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Introducción: el síndrome de Aicardi (SA; OMIM #304050) es un trastorno genético raro, cuya incidencia es de aproximadamente 1/100.000. Fue descrito en 1965 como una triada consistente en agenesia del cuerpo calloso, lagunas coriorretinianas y espasmos infantiles. Asocia discapacidad intelectual severa y epilepsia de difícil control. Aunque su espectro clínico es variable, tiene por lo general un pronóstico infausto debido a la elevada morbimortalidad asociada. Se considera un trastorno esporádico causado por variantes patogénicas en heterocigosis de un gen ligado al cromosoma X, que causa mortalidad embrionaria en varones hemicigotos. Objetivo: este trabajo pretende llevar a cabo una revisión bibliográfica acerca de la literatura científica disponible del síndrome de Aicardi. De esta manera se hará una actualización sobre esta entidad en cuanto a definiciones, prevalencia e incidencia, etiología, espectro clínico y pronóstico de los pacientes afectos. Materiales y métodos: se lleva a cabo una búsqueda bibliográfica retrospectiva en las principales bases de datos científicas. Para ello, se utilizan las palabras clave "Aicardi", "agenesia del cuerpo calloso", "espasmos infantiles" y "encefalopatía epiléptica". Conclusiones: desde su descripción se ha ido ampliando el espectro de manifestaciones clínicas del síndrome. Actualmente no se conoce la existencia de un biomarcador que posibilite el diagnóstico, por lo que éste continúa siendo eminentemente clínico. Se debe tener un alto nivel de sospecha en espasmos infantiles de debut precoz en mujeres con alteraciones en neuroimagen.
Introduction: Aicardi syndrome (AS; OMIM #304050) is a rare genetic disorder, with an incidence of approximately 1/100,000. It was described in 1965 as a triad consisting of agenesis of the corpus callosum, chorioretinal lacunae, and infantile spasms. It is associated with severe intellectual disability and difficult-to-control epilepsy. Although its clinical spectrum is variable, it generally has a poor prognosis due to the associated morbidity and mortality. It is considered a sporadic disorder caused by heterozygous pathogenic variants of a gene linked to the X chromosome, which causes embryonic mortality in hemizygous males. Objective: this article performs a bibliographic review of the available scientific literature on Aicardi syndrome. In doing so, we hope to update the disorder's definitions, prevalence and incidence, etiology, clinical spectrum and prognosis of affected patients. Materials and methods: we performed a retrospective bibliographic search in the main scientific databases. For this, we searched for the keywords "Aicardi", "agenesia of the corpus callosum", "infantile spasms" and "epileptic encephalopathy". Conclusions: since it was first described, the spectrum of clinical manifestations of the syndrome has been expanding. Currently, there is no known biomarker that makes diagnosis possible, so it continues to be eminently clinical diagnosis. A high level of suspicion should be present in cases of early-onset infantile spasms in women with neuroimaging abnormalities.
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Objective:To investigate the diagnostic value of two-dimensional ultrasound combined with volumetric contrast imaging (VCI) and magnetic resonance imaging (MRI) for the developmental abnormalities of the fetal corpus callosum.Methods:Seventy-three fetuses who underwent cranial MRI within 1 week after suspected fetal corpus callosum dysplasia on ultrasound and received a definitive diagnosis in the neonatal period were retrospectively recruited for the study. The fetal corpus callosum was observed in the transverse, coronal, and sagittal views of the fetus, and the hyaline septal cavity, lateral ventricle, third ventricle, and corpus callosum were observed in the MRI scan. The diagnostic results and sensitivity of two-dimensional ultrasound combined with volumetric contrast imaging and MRI were analyzed.Results:Neonatal imaging showed that among 73 fetuses, 32 had agenesis of the corpus callosum, 29 had hypoplasia of the corpus callosum, and 12 had normal development of the corpus callosum. The differences in diagnostic results and sensitivity between 2D ultrasound combined with volumetric contrast imaging and MRI testing for agenesis of the corpus callosum were not statistically significant (all P>0.05), and the differences in diagnostic results and sensitivity for hypoplasia of the corpus callosum were statistically significant ( P<0.05). Conclusions:Both 2D ultrasound combined with volumetric contrast imaging and MRI are of high value for the diagnosis of partial-type agenesis of the corpus callosum, but MRI is more advantageous for the diagnosis of agenesis of the corpus callosum, and MRI can be a useful supplement and verification tool for ultrasound to provide a more accurate clinical diagnosis.
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Introducción: El programa de estimulación temprana en la primera infancia, está diseñado para promover y mejorar el neurodesarrollo. El cuerpo calloso es una masa arqueada de sustancia blanca, compuesta por un haz de fibras transversales, situada al fondo del surco longitudinal que conecta a ambos hemisferios cerebrales. Se asocia con prematuridad y edad materna avanzada. Objetivo: Demostrar la validez de un programa de intervención temprana en la evolución de un paciente con agenesia de cuerpo calloso en las etapas del neurodesarrollo. Presentación del caso: Lactante venezolano, masculino de 4 meses de edad, blanco, producto de un segundo embarazo. Padres jóvenes, no consanguíneos. A las 19 semanas le realizan ecografía fetal: imagen quística cerebral interhemisférica, sugestivo de agenesia del cuerpo calloso. Parto por cesárea de urgencia: 34 semanas por: CIUR, oligoamnios severo, sufrimiento fetal agudo y preeclampsia, con Apgar 7-9, peso: 1800 g. Es traído al Centro Internacional de Salud La Pradera, con el diagnóstico de agenesia de cuerpo calloso más retardo del desarrollo psicomotor. Se inicia programa de intervención temprana cinco veces por semana con evaluaciones cuatrimestrales. Se involucra a los familiares. A los 18 meses de edad alcanza los hitos longitudinales propios de la edad Conclusiones: La intervención temprana favorece los mecanismos de neuroplasticidad cerebral y proporciona una evolución satisfactoria en las etapas del neurodesarrollo independiente de la agenesia de cuerpo calloso. La participación intensiva de la madre del niño es crucial para el éxito de la intervención(AU)
Introduction: The program of early stimulation in the early childhood is designed to foster and improve neurodevelopment. The callused body is a curved mass of a white substance composed by a beam of transverse fibers located in the back of the longitudinal track that connects both brain hemispheres. It is associated to prematurity and advanced maternal age. Objective: To prove the validity of an early intervention program in the evolution of a patient with agenesis of corpus callosum in the stages of neurodevelopment. Case presentation: Venezuelan newborn, 4 months old, masculine, white skin, product of a second pregnancy. Young parents, no blood relation. At 19 weeks of pregnancy, it is conducted a fetal echography: interhemispheric cystic image, suggestive to agenesis of the corpus callosum. Emergency cesarean section at 34 weeks of pregnancy due to: IUGR, severe oligoamnios; acute fetal distress and preeclampsia, with 7-9 Agar, weight: 1800 g. The newborn was admitted in La Pradera International Health Center with a diagnosis of agenesis of the corpus callosum, and delay in the psychomotor development. It was started a program of early intervention five times in the week with four-monthly assessments. Relatives were involved in the program. At 18 months old, the patient achieved the longitudinal milestones of that age. Conclusions: Early interventions favour brain neuroplasticity mechanisms, and provide a satisfactorily evolution in the stages of neurodevelopment, obviating the agenesis of the corpus callosum. Intensive participation of the child's mother is essential for the success of the intervention(AU)
Subject(s)
Humans , Male , Infant , Agenesis of Corpus Callosum/diagnostic imaging , Early Medical Intervention/methods , Psychomotor Performance/physiologyABSTRACT
Abstract Introduction: the Aicardi syndrome (SA) is characterized as a rare syndrome identified in the presence of three classic characteristics: corpus callosum agenesis, chorioretinal lacunaeand infantile spasms. Description: data collection involved information reported by the mother and the accompanying physiotherapist describing the patient's clinical history andmajor complications according to clinical evolution, treatment, and therapeutic response. At two months of age, the child presented a delayed neuropsychomotor development and infantile spasms.However,the diagnosis of the syndrome was only performed at six months of life, involving brain magnetic resonance imaging where corneal body agenesis was observed. A multidisciplinary treatment was assembledwith a neuropediatrician, a physiotherapist, a psychologist, a nutritionistand a speech therapist, besides drug treatment with baclofen and phenobarbital. Discussion: through the established treatment, the child displayedmotor gain, cervical control, improvement of the respiratory condition, and no need forhospital admissions;these outcomescharacterizea good clinical evolution associated with the physiotherapeutic intervention focused on prevention and minimization of respiratory alterationsthatare frequently associated with morbidity and mortality in these cases. The results obtained point out the fundamental role of multidisciplinary intervention in coping with this condition.
Resumo Introdução: a Síndrome de Aicardi (SA), caracteriza-se como uma síndrome rara identificada na presença das três características clássicas: agenesia de corpo caloso, lacunas coriorretinianas e espamos infantis. Descrição: a coleta de dados envolveu informações relatadas pela genitora e pelo fisioterapeuta acompanhante da paciente, descrevendo assim a história clínica da paciente, as principais complicações de acordo com a evolução clínica, o tratamento e resposta terapêutica. Aos dois meses de idade a criança apresentou atraso no desenvolvimento neuropsicomotor e espasmos infantis, porém o diagnóstico da síndrome foi realizado somente aos seis meses de vida envolvendo um exame de ressonância magnética de encéfalo onde foi observada agenesia de corpo caloso, iniciando-se tratamento multidisciplinar com neuropediatra, fisioterapeuta, psicólogo, nutricionista e fonoaudiólogo, além do tratamento medicamentoso com baclofeno e fenobarbital. Discussão: através do tratamento estabelecido, a criança obteve ganho motor, controle cervical, melhora da condição respiratória e sem internações hospitalares, caracterizando uma boa evolução associada particularmente à intervenção fisioterapêutica que teve enfoque na prevenção e minimização de alterações respiratórias frequentemente associadas à morbidades e mortalidade nestes casos. Os resultados obtidos apontam o papel fundamental da intervenção multidisciplinar para o enfrentamento desta condição.
Subject(s)
Humans , Infant , Aicardi Syndrome/complications , Aicardi Syndrome/diagnosis , Aicardi Syndrome/drug therapy , Phenobarbital/therapeutic use , Spasms, Infantile/complications , Baclofen/therapeutic use , Magnetic Resonance Spectroscopy , Chorioretinitis , Agenesis of Corpus CallosumABSTRACT
Objective To explore the value of the cavum vergae vanishing sign for prenatal ultrasound diagnosis of fetal agenesis of the corpus callosum ( ACC ) . Methods Fifty-one cases of ACC of 20 - 32 gestational weeks were confirmed by MRI or induced fetal autopsy . A random selection of 80 normal fetuses of 20 - 32 gestational weeks were chosed as control group . The displays of the cavum septum pellucidum ( CSP) and the cavum vergae( CV ) in the two groups were observed . Results There were 36 cases of complete agenesis of the corpus callosum ( CACC) and 15 cases of partial agenesis of the corpus callusom ( PACC) in ACC group . In 51 ACC cases ,43 cases were confirmed by prenatal MRI ,while 8 cases were confirmed by postnatal MRI . The comparison of display of CSP and CV between the ACC group and the health group was as follows : ① CSP vanishing rate in ACC group was 70 .6％ ( 36/51 ) ,meanwhile the disappearance rate of CSP in the health group was 0 ( 0/80 ) ,the difference between the two groups was statistically significant( χ2 = 77 .870 , P = 0 .000) . ② CV vanishing rate in ACC group was 96 .1％ (49/51) , meanwhile the disappearance rate of CV in the health group was 1 .2％ ( 1/80) ,the difference between the two groups was statistically significant ( χ2 = 118 .673 , P = 0 .000) . The correlation coefficient between the CV vanishing sign and the occurrence of ACC was 0 .952 ( P = 0 .000) ,while the correlation coefficient between the CSP vanishing sign and the occurrence of ACC was 0 .771 ( P = 0 .000) . There were significant differences in CSP disappearance rate and CV disappearance rate between ACC group and control group at different gestational weeks ( 20 - 24 weeks ,25 - 28 weeks and 29 - 32 weeks) ( all P < 0 .001) . Conclusions The cavum vergae vanishing sign ,as an important indirect sign of fetal agenesis of the corpus callosum ,can be obtained quickly from horizontal transverse section of the cavum septum pellucidum . During the middle pregnancy ,it could be an important prenatal ultrasound screening clue for fetal agenesis of the corpus callosum .
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Mild encephalitis/ encephalopathy with a reversible splenial lesion (MERS)in the corpus callosum is a clinical - radiological syndrome with typical imaging characteristics,which can be divided into 2 types (MERS Ⅰand MERS Ⅱ)according to the affected parts. The main cause is infection in children. Patients can be presented with symptoms that are common for acute mild encephalitis or encephalopathy such as disturbance of consciousness,hea-dache,vomiting,seizure. Brain magnetic resonance imaging(MRI)indicates lesions in the splenium of the corpus callo-sum. The symptoms and brain MRI lesions disappear almost within 1 month,and the prognosis is usually good. Early recognition is necessary and excessive treatment should be avoided.
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OBJECTIVE: With recent advances and frequent use of prenatal ultrasound, the antenatal diagnosis of agenesis of the corpus callosum (ACC) is not rare in obstetrics practices. However, information regarding the long-term neurological outcome remains uncertain. The aim of this study was to investigate clinical outcomes of prenatally diagnosed ACC and to analyze postnatal neurodevelopmental outcomes of ACC neonates born in our single center. METHODS: We retrospectively reviewed 56 cases of prenatally suspected ACC referred to our center. RESULTS: Fifty-six fetuses were diagnosed with ACC, and 12 of those were followed-up in our center until delivery. Of the remaining 44, 7 were delivered after being referred back to the original hospital, 23 were lost to follow-up, and 14 had unknown outcomes. Among all 56, 29 were considered to have isolated ACC and 27 were considered to have non-isolated ACC. Of the 10 live fetuses delivered in our center, four had isolated ACC, three had non-isolated ACC, and the rest had outcomes unrelated to ACC. Neurodevelopmental outcome was followed-up until approximately age 3 years. Of the four with isolated ACC, three (75%) had normal neurodevelopmental outcomes. CONCLUSION: Similar to other studies, the results of our single-center study included positive neurodevelopmental outcomes for those with isolated ACC. However, despite our endeavor to counsel patients with prenatally diagnosed ACC, the delivery rate in our center was quite low. Therefore, larger, multicenter, retrospective studies including long-term neurological development outcomes are crucial and urgently needed to provide better counseling.
Subject(s)
Humans , Infant, Newborn , Agenesis of Corpus Callosum , Corpus Callosum , Counseling , Fetus , Korea , Lost to Follow-Up , Obstetrics , Prenatal Diagnosis , Retrospective Studies , UltrasonographyABSTRACT
Se presenta el caso clínico de una infante de 13 meses de edad, con antecedente de agenesia del cuerpo calloso, quien ingresó en la sala de nutrición del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba por presentar ganancia insuficiente peso, pérdida de la visión en ambos ojos y audición disminuida. Se realizó resonancia magnética por imágenes donde la presencia del esplenio confirmó la agenesia parcial.
The case report of a 13 months child is presented with a history of agenesis of the corpus callosum, who was admitted in the nutrition room of "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba, due to poor weight gain, loss of vision in both eyes and diminished audition. A magnetic resonance imaging was carried out where the presence of the splenium confirmed the partial agenesis.
Subject(s)
Magnetic Resonance Spectroscopy , Agenesis of Corpus Callosum , Child, PreschoolABSTRACT
El síndrome de Aicardi (SA), es una rara enfermedad neurogenética, diagnosticada clínicamente por la triada clásica de agenesia del cuerpo calloso, espasmos infantiles y lagunas corioretinales. El objetivo de nuestro trabajo fue presentar el espectro clínico y la evolución de este trastorno en un caso. Reportamos una lactante de dos meses, de malformaciones cerebrales múltiples, que ingresa a emergencia por presentar crisis convulsivas. Durante la hospitalización, los hallazgos clínicos û electroencefalográficos, neuroimágenes y evaluación oftalmológica confirman el diagnóstico de SA. Se resalta la importancia de conocer las manifestaciones clínicas del síndrome, para tenerlo en cuenta como diagnóstico diferencial, sobre todo en aquellos casos que presenten espasmos infantiles asociados a agenesia del cuerpo calloso.
AicardiÆs syndrome (SA) is a rare genetic disease, clinically characterized by the classic triad of agenesis of the corpus callosum, infantile spasms and chorioretinal lacunae. The aim of this presentation is to describe the clinical spectrum and evolution of the disorder. We report the case of a 2-month old female infant with a prenatal diagnosis of multiple brain malformations, brought into the Emergency Room while experiencing seizure spells. During her hospitalization, electroencephalography, neuroimaging and ophthalmologic evaluations confirmed the diagnosis of SA. The importance of knowing the clinical manifestations of the syndrome is emphasized, in order to keep it in mind as part of the differential diagnosis for cases presenting infantile spasms associated with agenesis of the corpus callosum.
Subject(s)
Humans , Female , Infant , Spasms, Infantile , Aicardi Syndrome , Aicardi Syndrome/diagnosisABSTRACT
Objective To evaluate DTI for early diagnosis and prognosis of diffuse axonal injury (DAI)in the moderate and sever traumatic brain injury (sTBI).Methods 30 patients with sTBI and 30 healthy controls were studied with T1 WI and DTI.The frac-tional anisotropy(FA)and ADC were quantified from different regions of interest(ROI)including the genu of corpus callosum(gCC), the trunk of CC,the splenium of CC(sCC)and the integrity CC.The FA and ADC of the same R0I was compared between TBI group and control group,and FA and ADC of the different parts of CC were compared in TBI group.Correlations between the FA or ADC and coma duration of the TBI patients were analyzed by Pearson linear correlation.Results Compared with control group,the FA value decreased significantly in each ROI,while ADC was reversed.The FA or ADC of the different ROI were correlated with co-ma duration in TBI group.Conclusion DTI is sensitive to detect the white matter injury of TBI.FA value detected in the CC can help diagnose DAI earlier and evaluate the degree of injury.
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Constitutional trisomy 8 is a relatively rare aneuploidy; most identified cases are mosaic with a normal cell line. The phenotype is highly variable from apparently normal to severe disability. The proportion of abnormal cells is dramatically different between tissues and the severity of the phenotype is not directly related to the level of mosaicism. Therefore, it is very difficult to provide a definitive prognosis. We report here a case of constitutional trisomy 8 mosaicism with agenesis of the corpus callosum, congenital heart disease and micrognathia. The trisomy 8 cell line was not detected by prenatal cytogenetic study. This is the fourth reported case of constitutional trisomy 8 mosaicism in Korea.
Subject(s)
Aneuploidy , Cell Line , Corpus Callosum , Cytogenetics , Heart Defects, Congenital , Korea , Mosaicism , Phenotype , Prognosis , TrisomyABSTRACT
The authors report a case of interhemispherical fissure arachnoid cyst with agenesis of the corpus callosum who was 11-year-old child suffering from partial seizure. The interhemispheric area is a rather uncommon site for arachnoid cysts. Careful analysis of the anatomical and radiological features of this case seems to suggest that two morp-hologically distinct types of cysts occurred in the interhemispheric area; (1) Interhemispheric cyst associated with agenesis of the corpus callosum(2) parasagittal cyst, not associated with such an anomaly. The interhemispheric fissure arachnoid cyst occurs in the midline, straddling the falx, and extends about equally on either side, compressing the medial surface of both hemispheres. A coronal CT or MRI view shows a "batwing" appearance of the lateral horns and dorsal displacement of the third ventricle. It should be stressed that a histologically heterogenous group of cysts(ependymal, glial, choroid epithelial, and arachnoid) may give rise to this same morphologic appearance. The anterior interhemispheric approach was performed and removal of cystic membrane was achieved. Postoperatively, there was no focal neurological deficit.