1016/j.clinimag.2004.11.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2004] [Revised: 10/20/2004] [Accepted: 11/15/2004] [Indexed: 11/23/2022]
Abstract
BACKGROUND The aim of this retrospective study is to assess the accuracy of single slice helical CT scan with intravenous, and rectal contrast (CTRC) in the diagnosis of acute appendicitis (AA) in patients with suspected AA, with particular analysis of the diagnostic signs. PARTICIPANTS AND METHODS Abdomino-pelvic helical CTRC was performed on 75 consecutive patients with suspicion of AA. Radiologic diagnosis was compared with surgical/pathologic results and clinical follow-up. In addition, the CTRC examinations were retrospectively reviewed independently by two experienced radiologists using predefined diagnostic criteria. The sensitivity, specificity, and frequency of each diagnostic sign were calculated. The interobserver agreement and the statistical significance of the frequency for each diagnostic criterion were assessed using the Kappa and Fisher tests, respectively. RESULTS The accuracy of helical CTRC in the diagnosis of AA was 94.7%, sensitivity 100%, specificity 90%, PPV 89.7%, and the NPV 100%. Wall enhancement and nonopacification of the appendix recorded the highest sensitivity and specificity (97% and 100%, 94% and 95%, respectively). Appendiceal thickness greater than 6 mm was present in 100% of true-positive cases. However, 26.5% of true-negative cases had also an appendiceal diameter exceeding 6 mm, a value used as a cut-off for normal appendiceal diameter. The highest interobserver agreement was recorded for appendiceal wall enhancement and for nonopacification of the appendix (K=0.97 and 0.88, respectively). CONCLUSIONS CTRC is an accurate and relatively fast technique for investigation of patients with suspected AA. A negative CTRC can exclude completely the diagnosis of AA. Nonopacification of the appendix and appendiceal wall enhancement are highly sensitive, specific, and reproducible, signs representing major criteria for the diagnosis of AA.
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Affiliation(s)
- Lena N Naffaa
- Department of Diagnostic Radiology, American University of Beirut Medical Center, PO Box 11-0236, Beirut, Lebanon
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