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Pascual-Castroviejo I, Pascual-Pascual S, Velazquez-Fragua R, Viaño J, Quiñones D. Schizencephaly: A study of 16 patients. Neurología (English Edition) 2012. [DOI: 10.1016/j.nrleng.2011.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Pascual-Castroviejo I, Pascual-Pascual S, Velazquez-Fragua R, Viaño J, Quiñones D. Esquisencefalia. Estudio de 16 pacientes. Neurologia 2012; 27:491-9. [PMID: 21890242 DOI: 10.1016/j.nrl.2011.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 06/22/2011] [Accepted: 06/29/2011] [Indexed: 10/17/2022] Open
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Pascual-Castroviejo I, Pascual-Pascual SI, Velazquez-Fragua R, Viaño Lopez J. [Congenital cytomegalovirus infection and cortical/subcortical malformations]. Neurologia 2012; 27:336-42. [PMID: 22365270 DOI: 10.1016/j.nrl.2011.12.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 12/17/2011] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Intrauterine infection due to cytomegalovirus is the most common of the intrauterine viral/parasitic infections that affect the central nervous system and cause permanent lesions in the cortex as well as the subcortical white matter. Studies using brain magnetic resonance imaging (MRI) are limited. MATERIAL AND METHODS Six patients (4 females and 2 males) were studied in the first months of life in order to make a diagnosis of congenital cytomegalovirus, and identify the cortical and subcortical lesions using the necessary MRI sequences. RESULTS The six patients showed malformations of cortical development (MDC) (schizencephaly, polymicrogyria or lissencephaly-pachygyria) from the neonatal period, and diffuse changes of the white matter, which remained with few changes during the first two years. They then began reducing in size in the form of high signal areas in T2, restricted to certain areas, and were evident for a few years more with little change. CONCLUSION Intrauterine infection due to cytomegalovirus causes changes in the cortical grey matter, which consists of MDC, and in the subcortical white matter. The latter show a changing aspect as they appear as diffuse and wide areas of high signal intensity, which is usually due to delay in myelinisation, but could also be caused directly by the cytomegalovirus. These changes in the white matter are subjected to morphological changes throughout the first years of life, leading to brain atrophy. The neurological sequelae of these lesions left by these alterations are severe and chronic.
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Pascual-Castroviejo I, Hernández-Moneo JL, Gutiérrez-Molina ML, Viaño J, Pascual-Pascual SI, Velazquez-Fragua R, Morales C, Quiñones D. Focal cortical dysplasia. Clinical-radiological-pathological associations. Neurologia 2012; 27:472-80. [PMID: 22217526 DOI: 10.1016/j.nrl.2011.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Revised: 10/11/2011] [Accepted: 10/15/2011] [Indexed: 10/14/2022] Open
Abstract
INTRODUCTION The term focal cortical dysplasia (FCD) describes a particular migration disorder with a symptomatology mainly characterised by drug-resistant epileptic seizures, typical neuroradiological images, and histological characteristics, as well as a very positive response to surgical treatment in the majority of cases. MATERIAL AND METHODS A total of 7 patients were studied, comprising 6 children with a mean age of 34.3 months and one 25-year-old male with very persistent focal seizures and MRI images that showed FCD. RESULTS Three of the patients (all girls) were operated on while very young, with extirpation of the FCD and the surrounding area; with the histopathology study showed agreement between the MRI images and the macroscopic study of the slices. The histology study showed findings typical of a Taylor-type FCD (poor differentiation between the cortical grey matter and the subcortical white matter, and balloon cells). Three years after the FCD extirpation, the same 3 patients remained seizure-free with no anti-epilepsy medication. Two others have seizure control with medication, another (the adult) is on the surgical waiting list, and the remaining patient refused the operation. CONCLUSION Taylor-type FCD is associated with a high percentage of all drug-resistant focal seizures, and it needs to be identified and extirpated as soon as possible. Well planned and well-performed surgery that leaves no remains of dysplasia can cure the disease it in many cases.
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Pascual-Castroviejo I, Viaño J. [Schizencephaly versus porencephaly]. Rev Neurol 2011; 52:623-624. [PMID: 21488010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- I Pascual-Castroviejo
- UAM, Universidad Autonoma de Madrid, Hospital Universitario La Paz, 28046 Madrid, Espana.
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Pascual-Castroviejo I, Parrón Pajares M, Pascual-Pascual SI, Jara P, Velázquez-Fragua R. Cutaneous, mediastinal and hepatic hemangiomas in a girl followed during 12 years. Neuropediatrics 2011; 42:24-7. [PMID: 21557145 DOI: 10.1055/s-0031-1273705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 10/18/2022]
Abstract
We present in this paper the case of a 12-year-old girl who had the clinical features of 2 different disorders: neurofibromatosis 1 (NF1) and 3 hemangiomas located in the skin, liver and mediastinum. The patient did not receive any specific treatment and showed a normal progressive evolution that lasted 1 / to 2 years and a very slow regression that lasted for a more prolonged time than expected (the 3 hemangiomas have not completely disappeared yet), although all 3 have been asymptomatic. MRI of the brain did not disclose a hemangioblastoma of the cerebellum or any other vascular lesion of the brain. Mental development of this girl was in the borderline range, as is commonly seen in Pascual-Castroviejo II syndrome (P-CIIS)/PHACE syndrome and in NF1, 2 syndromes which have not been reported to be associated in the same patient previously.
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Abstract
We report on a girl with a left facial hemangioma and absence of the right ear and canal who also showed absence of the left vertebral and anterior cerebral arteries (ipsilateral to the facial hemangioma), and absence of the external carotid artery and presence of stapedial artery on the right side (contralateral to the facial hemangioma and ipsilateral to the auditory organ malformation). Persistence of the stapedial artery may be related to the facial hemangioma or with the hemifacial hypoplasia with similar possibilities. This is the first case to the best of our knowledge of the association between P-CIIS and a persistent stapedial artery.
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Pascual-Castroviejo I, Pascual-Pascual SI, Velázquez-Fragua R, Viaño J, Carceller F, Hernández-Moneo JL, Gutiérrez-Molina M, Morales C. [Subependymal giant cell astrocytoma in tuberous sclerosis complex. A presentation of eight paediatric patients]. Neurologia 2010; 25:314-321. [PMID: 20643042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
OBJECTIVE Presentation of 8 patients with subependymal giant-cell astrocytomas (SGCA) associated with tuberous sclerosis complex (TSC). MATERIAL AND METHODS There are 8 patients, 6 males and 2 females with TSC, who presented with the tumour between the neonatal period and 24 years. RESULTS All patients showed bilateral hypersignalised areas in zones close to the foramen of Monro. Three of the patients were admitted urgently due to blindness and increased intracranial pressure. Incomplete removal of the tumour has always been bad solution as it resulted in the death of the patient (in one case) or further surgery operation in the short term. Only one patient developed the tumour suddenly from pre-existing subependymal nodules from the childhood and they had to be removed at 24 years of age. By contrast, 32 patients with TSC and images of subependymal nodules whose CT or MR progress was followed up for between 10 and 30 years did not develop a tumour. One patient had to be operated four times over 20 years. CONCLUSIONS SGCA associated with TSC is a severe complication which as likely to develop and careful monitoring is required from neonatal age with periodicclinical and imaging studies in order to avoid its irreversible complications. Hydrocephaly, blindness and even the death can be the main consequences. Reintervention of the recurrent tumour is often necessary.
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Pascual-Castroviejo I, Pascual-Pascual SI, Velazquez-Fragua R, García-Guereta L, López-Gutiérrez JC, Olivares P, Tovar J. Association of cutaneous red-to-purple hemangiomas with leptomeningeal hemangiomas. a clinical study of two patients. Neuropediatrics 2010; 41:7-11. [PMID: 20571984 DOI: 10.1055/s-0030-1254102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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: 10/19/2022]
Abstract
Cutaneous hemangioma is a benign vascular tumor of infancy with an initial proliferating period that appears between 1 to 2 weeks of life, extends during 18 months to 2 years of life, and then slowly regresses during several years until it disappears completely. They are characterized by endothelial cell proliferation followed by diminishing hyperplasia and progressive fibrosis. Vascular malformations are present at birth, grow commensurately with the child, and are characterized histologically by a normal rate of endothelial cell turnover, flat endothelium, thin (normal) basal membrane and normal mast cells. These cutaneous anomalies are commonly associated with cerebellar malformations, main cerebral arteries anomalies, congenital cardiac anomalies and/or coarctation of the aorta and persistence of embryonic arteries. Cutaneous hemangiomas can be associated with intracranial or extracranial hemangiomas that regress at the same time as the cutaneous hemangiomas. Cutaneous hemangiomas may show different types of color. Cutaneous red-to-purple hemangiomas are uncommon and their bright-red color is evident from the first weeks of life and remains unaltered until the hemangioma disappears. The intracranial angiographic studies in our series of more than 50 cases with facial hemangioma showed that patients with red-to-purple hemangiomas are commonly associated with localized leptomeningeal hemangiomas either in the ipsilateral or contralateral side. These leptomingeal hemangiomas were visualized only by MR enhanced with gadolinium. Involution of the cutaneous and leptomeningeal hemangiomas seems to occur simultaneously as in other types of external and internal hemangiomas.
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Pascual-Castroviejo I, Pascual-Pascual S, Velázquez-Fragua R, Viaño J, Carceller F, Hernández-Moneo J, Gutiérrez-Molina M, Morales C. Subependymal giant cell astrocytoma in tuberous sclerosis complex. A presentation of eight paediatric patients. Neurología (English Edition) 2010. [DOI: 10.1016/s2173-5808(10)70059-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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Travaglini L, Brancati F, Attie-Bitach T, Audollent S, Bertini E, Kaplan J, Perrault I, Iannicelli M, Mancuso B, Rigoli L, Rozet JM, Swistun D, Tolentino J, Dallapiccola B, Gleeson JG, Valente EM, Zankl A, Leventer R, Grattan-Smith P, Janecke A, D'Hooghe M, Sznajer Y, Van Coster R, Demerleir L, Dias K, Moco C, Moreira A, Kim CA, Maegawa G, Petkovic D, Abdel-Salam GMH, Abdel-Aleem A, Zaki MS, Marti I, Quijano-Roy S, Sigaudy S, de Lonlay P, Romano S, Touraine R, Koenig M, Lagier-Tourenne C, Messer J, Collignon P, Wolf N, Philippi H, Kitsiou Tzeli S, Halldorsson S, Johannsdottir J, Ludvigsson P, Phadke SR, Udani V, Stuart B, Magee A, Lev D, Michelson M, Ben-Zeev B, Fischetto R, Benedicenti F, Stanzial F, Borgatti R, Accorsi P, Battaglia S, Fazzi E, Giordano L, Pinelli L, Boccone L, Bigoni S, Ferlini A, Donati MA, Caridi G, Divizia MT, Faravelli F, Ghiggeri G, Pessagno A, Briguglio M, Briuglia S, Salpietro CD, Tortorella G, Adami A, Castorina P, Lalatta F, Marra G, Riva D, Scelsa B, Spaccini L, Uziel G, Del Giudice E, Laverda AM, Ludwig K, Permunian A, Suppiej A, Signorini S, Uggetti C, Battini R, Di Giacomo M, Cilio MR, Di Sabato ML, Leuzzi V, Parisi P, Pollazzon M, Silengo M, De Vescovi R, Greco D, Romano C, Cazzagon M, Simonati A, Al-Tawari AA, Bastaki L, Mégarbané A, Sabolic Avramovska V, de Jong MM, Stromme P, Koul R, Rajab A, Azam M, Barbot C, Martorell Sampol L, Rodriguez B, Pascual-Castroviejo I, Teber S, Anlar B, Comu S, Karaca E, Kayserili H, Yüksel A, Akcakus M, Al Gazali L, Sztriha L, Nicholl D, Woods CG, Bennett C, Hurst J, Sheridan E, Barnicoat A, Hennekam R, Lees M, Blair E, Bernes S, Sanchez H, Clark AE, DeMarco E, Donahue C, Sherr E, Hahn J, Sanger TD, Gallager TE, Dobyns WB, Daugherty C, Krishnamoorthy KS, Sarco D, Walsh CA, McKanna T, Milisa J, Chung WK, De Vivo DC, Raynes H, Schubert R, Seward A, Brooks DG, Goldstein A, Caldwell J, Finsecke E, Maria BL, Holden K, Cruse RP, Swoboda KJ, Viskochil D. Expanding CEP290 mutational spectrum in ciliopathies. Am J Med Genet A 2009; 149A:2173-80. [PMID: 19764032 DOI: 10.1002/ajmg.a.33025] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Ciliopathies are an expanding group of rare conditions characterized by multiorgan involvement, that are caused by mutations in genes encoding for proteins of the primary cilium or its apparatus. Among these genes, CEP290 bears an intriguing allelic spectrum, being commonly mutated in Joubert syndrome and related disorders (JSRD), Meckel syndrome (MKS), Senior-Loken syndrome and isolated Leber congenital amaurosis (LCA). Although these conditions are recessively inherited, in a subset of patients only one CEP290 mutation could be detected. To assess whether genomic rearrangements involving the CEP290 gene could represent a possible mutational mechanism in these cases, exon dosage analysis on genomic DNA was performed in two groups of CEP290 heterozygous patients, including five JSRD/MKS cases and four LCA, respectively. In one JSRD patient, we identified a large heterozygous deletion encompassing CEP290 C-terminus that resulted in marked reduction of mRNA expression. No copy number alterations were identified in the remaining probands. The present work expands the CEP290 genotypic spectrum to include multiexon deletions. Although this mechanism does not appear to be frequent, screening for genomic rearrangements should be considered in patients in whom a single CEP290 mutated allele was identified.
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Affiliation(s)
- Lorena Travaglini
- CSS-Mendel Institute, Casa Sollievo della Sofferenza Hospital, Rome, Italy
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Pascual-Castroviejo I, Pascual-Pascual SI, Viaño J. [Neurofibromatosis type 2 (NF2). Study of 7 patients]. Neurologia 2009; 24:457-461. [PMID: 19921555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVE The aim of this paper is to present the cases of 7 young children and young adult with type 2 neurofibromatosis (NF2). MATERIAL AND METHODS Seven patients, 5 females and 2 males, aged 2 to 33 years, were studied by intracranial and spinal magnetic resonance (MRI) and clinically. In 5 patients, the symptoms because around the time of the diagnosis while 2 patients, who had no previous symptoms, were diagnosed by MRI after undergoing the test because a parent had been diagnosed of NF2 by MRI. RESULTS All 7 patients had bilateral vestibular schwannomas (VS) and only two had no associated intracranial and/or spinal tumors. Four patients had intracranial meningiomas, mainly located in the lesser wing of the temporal fossa and in the falx, and 5 had spinal cord tumors (ependymomas and meningiomas). An attempt to made to remove the VS in all but one case, however, it was not possible to remove completely the tumors in any case. Deafness was the common sequel in all operated cases, associated with permanent bilateral facial paralysis in one and unilateral facial parenthesis in another. CONCLUSION A comparison of our series of NF1 and NF2 cases shows that the ratio of NF2:NF1 in childhood is approximately 1:100, and that the clinical features of NF2 are considerably more severe than in NF1.
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Pascual-Castroviejo I, Viaño J, Pascual-Pascual SI, Quiñones D. Congenital and evolving vascular disorders associated with cutaneous hemangiomas: case report. Neuropediatrics 2009; 40:148-51. [PMID: 20020403 DOI: 10.1055/s-0029-1239507] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [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] [Indexed: 10/20/2022]
Abstract
Conventional arteriography in an 11-month-old boy with cardiopathy, aortic arch coarctation and haemangiomas showed the absence of the right internal carotid and vertebral arteries, hypertrophy of the right external carotid artery, with enlargement of the internal maxillary and ophthalmic arteries that supplied the right cerebral hemisphere. An MRI study showed an infarcted area in the posterior zone of the left cerebral hemisphere vascularised by the middle cerebral artery that was caused by a thrombosis during a severe bout of gastroenteritis. MRA studies performed at 16 and 23 years of age revealed progressive narrowing of the left carotid and vertebral arteries, persistence of the proatlantal and trigeminal arteries, and poor cerebral vascularisation that, at adult age, was entirely supplied through collateral arteries, branches of both external carotids, the presence of unilateral duplication of the vertebral arteries and ascending pharyngeal artery.
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Pascual-Castroviejo I, Viaño J, Pascual-Pascual SI, Velázquez-Fragua R. [Subcortical focal heterotopias: their different sizes]. Rev Neurol 2009; 48:496-497. [PMID: 19396767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Abstract
We present a 3-month-old girl who showed segmental NF1 and Cobb syndrome. She has a cutaneous vascular malformation located on the middle T (4)-T (6) region superimposed on a giant cutaneous café-au-lait spot. Magnetic resonance arteriography (MRA) revealed bilateral renal artery stenosis, extensive hypertrophy of the spinal epidural venous plexus, coarctation and tubular hypoplasia of the aortic arch and proximal portion of descending aorta. To the best of our knowledge the association of both neurocutaneous disorders has not being previously described.
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Pascual-Castroviejo I, Pascual-Pascual SI, Velázquez-Fragua R, Viaño J, López-Gutiérrez JC. [Segmental neurofibromatosis in children. Presentation of 43 patients]. Rev Neurol 2008; 47:399-403. [PMID: 18937200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION It is known as segmental neurofibromatosis type 1 (NF1) a type of NF1 characterized by the features circumscribed to one or more body cutaneous and/or subcutaneous segments. This entity is recognized from recently and it is related with somatic mosaicism. PATIENTS AND METHODS 43 patients (29 females and 14 males) with ages below 16 years were retrospectively studied. Image study of the affected region of the body was performed in all patients to discard a subjacent organic disease, and a neurofibroma was histologically demonstrated in some cases. Somatic or gonosomal mosaicism was not investigated in any of the patients. RESULTS Only 8 patients showed cutaneous lesion--7 with café-au-lait spots (3 of freckles type, 4 of large spots, of which, 3 were bilateral and 1 unilateral ) and 1 presented neurofibromas-. The other cases (81%) had cutaneous lesion with subjacent lesion (neurofibromas and bone dysplasia in most cases). The subcutaneous lesions were seen in all parts of the body without a preferent location. In cases with only cutaneous lesion, the clinical features were seen on the trunk skin. CONCLUSION Segmental NF1 is considered to be the result of a somatic or gonosomal mosaicism and still is underdiagnosed. Features of segmental NF1 can be found in as many regions of the body as NF1 without mosaicism. The types of segmental NF1 that were seen less frequently in this series were those with only cutaneous features (café-au-lait spots and neurofibromas). Types with subcutaneous features that involved subjacent organs were seen in 81% of patients. Familial patients, with NF1 or segmental NF1 was shown in 15 patients (35%) and bilateral lesion in 4 cases (9.3%).
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Affiliation(s)
- I Pascual-Castroviejo
- Servicio de Neurología Pediátrica, Sanatorio Nuestra Señora del Rosario, Madrid, España.
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Pascual-Castroviejo I, Pascual-Pascual SI, Velázquez-Fragua R. [Abnormal origin of middle cerebral artery in the basilar artery]. Neurologia 2008; 23:536-537. [PMID: 19035000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
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Pascual-Castroviejo I. [Moyamoya disease among children]. Rev Neurol 2008; 47:278-280. [PMID: 18780279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Pascual-Castroviejo I, Lobo-Llorente A. [Hand and finger anomalous developmental coordination to write in children with attention deficit/hyperactivity syndrome]. Rev Neurol 2008; 47:129-133. [PMID: 18654966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
AIM To present a developmental coordination disorder in children with attention deficit/hyperactivity syndrome (ADHS) characterized by anomalous handwriting posture of hands and fingers. PATIENTS AND METHODS Forty-five children who presented with ADHS were studied (39 males and 6 females) with ages ranging from 6 to 16 years (average 10.8 years) and an analysis of the position of the hands and fingers during handwriting was made within the context of a complete neurological evaluation. RESULTS Only 2 of the 6 hyperactive patients showed a discrete anomalous posture of the fingers, with normality in the other four patients. Seventeen of the 25 children (68%) with ADHS combined type showed poor posture of the fingers when writing. Among the 14 children with ADHS attention deficit type, 8 had abnormal posture when using a pencil, and 4 had shown the problem several years before consulting, and the problem had disappeared after local orthopedic treatment. All 4 left-handed children (3 females and 1 male) presented abnormal posture of the fingers when writing. CONCLUSIONS Evaluation of the anomalous posture of the fingers when writing of patients with ADHS is a test that we commonly use because it is easy to do, the patients collaborate very well to do it and uncovers very early the developmental coordination disorder. The anomalous posture is associated with other coordination disorders and problems of muscular tone such as splay-foot, genu recurvatum, problems with jumping, walking on one foot, etc. in most patients.
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Pascual-Castroviejo I, Viaño J, Pascual-Pascual SI. [Generalized peripheral nerve tumors in neurofibromatosis type 1]. Rev Neurol 2008; 46:758-759. [PMID: 18543203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Pascual-Castroviejo I. [Segmental spinal dysgenesis]. Rev Neurol 2008; 46:703. [PMID: 18509834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Pascual-Castroviejo I, Pascual-Pascual SI, Velázquez-Fragua R, Viaño J, García-Segura JM, Botella MP. [Neurofibromatosis type 1 and optic pathway gliomas. A series of 80 patients]. Rev Neurol 2008; 46:530-536. [PMID: 18446694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PATIENTS AND METHODS From a series of 530 patients with neurofibromatosis type 1 (NF1), we performed a retrospective assessment of the long-term neurologic, visual, neuroimaging and evolution of 80 patients (15%) with optic pathway gliomas (OPG). All the 80 patients, 58 (72.5%) females and 22 (27.5%) males were diagnosed during childhood (below age 16 years), range 13 months to 15 years (average: 4.6 years). RESULTS Image studies showed the distribution of the lesions among optic nerves, chiasm, tracts and radiations demonstrated that only 25% of the tumors involved only one optic nerve and 11.5% were located only in the chiasm, while 40% involved one or both optic nerves and chiasm, tracts and radiations. Two patients showed pilocytic astrocytoma in the histological study. Late diagnosis (after 7 years of age) of OPG was made in three patients and late progression was evident in three others who required surgical resection, radiotherapy or chemotherapy. CONCLUSIONS All patients were diagnosed during childhood (below 16 years of age). Incidence was double in girls than in boys. Despite the apparent tumoral agressivity of the magnetic resonance and magnetic resonance spectroscopy images, histological findings corresponded to benign pilocytic astrocytoma. Some tumors follow the growth after 7 years. Continued monitoring of patients with NF1 into adulthood is advisable.
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Affiliation(s)
- I Pascual-Castroviejo
- Servicio de Neurología Pediátrica, Hospital Universitario La Paz, 28046 Madrid, España.
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Pascual-Castroviejo I, Pascual-Pascual SI, Viaño J. [Klüver-Bucy syndrome. Seven year follow-up of one patient]. Neurologia 2008; 23:114-118. [PMID: 18322831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
OBJECTIVE To present a left-handed patient who had an acute encephalopathy, possibly of viral etiology, followed by remote and recent memory loss, several types of apraxia and emotional disturbance, without any motor abnormalities. He had cerebral lesions that involved both temporal lobes and other brain regions. All features corresponded to the Klüver-Bucy syndrome. After a seven year follow-up, no improvement of the neurological and neuroradiological, mainly by magnetic resonance imaging (MRI) features was observed. CASE REPORT A 14 year-old left-handed boy suffered sudden onset of fever (40.4 degrees C), headache, vomiting, focal and generalized seizures and coma. After the acute illness, the patient had severe neurological sequels consisting in total loss of memory without any capacity to recognize persons (including family members) and remote events and he was not capability of remember hardly anything that he was taught after his disease, these alterations continued almost completely during the seven years (from 14 to 21 years) that we followed him up. The only abilities that he conserved in similar conditions to those prior to his acute disease were his capacity to swim (including the style of jumping into the water), bike riding, playing football, dominoes, cards, etc., which he had learned during his childhood, to say the numbers and the alphabet letters rapidly by heart (without knowing them) and to avoid cars on the street. MRI showed post-inflammatory lesions in the temporal and the parieto-temporo-occipital regions bilaterally (cortical and subcortical regions) and in the left occipital region. He presented almost all types of apraxia. CONCLUSION Klüver-Bucy syndrome, which can be secondary to more than 50 different causes, not only presents remote memory loss but also recent memory loss as in our patient, who appeared to be isolated from the surrounding world. Motor function and automated activities learned before the acute brain illness were not affected and could be recovered. Etiology, location and extent of the anatomic brain lesion appear to be the most important prognostic conditions.
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Pascual-Castroviejo I, Pascual-Pascual SI, López-Gutiérrez JC, Velazquez-Fragua R, Viaño J. Facial hemangioma and hemispheric migration disorder: presentation of 5 patients. AJNR Am J Neuroradiol 2007; 28:1609-12. [PMID: 17846222 PMCID: PMC8134379 DOI: 10.3174/ajnr.a0583] [Citation(s) in RCA: 12] [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 The association of cortical organization disorders with facial hemangiomas or vascular malformations has been described in only a few reports. The purpose of this study was to show the close association of these cutaneous anomalies with cortical dysplasias and intracranial vascular abnormalities. MATERIALS AND METHODS Five patients, all women, with cutaneous vascular abnormalities, 4 with hemangioma and 1 with vascular malformation, were studied with MR and MR angiography. RESULTS All 5 of the patients showed cortical dysplasia. The cutaneous lesions involved the left frontal region, ipsilateral to the cerebral hemisphere with cortical dysplasia, in all of the patients. Four patients had seizures that responded well to antiepileptic drugs. Hemispheric hypoplasia was associated with the cortical dysplasia in all 5 of the patients. Arterial abnormalities were found in all of the patients, consisting of aplasia of the ipsilateral internal carotid artery in 2, persistence of the trigeminal artery in 2, persistence of both proatlantal arteries and double kinking in the internal carotid artery in 1, and origin of both anterior cerebral arteries from the same internal carotid in all 5 of the patients, 1 of whom also showed an intracavernous anterior cerebral artery origin of the same side of the hemispheric hypoplasia and polymicrogyria. Seizures and mild psychomotor delay could be caused by the cortical dysplasia and the hemispheric hypoplasia. CONCLUSIONS The presence of many congenital vascular abnormalities in this series suggests that facial hemangioma and vascular malformations may be in close relationship with cortical and vascular abnormalities. The reason that the vascular and cortical abnormalities occurred in the left side in all 5 of the patients and the mechanism underlying the association of both malformations are unclear. A genetic origin is suggested.
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Velázquez-Fragua R, Pascual-Pascual SI, Pascual-Castroviejo I, Sastre-Urgellés A, Plaza-López de Sabando D, Laporta-Báez Y, Martínez-Bermejo A. [A paediatric case report of critical illness polyneuropathy]. Rev Neurol 2007; 45:61-2. [PMID: 17620269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
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Pascual-Castroviejo I, Pascual-Pascual SI, Velázquez-Fragua R, Viaño J, Carceller-Benito F. [Aqueductal stenosis in the neurofibromatosis type 1. Presentation of 19 infantile patients]. Rev Neurol 2007; 45:18-21. [PMID: 17620261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
AIM To present a series of infantile patients with aqueductal stenosis associated with neurofibromatosis type 1 (NF1). PATIENTS AND METHODS Nineteen patients with ages below 16 years, 11 girls and 8 boys, with NF1 presented hydrocephalus due to aqueductal stenosis. All patients, except one who died before the imaging study was performed and was diagnosed by autopsy, were studied by pneumoencephalography (since 1965 to 1974), computerized tomography (CT) (since 1975 to 1984), magnetic resonance (MR) or MR and CT (since 1985 to 2004) (two children had been studied by pneumoencephalography some years before) most times to discard optic pathway tumor and, in few patients, because of intracranial hypertension. RESULTS All patients showed three ventricular hydrocephalus with aqueductal stenosis. Eleven patients showed optic pathway tumor. One patient had a benign aqueductal tumor that impaired the normal flow of cerebrospinal fluid. Neurological features of hydrocephalus occurred very rapidly in some patients and after several years of evolution in others. Two boys showed precocious puberty. All patients were treated with shunt. CONCLUSIONS In our series, aqueductal stenosis occurred in about 5% of children with NF1. Aqueductal stenosis and hydrocephalus were identified at a short age because many patients were studied suspecting optic pathway tumor. Eleven patients (about 60%) associated optic pathway tumor and aqueductal stenosis.
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Affiliation(s)
- I Pascual-Castroviejo
- Servicio de Neurología Pediátrica, Hospital Universitario La Paz, 28046, Madrid, Spain.
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Pascual-Castroviejo I, Pascual Pascual SI, Velázquez-Fragua R. [Cerebrofaciothoracic dysplasia (Pascual-Castroviejo type I syndrome): presentation of two new patients]. Neurologia 2007; 22:401-5. [PMID: 17610171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
OBJECTIVE To report two new patients with cerebrofaciothoracic dysplasia (Pascual-Castroviejo type I syndrome). MATERIAL AND METHODS We present two boys of 16 months and 9 years of age who were studied because of facial features, costovertebral defects and psychomotor delay. RESULTS Both patients had the facial and thoracic phenotype that characterizes this syndrome, associated with corpus callosum hypogenesis. Patient 1 had double kidney and ureter on the left side and the patient 2 a smaller left hand than the right one with anomalies of the first fingers. This second patient had affable behavior, but the psychomotor delay was obvious. CONCLUSION In both patients, some anomalies unreported to date in this syndrome, such as double kidney and ureter (patient 1) and anomalies of fingers on one hand (patient 2) were found.
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Pascual-Castroviejo I, Pascual-Pascual SI, Jaureguizar Monereo E. [Segmental spinal dysgenesis]. Neurologia 2007; 22:320-1. [PMID: 17508306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
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Abstract
Familial spinal neurofibromatosis (FSNF) is a rare localized subtype of NF1 which shows neurological symptomatology during adult life. Only a few families have been reported to date. We describe a family in which three members in two generations, mother, son and daughter, were affected. The patients, aged 48, 22 and 18 years, had spinal bilateral neurofibromas affecting all spinal roots. Spinal symptoms were not present in any of the patients. However, the son had generalized nerve sheath tumors that caused important signs of peripheral neuropathy. The daughter also had benign tumors that involved the left optic nerve and chiasm and the left cerebellar hemisphere. The spinal neurofibromas underwent an important growth in size between 20 and 22 years of age. A specific mutation G848R, 2542 G > C in NF1 exon 16 was present in all three patients.
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Abstract
The authors describe a girl who was evaluated at 7 years old because of facial segmental hemangioma associated with unilateral persistent trigeminal artery, bilateral proatlantal arteries, hypoplasia of 1 posterior cerebral artery, kinking of 1 internal carotid artery at 2 different levels, and transdural collateral vascularization supplying the posterior areas of the cerebral hemispheres. This is the first patient known to have a cutaneous hemangioma associated with bilateral proatlantal arteries despite having a unilateral facial hemangioma.
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Pascual-Castroviejo I, Pascual-Pascual SI, Delgado J. Cutaneous hemangiomas and vascular abnormalities: persistence of embryonic vascularization. AJNR Am J Neuroradiol 2007; 28:390-1. [PMID: 17297020 PMCID: PMC7977427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
A 2-year-old girl presented with cutaneous facial, palpebral, back, perianal, and perineal hemangiomas and a subcutaneous neck and parotid voluminous hemangioma, associated with several extracranial vascular abnormalities, such as the absence of the ipsilateral internal carotid artery and hypoplasia of the common carotid arteries. Both vertebral arteries showed an embryonic appearance, without completing their maturation and without obliteration of all the right and left longitudinal neural arteries.
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Pascual-Castroviejo I, Pascual-Pascual SI, Carceller-Benito F, Martínez-de Vega V. [Sinus pericranii]. Rev Neurol 2007; 44:113-4. [PMID: 17236151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
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Pascual-Castroviejo I. [Topiramate in the treatment of epilepsy and a weight loss of 24 kg]. Rev Neurol 2007; 44:63-4. [PMID: 17199231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
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Pascual-Castroviejo I, Pascual-Pascual SI, Velázquez R, Viaño J, Martínez V. [Moyamoya disease: follow-up of 12 patients]. Neurologia 2006; 21:695-703. [PMID: 17106822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
INTRODUCTION We present 12 patients with moyamoya disease and their evolution from an early age to adulthood in some cases. MATERIAL AND METHODS The patients (nine females and three males) were first studied before 10 years of age because of neurological disease. Bilateral carotid and vertebrobasilar arteriographies were performed during initial evaluation. In the patients who were followed-up during several or many years (in one, during 33 years and, in two, during 25 years), neuroimaging studies were done by magnetic resonance angiography (MRA). One patient also had neurofibromatosis type 1 (NF1). RESULTS All patients showed bilateral occlusion of the supraclinoid portion of the internal carotid arteries. The basilar artery was markedly narrowed in one patient. One patient with very early onset of symptoms also showed collateral vascularization through the Bernasconi- Cassinari artery. Cerebral multifocal cortical and subcortical lesions were seen in the patients who had very long follow-up, although these already had appeared in the first MR studies. One patient showed arterial moyamoya 31 images and fibromuscular dysplasia. She was the only patient treated surgically during childhood with death after a short time. Another patient had a pregnancy and vaginal delivery at 26 years of age without complications. Images of moyamoya did not disappear in any of the patients in this series. Seizures were controlled with antiepileptic medication in all patients except in one who had NF1 and severe cerebral lesions. Although it is difficult to demonstrate the efficacy of calcium-antagonist medication (nicardipine), we found that it improved the neurological symptoms in most of our patients. CONCLUSIONS Long-term follow-up of the patients in this series showed some neurological problems, although most of them did well, including those cases with early onset of symptoms. All adult patients in this series were working, although some of them in low qualified jobs. Collateral vascularization was very marked in all patients except in one who also showed fibromuscular dysplasia. Moyamoya images did not disappear in any patient. Ischemic cerebral lesions seem to be underlying the cause of the neurological sequelae. Seizures responded well to antiepileptic medication.
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Pascual-Castroviejo I. [Persistent embryonic arteries]. Neurologia 2006; 21:727-8. [PMID: 17106826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
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Pascual-Castroviejo I, Pascual-Pascual SI, Burgueno M, Martin-Perez M, Palencia R, Garcia-Segura JM, Valero C. [Unilateral facial and cerebral hyperplasia associated with neurofibromatosis type 1. Report of four patients]. Rev Neurol 2006; 43:346-52. [PMID: 16981165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
INTRODUCTION Plexiform neurofibroma in any location is one of the commonest complications associated with neurofibromatosis type 1 (NF1). Plexiform neurofibroma of the upper eyelid and orbit is usually associated with ipsilateral hemifacial hyperplasia. We present four patients with NF1 and plexiform neurofibroma of the eyelid and orbit associated with hemifacial hyperplasia, who also showed hyperplasia of the unilateral cerebral hemisphere. CASE REPORTS There are four patients, three females and one male, who consulted because of NF1 with plexiform neurofibroma of upper eyelid and hemifacial hyperplasia. Upper eyelid involvement was observed since birth and progressed during the first years of life. The patients showed normal neurological and mental development without motor or cerebellar disorders. Magnetic resonance studies demonstrated the asymmetric hyperplasia of the ipsilateral hemisphere in all four cases and of the cerebellar hemisphere in one case. The degree of hemispheric hyperplasia was related to the size and extension of the plexiform neurofibroma, as well as to the severity of the hemifacial hyperplasia. In our case which had the plexiform neurofibroma extended to the neck and the upper thorax, the hyperplasia not only affected the cerebral hemisphere but also the ipsilateral cerebellar hemisphere. All parts of the hemisphere showed increased size. The cortex of the entire hemisphere showed normal differentiation of the subcortical white matter. CONCLUSION NF1 appears to be related with facial and cerebral ipsilateral hemihyperplasia. The relation between the size and extension of the orbital, eyelid and facial plexiform neurofibroma and the degree of asymmetry of the hemispheric hyperplasia suggest that different influences of a still unknown agent, possibly a gene, obviously related to NF1, causes both the intracranial and extracranial abnormalities.
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Affiliation(s)
- I Pascual-Castroviejo
- Servicio de Neurología Pediátrica, Hospital Universitario La Paz, 28046 Madrid, Espana.
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Pascual-Castroviejo I, Pascual-Pascual SI, Velazquez R, van den Ouweland AMW, Halley DJJ. [Tuberous sclerosis complex type 1 (TSC1): diagnostic significance of the cutaneous mini-lesions in a familial presentation]. Neurologia 2006; 21:386-8. [PMID: 16977561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
We present a family with tuberous sclerosis complex type 1 (TSC1). The family is formed by six patients. Two sibs, female and male, both patients having minor signs of the disorder. The woman have two daughters, one of them with severe clinical and radiological features of TSC1, and the other who only has a small cutaneous acromic spot. The man has two sons, one with severe features of TSC1, and the other with cutaneous mini-lesions. DNA study of the two cousins, woman and man, with cutaneous mini-lesions, showed a mutation in the chromosome 9 (1749 del GA) (TSC1 ex 15) in both patients. No pathogenic mutation in the TSC2 gene was detected in the two cousins.
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Pascual-Castroviejo I, Pascual-Pascual SI, Quijano-Roy S, Gutiérrez-Molina M, Morales MC, Velázquez-Fragua R, Maties M. [Cerebellar ataxia of Norman-Jaeken. Presentation of seven Spanish patients]. Rev Neurol 2006; 42:723-8. [PMID: 16775797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
AIM To show that the cerebellar ataxias described by Norman and by Jaeken (CDG1a) are the same disease. PATIENTS AND METHODS Seven patients, five females and two males (there were two siblings pairs), who presented a severe cerebellar disease slowly progressive associated with generalized cerebellar atrophy. The sister of one of the patients of the series had been studied because of psychomotor retardation but she died at two years of age due to respiratory problems. An autopsy was carried out that showed severe cerebellar atrophy, and the histological study revealed loss of granular cells and diverse abnormalities of Purkinje's cells, especially focal swellings of 'asteroid bodies' or 'cactus like' type. This suggested to us that Norman's ataxia and CDG1a could be the same pathological entity. RESULTS All seven patients had severe cerebellar hypoplasia-atrophy and a small brainstem. Most patients showed peripheral neuropathy with decreased motor nerve conduction velocity, but very little decreased sensory nerve conduction velocity. All seven patients had highly raised serum concentrations of asialotransferrin, and heterozygous molecular PMM2 deficit (CDG1a). One of these seven cases was the patient whose sister had histological cerebellar changes corresponding to Norman's ataxia. CONCLUSION The findings observed in our series suggest that the diseases described by Norman and Jaeken are the same pathological entity and CDG1a can be the biological basis of the histological changes of the cerebellum in Norman's ataxia. We suggest the name of Norman-Jaeken ataxia or disease for this entity.
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Affiliation(s)
- I Pascual-Castroviejo
- Servicio de Neurología Pediátrica, Hospital Universitario La Paz, 28046 Madrid, España.
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Pascual-Castroviejo I. [Many bone alterations in Larsen's syndrome]. Rev Neurol 2006; 42:702-3. [PMID: 16736405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
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Pascual-Castroviejo I, Pascual-Pascual SI, Velázquez-Fragua R, Martinez V. [Incontinentia pigmenti: clinical and neuroimaging findings in a series of 12 patients]. Neurologia 2006; 21:239-48. [PMID: 16788866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVE To describe the clinical, neuroimaging 51 with magnetic resonance imaging (MRI) and evolutive findings in 12 patients with incontinentia pigmenti (IP). Five patients show cutaneous and neurological lesions and seven only show cutaneous lesions without neurologic or/ and ophthalmologic abnormalities. MATERIAL AND METHODS Five mothers and seven daughters from four families were studied and followed between 1965 and 2004. The studies consisted of detailed clinical history since birth, physical examination, family history, EEG recordings and MRI studies. In some patients, at least three MRI studies were performed during our follow-up. All patients were followed-up since their first visit until 2004. Including four patients since birth or early infancy. Skin biopsies were obtained from two infants for histological study. RESULTS MRI studies revealed brain abnormalities in five girls who had neurologic signs associated with the cutaneous lesions of IP. Brain lesions were bilateral in four and unilateral in one. Cerebellar changes were observed only in one case who also showed severe cerebral lesions. The lesions involved cortex, subcortical and deep white matter, ependymal and subependymal zones of one or both cerebral hemispheres. Lesions usually were localized and extended radially to involve all the cerebral parenchyma between ependyma and cortex. Affected areas did not correspond to territories vascularized by any determined artery. The corpus callosum showed generalized or localized atrophy in the five patients who had cerebral hemispheric lesions. Although parenchymal changes were seen in both the T1 and T2 weighted images, these were most evident in the latter. Parenchymal abnormalities were most severe in patients with neonatal severe cutaneous lesions, especially if these were located in the scalp. Cerebral lesions were present from birth or the first months of life and changed little thereafter. The acute appearance and distribution of cerebral lesions always during the neonatal period, associated with scalp lesions in stage 1, suggest an acute inflammatory origin of unknown etiology and of nonprogressive course. Ocular lesions were directly related with cerebral abnormalities. Patients who only had cutaneous lesions without neurologic symptoms showed no MRI abnormalities. CONCLUSIONS Neuroimaging studies reveals brain lesions only in patients with neurologic disease in this serie. The brain lesions may involve one or both cerebral hemispheres, corpus callosum, and cerebellum. The brain lesions correlate with the neonatal scalp lesions in stage 1, suggests an inflammatory process of unknown etiology and non-progressive course. The appearance and distribution of the cerebral lesions do not follow the territories vascularized by specific arteries. Ocular lesions are observed only in patients with severe cerebral changes. Early onset of cerebral lesions may be the most reasonable explanation for the progressive microcephaly within the first year of life in IP.
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Pascual-Castroviejo I, Pascual-Pascual SI, Martinez V, Maties M. [Norman-Jaeken cerebellar atrophy]. Neurologia 2006; 21:256-7. [PMID: 16788868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
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Pascual-Castroviejo I, Pascual-Pascual SI, Velázquez-Fragua R, García L, López-Gutiérrez JC, Viaño-López J, Martínez V, Palencia R. [Cutaneous hemangiomas and vascular malformations and associated pathology (Pascual-Castroviejo type II syndrome). Study of 41 patients]. Rev Neurol 2005; 41:223-36. [PMID: 16075401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
AIM To describe the clinical, diagnostic and therapeutic features of this angiomatous neurocutaneous syndrome, which is the most frequent one, and to report a personal series of 41 patients. PATIENTS AND METHODS Forty one patients--31 females and 10 males--were studied during childhood and then, several patients were followed during many years, which allowed us to learn about the evolution of the abnormalities. The cutaneous lesions were classified as hemangiomas in 30 patients (73%) and as vascular malformations in 11 patients (27%). RESULTS A cerebellar anomaly (unilateral hemispheric hypoplasia and Dandy-Walker malformation) was seen in 13 patients (31.5%) cerebral cortical dysplasia in 4 patients (10%), aortic arch coarctation in 6 patients (15%), and congenital cardiopathy in 5 patients (12%). The most frequent abnormalities were intracranial and/or extracranial vascular malformations. Persistence of the trigeminal artery was observed in 7 patients (17%), absence or severe hypoplasia of an internal carotid artery in 13 patients (32%), absence of a vertebral artery in 7 patients (17%), hypoplasia of intracranial arteries in 6 patients (15%) and aneurysmal enlargement of carotid or vertebral arteries in 5 patients (12%). Also were observed 4 patients (10%) with intracranial hemangioma, 2 (5%) with hemangioma in mediastinum, and 3 (7.5%) with intestinal hemangioma, all of which disappeared during the first years of life. Aneurysmal enlargement of the carotid and vertebral arteries and intracranial branches also disappeared after a process of progressive narrowing of the arterial lumen that caused complete obstruction of these arteries. At the same time the cutaneous hemangioma regressed. During this process, collateral vascularization through branches of the external carotid artery and of the non-affected branches of the contralateral intracranial arteries developed. CONCLUSION This neurocutaneous syndrome is the most frequent one and it is associated with several types of vascular and non-vascular abnormalities which can involve any organ of the body. Internal and external hemangiomas and hemangiomatous lesions progress and tend to regress concomitantly.
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Pascual-Castroviejo I, Pascual-Pascual SI, Gutiérrez-Molina M, Saarinen A, Joensuu TH, Bayés M, Cormand B. [Muscle-eye-brain disease. Presentation of one case with genetic study]. Neurologia 2005; 20:261-6. [PMID: 15954036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
INTRODUCTION The objective [corrected] is to present a case of muscle-eye-brain (MEB) disease with genetic study. MATERIAL AND METHODS We studied an affected male from the age of 7 months to 21 years. During this time, clinical, analytical, neurophysiological (EEG, EMG, visual evoked potential [VEP], electroretinogram [ERG]), image (CT, MR), cerebral biopsy and genetic studies were performed. RESULTS Severe visual acuity impairment with optic atrophy from the first months of life, abnormal VEP and ERG, CT and MR showing <<cobblestone complex>> image of the cerebral cortex and subcortical white matter with myelinating changes; the histologic study of the cerebral biopsy sample showed hypomyelinating lesions and migration changes. The patient is alive at 21 years of age. The genetic study confirmed the presence of two recessive mutations, c.1274G>C and c.1895+1_4delGTGA, within the POMGnT1 gene. CONCLUSIONS The patient shows typical clinical, neurophysiological, histological and genetic MEB features.
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Pascual-Castroviejo I, Pascual-Pascual SI, Merinero B, Ugarte M, Garcia-Segura JM, Viaño J, Velazquez R. [Glutaric aciduria type 1 with normal evolution: follow-up of one case until adult age]. Neurologia 2005; 20:189-93. [PMID: 15891948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
We present a patient of 20 years of age with glutaric aciduria type 1 (GA1) and normal psychomotor development. Her symptoms consisted of a few convulsions between 2.5 and 4.5 years of age. She was diagnosed at 9 years of age because of the typical alterations of GA1 that appeared in computed tomography and magnetic resonance (MR) imaging studies. Enzymatic activity in fibroblasts culture was nonexistent and glutarate excretion was elevated in the annual controls where this was investigated from the diagnosis of the disease so far. MR studies showed hyposignal in T1 of the subcortical white matter, severe dilatation of the Sylvian region and temporal fossa subarachnoid spaces, and hypoplasia of the subjacent cerebral parenchyma and of both temporal lobes. The corpus callosum and the surrounding zones appeared very enlarged and with signal changes. Spectroscopic MR showed signs of membrane instability and cellular impoverishment in subcortical white matter and basal ganglia and presence of lactic acid. Macrocephaly always maintained centiles over 98. The patient has no abnormal movements or motor disturbances, her behavior and intelligence being normal and she is able to follow studies of middle level.
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MESH Headings
- Basal Ganglia/pathology
- Brain/pathology
- Brain Chemistry
- Brain Diseases, Metabolic, Inborn/drug therapy
- Brain Diseases, Metabolic, Inborn/enzymology
- Brain Diseases, Metabolic, Inborn/genetics
- Brain Diseases, Metabolic, Inborn/pathology
- Brain Diseases, Metabolic, Inborn/urine
- Carnitine/therapeutic use
- Cells, Cultured/enzymology
- Child Development
- Child, Preschool
- Chromosomes, Human, Pair 19/genetics
- Corpus Callosum/pathology
- Female
- Fibroblasts/enzymology
- Follow-Up Studies
- Glutarates/urine
- Glutaryl-CoA Dehydrogenase
- Heterozygote
- Humans
- Intelligence
- Lactic Acid/analysis
- Magnetic Resonance Imaging
- Mutation, Missense
- Oxidoreductases Acting on CH-CH Group Donors/deficiency
- Oxidoreductases Acting on CH-CH Group Donors/genetics
- Riboflavin/therapeutic use
- Seizures/etiology
- Seizures/genetics
- Sequence Deletion
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Pascual-Castroviejo I, Pascual-Pascual SI, Velázquez-Fragua R, Palencia R. [Kabuki make-up syndrome. A report of 18 Spanish cases]. Rev Neurol 2005; 40:473-8. [PMID: 15861328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
AIM To present 18 cases of Kabuki make-up syndrome with the associated morphological and neurological alterations. CASE REPORTS The series consists of 18 patients, 14 males and 4 females, who show the peculiar facial morphology of this disease. Ten cases were studied between 1968 and 1978, before the description of the syndrome. Most of these patients are now over 30 years and two perhaps surmounting the 40, if surviving. The other 8 cases were studied during the last 20 years (a few within the last 3 years). The studies of the patients were anamnesis with genetic history, EEG, image, cytogenetic, laboratory studies, and mental evaluation when the patients collaborated. The most important findings are the peculiar facial characteristics as well as the psychomotor and language retardation, the persistent fingertip pads and clinodactyly that were observed in all patients. Other studies, such as EEG, caryotype, biochemical investigation in blood, urine and CSF (in the studied cases), and the cerebral neuroradiological images (pneumoencephalography, CT or MR) disclosed normal results. None of the patients of this series were neurologically normal. Hyperactivity, respiratory infection and/or otitis were frequently observed. CONCLUSION Kabuki make-up syndrome is a dysmorphologic and neurological disease of unknown origin. Its main manifestations involve facial appearance and brain function without anatomical anomalies. None of the patients was sent to the Pediatric Neurology service with the suspicion of Kabuki make-up syndrome.
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Pascual-Castroviejo I, Pascual-Pascual S. [Costello syndrome. Presentation of a case with a follow-up of 35 years]. Neurologia 2005; 20:144-8. [PMID: 15815950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
OBJECTIVE To present a patient of 35 years with Costello syndrome. MATERIAL AND METHODS A male consulted at 11 months of age because of psychomotor delay and peculiar face. RESULTS The main clinic features corresponded to the cutis laxa disease, although the picture and the results of the performed studies were not similar to any of the dysmorfic recognized syndromes. CONCLUSION The follow-up of the patient during 35 years showed a long survival, despite the cardiopathy, although he has a severe psychic retardation, showed very low height and weight centiles, and very high head circumference centiles.
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Pascual-Castroviejo I, Pascual-Pascual SI, Velázquez Fragua R, Ferrer I, Ugarte M, García-Segura JM. [L-2 hydroxyglutaric aciduria in a patient with Klinefelter syndrome]. Neurologia 2005; 20:90-3. [PMID: 15726477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
We present a of 22 years old patient who has a severe cerebellar disease that started during the first years of life, borderline mental level, epilepsy and Klinefelter syndrome. Brain magnetic resonance (MR) imaging revealed swollen white matter with a loss of signal on T1-weighted slices and an increase in signal intensity on T2-weighted images in both cerebral hemispheres and in both cerebellar dentate nuclei. MRI alterations did not change during the studies performed from 4 to 21 years. Blood and urine were analyzed and showed great elevation of L-2-hydroxyglutaric acid (L-2-HGA) and more discrete elevation of its metabolites and lysine. The parents of the patient are first cousins.
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Abstract
We describe two cases of oculocerebrocutaneous syndrome (OCCS) or Delleman syndrome, characterized by congenital anomalies that involve the skin, orbit, and central nervous system (CNS). Complete MRI studies of the orbit, CNS and the entire spinal region must be performed in these cases. New MRI techniques can show cortical malformations, such as polymicrogyria, lissencephaly, or abnormal disposition of cortical sulci and gyri. Lesions can be bilateral or unilateral, as occurred in our patients. In one case, the ocular, skin, cerebral, and cerebellar lesions involved mainly the same side, whereas in the second case, all anomalies were generalized and the patient also showed skin hypopigmented lesions distributed bilaterally. Both patients show severe encephalopathy and Dandy-Walker malformation. One case is blind and shows generalized hydrocephalus, and the other one has vision through an eye, and has complete agenesis of the corpus callosum and severe disorder of neuronal migration and cortical organization with polymicrogyria and abnormal cortical sulci and gyri in a cerebral hemisphere. Our second case shows arachnoid cysts in both temporal, retrocerebellar, and spinal (D(8)-D(11)) regions, and lipoma in the pontomedullary and spinal (D(4)-D(7)) regions. The latter features correspond more to ECCL than to OCCS. The overlap between the two syndromes is unquestionable and it is possible that they constitute different manifestations of the same disorder.
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Pascual-Castroviejo I, van der Knaap MS, Pronk JC, García-Segura JM, Gutiérrez-Molina M, Pascual-Pascual SI. Vacuolating megalencephalic leukoencephalopathy: 24 year follow-up of two siblings. Neurologia 2005; 20:33-40. [PMID: 15704020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
Megalencephalic leukoencephalopathy with subcortical cysts (MLC) is an autosomal recessive disorder with a chronic progressive course. The gene, MLC1, has been localized on chromosome 22qtell and 26 different mutations have been described. We report two siblings of non-consanguineous parents who presented with characteristic features of MLC. They showed macrocephaly from the first months of life. After a short time, motor clumsiness, ataxia, seizures and psychomotor retardation were observed. During childhood, both patients had a coma that lasted several days following a minor head trauma. The eldest sister experienced a permanent deterioration of the clinical picture after the coma. Epilepsy and electroencephalographic alterations were chronic, tending to improve during adulthood. Cerebral biopsy showed normal or minor changes in the cortical grey matter, and in the white matter gliosis, increased extracellular spaces and decreased numbers of fibres with thin myelin sheets. We have followed the patients during 24 years, from the ages of 4 and 8 years to the their present ages of 28 and 32 years. Clinical and neuro-imaging follow-up showed a chronic course with more prominent progression of the white matter abnormalities than of the neurological features. A homozygous mutation of the MLC1 gene was found in both siblings. The eldest patient, 32 years-old, needs a wheel-chair but has a good contact with the family and surrounding people. The youngest, 28-years-old, shows mild ataxia, spasticity and motor clumsiness, but she is able to participate in activities of daily life.
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Pascual-Castroviejo I, Pascual-Pascual SI, García-Peñas JJ, Hernández-Moneo JL. [Cervical spinal cord compression in chondrodysplasia punctata: report of two cases]. Rev Neurol 2004; 39:826-9. [PMID: 15543497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
AIM To present two patients with chondrodysplasia punctata and cervical spine compression who had a chronic myelopathy. CASE REPORTS The patients are a boy who was seen in our service at 13 years of age because of a progressive spastic quadriparesis since infancy and muscle spasm, and a girl, actually 15-year-old, who was studied by us since 2 years of age because of the same problem and moderate mental retardation. Magnetic resonance study disclosed narrowing of the spinal canal at the level of C1-C2 and C5-C6. Surgical decompression was performed in both cases. The case 2 also received physiotherapy, myorrelaxing medication and botulinum toxin treatments. The case 2 has short stature and intellectual level below normality. CONCLUSION Chondrodysplasia punctata, that exhibits well defined clinical and radiological manifestations, is a disease that can present spinal cord compression during the first years of life. However, other pathological causes of still unknown origin may contribute to the progressive evolution and lack of recuperation of the problems derived of the spasticity as well as the mental retardation and the short stature.
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