[Rhombencephalosynapsis : a rare cerebellar malformation not to miss]. / Rhombencéphalosynapsis : une malformation cérébelleuse rare à ne pas méconnaître.

Rhombencephalosynapsis (RS) is a rare cerebellar malformation characterized by the association of partial or total vermis agenesis and fusion of the cerebellar hemispheres. This malformation is often associated with supratentorial cerebral abnormalities and more rarely with extra-cranial abnormalities. The severity of the clinical manifestations and the prognosis of RS depend on the findings of the posterior fossa and the associated anomalies. This clinical case presents an isolated complete RS, documented by antenatal ultrasound, fetal and postnatal/mortem magnetic resonance imaging (MRI) and pathological examination. A RS should be suspected on antenatal morphological ultrasound in case of reduction in size of the posterior fossa and in the absence of vermis. Fetal MRI is the imaging modality of choice to confirm the diagnosis. In the event of medical termination of pregnancy, the autopsy is rarely accepted by the parents, limiting postnatal investigations. This is why postnatal/postmortem MRI can prove to be an alternative to confirm and better document this rare pathology. Finally, multidisciplinary collaboration is essential to make the diagnosis and to ensure the best care.

Le rhombencéphalosynapsis (RS) est une malformation cérébelleuse rare, caractérisée par l'association d'une agénésie partielle ou totale du vermis et d'une fusion des hémisphères cérébelleux. Cette malformation est souvent associée à des anomalies cérébrales supra-tentorielles et, plus rarement, à des anomalies extra-crâniennes. La sévérité des manifestations cliniques et le pronostic du RS dépendent des atteintes de la fosse postérieure et des anomalies associées. Ce cas clinique présente un RS complet isolé, documenté par une échographie anténatale, une imagerie par résonance magnétique (IRM) fœtale et postnatale/mortem ainsi qu'un examen anatomo-pathologique. Un RS doit être suspecté à l'échographie morphologique anténatale en cas de réduction de taille de la fosse postérieure et en l'absence de vermis. L'IRM fœtale est l'examen de choix pour confirmer le diagnostic. En cas d'interruption médicale de grossesse, l'autopsie est rarement acceptée par les parents, ce qui limite les investigations postnatales. C'est pourquoi, l'IRM postnatale/postmortem pourrait s'avérer être très utile pour confirmer et mieux documenter cette rare pathologie. Enfin, la collaboration multidisciplinaire est essentielle, d'une part, pour poser le diagnostic et, d'autre part, pour assurer la meilleure prise en charge possible.

Exercise-Triggered Chest Pain as an Isolated Symptom of Myocarditis in Children.

In childhood, chest pain occurring at exercise is a common complaint. A cardiac etiology for it is exceptionally found, explaining that most children do not undergo systematic cardiological investigation. However, chest pain at exercise may manifest as the unique symptom of a viral myocarditis. Recognizing this form of myocardial injury, however, might help to avoid clinical deterioration by providing adequate care. In this paper, we report on two children presenting with the unique clinical symptom of chest pain related to physical activity and in whom laboratory and cardiac investigations suggested transient myocardial damage related to myocarditis.

Paraspinal Arterio-Venous Fistula in Children: Two More Cases of an Exceptional Malformation.

We report on the case of two toddlers who presented in the last 2 years with heart and vascular murmur, respectively, and in whom the diagnosis of paraspinal arterio-venous fistula was made. Paraspinal arterio-venous fistulae in children are extremely rare congenital or post-traumatic vascular malformations. In the rare case of connection with the spinal venous system, they might affect spinal vascularization due to potential venous congestion. Interventional embolization rather than surgery is the treatment of choice for such lesions. Up to now, there is no consensus about the indication of prophylactic closure of asymptomatic fistulae. However, close clinical follow-up with repeated spinal magnetic resonance imaging to exclude venous congestion is mandatory for young asymptomatic patients until treatment.

Floating-Harbor syndrome associated with middle ear abnormalities.

Floating-Harbor syndrome is a rare syndrome of unknown etiology, which was first described in 1973. A triad of main features characterizes Floating-Harbor syndrome: short stature, characteristic face, and an expressive speech delay. We present a patient in whom the hearing thresholds improved insufficiently after placement of grommets. High-resolution CT scan of the temporal bone showed a prominent soft-tissue thickening suspected of causing fixation of the malleus, and fusion of the malleus head with the body of the incus. To our knowledge this is the first reported abnormal middle ear anatomy in a patient with Floating-Harbor syndrome. A conservative treatment with hearing aids was preferred as an initial treatment in favor of a surgical exploration.

Early onset Huntington disease: a neuronal degeneration syndrome.

UNLABELLED: Huntington disease (HD) is an autosomal dominant, lethal neurodegenerative disorder of the central nervous system, caused by an uncontrolled expansion of a CAG dynamic mutation in the coding region of the IT15gene. Although a majority of patients have a midlife onset of the disease, in a small number of patients the disease manifests before 20 years of age. In adults, HD is mainly characterised by involuntary movements, personality changes and dementia. By contrast, in children a dominant picture of bradykinesia, rigidity, dystonia and epileptic seizures is noticed. The earlier onset is often associated with a paternal transmission of the disease allele to the offspring. We report here a rather unusual infantile onset of the disease in a little girl who presented with a history of seizures and psychomotor regression starting at the age of 3 years. A progressive cortical-subcortical atrophy, progressive cerebellar atrophy and lesions in the basal ganglia were found on MRI. An important expansion, of 214 triplet numbers, of the CAG repeat size associated with HD, was observed. CONCLUSION: Juvenile Huntingdon disease should be considered in children suffering from a progressive neurodegenerative disease.

Biliary atresia and cerebellar hypoplasia in polysplenia syndrome.

We report a 3.5-month-old boy with polysplenia syndrome who demonstrated hemiazygos continuation of the inferior vena cava, extrahepatic biliary atresia, multiple splenunculi, bowel malrotation, and the rare finding of brainstem and cerebellar hypoplasia. A possible pathogenesis for cerebellar hypoplasia in this syndrome is suggested after review of the literature. The importance of seeking associated anomalies in biliary atresia, which may be possible indicators of polysplenia syndrome, is stressed since these patients need appropriate management when surgery is considered.