Glossary in Congenital Malformations

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General:

#Schizencephaly:

·         Clinical features: Extremely variable and correlates with the anatomical anomalies.

·         Pathology: Abnormal division, fissure, or cleft of the brain substance. The lesions may be symmetrical. In the malformative type of schizencephaly, there is believed to be a complete agenesis of a portion of the germinative zones and thereby the cerebral wall at the lesion site, leaving seams of clefts. Schizncephaly, on the other hand, can be generated by a destructive process that destroy damage the cerebral mantle. Cases with collapsed clefts are refered to closed-lips schizencephaly and those with wide open clefts are refered as opened-lips schizencephaly.

·         EMX2 gene: Some sporadic cases are associated with mutations in this homeobox gene.

·         Comment: This term was first used by Yakovlev and Wadsworth. According to Fride and Rorke, this term should no longer be used because of the hypothetical destruction of the germinal zones. In my opinion, this term should be used as a descriptive term without reference to the pathogenesis and reserved for cleft like lesion of the brain that has no communication between the subarachnoid space and the ventricles. Cavitary lesion that has communication between the subarachnoid space and ventricles (being termed "communicating schizencephaly"), regardness of whether the communicating channel is wide open or collapsed, should be classified as porencephaly.

#Septo-optic dysplasia: see de Moriser Syndrome.

#Sequence: a pattern of cascade anomalies. In some instances, the constellation of anomalies may be explained by a single, localized aberration in organogenesis (malformation, disruption, or deformation)leading to secondary effects in other organs.

#Sirenomelia: (syn. Mermaid syndrome). Incidence is about 1 in 25,000 to 50,000 live birth. The severest form of caudal regression syndrome. Sirenomelia is the only anomaly invariably associated with a single umbilical artery. The babies are usually stillborn or die immediately after birth due to renal agenesis and pulmonary hypoplasia.

#Spina bifida: this is the defect of the osseous spine. Dorsal defects are the most common.

·         Spina bifida cystica: spina bifida with an external saccular protrusion. This term is not used any more.

·         Spina bifida occulta: the spinal osseous defect is limited to the posterior neural arches, laminae and the spines. This term is not used any more.

#Status verrucus deformis: the second cortical layer makes irregular protrusions into the molecular layer, while the external surface is smooth. Some consider that this is a transitional stage of development. Others consider thatis to be a true malformation and is related to polymicrogyria.

#Status verrucus simplex: innumerable uniform, semicicular protrusion at the cortical surface. Each protrusion was formed by an outward bulge of molecular and upper cell layers, separated from the next bulge by a sharp indentation. This is a fixation artifact (e.g., fixing the brain in a bag of gauze).

#Subcortical band heterotopia: see "Heterotopic gray matter".

#Syndromes: a constellation of congenital anomalies believed to be pathologically related, that, in contrast to a sequence, cannot be explained on the basis of a single, localized, initiating defect or insult.

#Syringobulbia: Cavities situitated in the medulla. Slit-like cavities usually lie in three locations: most commonly an anteriolateral slit, usually in the lower half or two third of the medulla, running from the floor of the 4th ventricle external to the hypoglossal nucleus; extension of the fourth ventricle along the median raphe for a variable distance; a cavity in between the pyramid and the inferior olive where it interrupts the emerging fibers of the hypoglossal nerve.

#Syringomyelia/syringobulbia:

·         Clinically: Syringomyelia usually begins during the second and third decade and is slowly progressive or the symptoms may increase at first rapidly and then more slowly. They may cease to progress at any time. Symptoms and signs associated with cervical syringomyelia/syringobulbia include sensory loss that spreads from the baci of the head forwards on to the facedue to compression of the descendting tract of the trigerminal nerve. The hypoglossal nuclei are the first cranial nuclei to be affected and case bilateral wasting and weakness of the tongue. Nystagmus and abnormal gaze may also be present.

·         Pathology: Tubular cavitation of the spinal cord extending over many segments. The syringomyelic cavity is not covered by ependymal cells and is not connected with the central canal. Communicating synringomyelia is the type that communicates with the central canal where ependymal lining could be found. The cavity is usually found to be largest in the cervical region and commonly extends through the upper thoracic segments for a varying distance.

·         Pathogenesis: Congenital abnormality at the foramen magnum is common; 90% of patients with idiopathic syringomyelia have a Chiari anormaly. The lumbosacral enlargement is rarely involved and other mechanisms such as tumor formation may be involved.

 

Syndromes and SequencesHead

#Sequence: a pattern of cascade anomalies. In some instances, the constellation of anomalies may be explained by a single, localized aberration in organogenesis (malformation, disruption, or deformation) leading to secondary effects in other organs.

#Short-rib polydactyly syndrome: Chondrodysplasia and extremely bizarre convolutional pattern of deep clefts and disorganized cerebral mantle.  Histologically with excessive and precocious gyral formation and cortical dysplasia.  

#Sturge-Weber syndrome: Also known as encephalofacial angiomatosis or encephalotrigerminal angiomatosis. Characteristics include cngenital angiomatosis which involves the skin of the face and cervical area, mucous membranes, meninges, and choroid of the retina. Usually unilateral.The skin lesions ("nevus flammeus" or “port wine stain") usually involves the territories of the sensory branches of the5th nerve, especially the ophthalmic branch. The gross and microscopic pathology depends on the age of the individuals.  

#Syndromes: a constellation of congenital anomalies believed to be pathologically related, that, in contrast to a sequence, cannot be explained on the basis of a single, localized, initiating defect or insult.

NeuroLearn NeuroHelp Malformations General Syndromes For Comment: KarMing-Fung@ouhsc.edu