Neuropediatrics 2004; 35(4): 234-238
DOI: 10.1055/s-2004-820894
Short Communication

Georg Thieme Verlag KG Stuttgart · New York

Severe Abnormalities of the Pons in Two Infants with Goldenhar Syndrome

M. Pane1 , G. Baranello1 , D. Battaglia1 , V. Donvito1 , F. Carnevale3 , M. C. Stefanini1 , F. Guzzetta1 , E. Mercuri1 , E. Bertini2
  • 1Department of Child Neurology and Psychiatry, Catholic University, Rome, Italy
  • 2Unit of Molecular Medicine, Bambino Gesù Hospital, Rome, Italy
  • 3Divisione XI, Malattie Metaboliche, Ospedale Pediatrico Regionale Giovanni XXIII, Bari, Italy
Further Information

Publication History

Received: November 24, 2003

Accepted after Revision: March 11, 2004

Publication Date:
10 August 2004 (online)

Abstract

We describe 2 cases of Goldenhar syndrome with severe abnormalities of the pons. The first case is a 10-month-old Caucasian female infant. At birth the girl showed polydactyly, labiopalatoschisis, right ear agenesis, left eye coloboma and vertebral anomalies. She also had marked hypotonia, severely reduced movements and respiratory and feeding abnormalities. She required gastrostomy at 5 months and tracheostomy at 7 months. Brain MRI scans showed moderate cerebellar hypoplasia and severe abnormalities of the pons with a congenital cleft. The child died at age 12 months. Case 2 is a Caucasian boy. Clinical signs and presentation were similar to case 1. The child also had severely reduced lacrimation, sweating, with thermoregulation abnormalities. He also underwent gastrostomy at 18 months. The child is now 3 years old and is able to sit only with support. Brain MRI was similar to case 1. The association of Goldenhar syndrome and pons abnormalities in 2 subjects suggests that this is more than a mere coincidence. Further studies and characterization of the genes involved in Goldenhar syndrome are needed to establish an adequate genotype-phenotype correlation.

References

  • 1 Barth P G. Pontocerebellar hypoplasia - how many types?.  Eur J Paediatr Neurol. 2000;  4 161-162
  • 2 Cortez S C, Kinney H C. Brainstem tegmental necrosis and olivary hypoplasia: a lethal entity associated with congenital apnea.  J Neuropathol Exp Neurol. 1996;  55 841-849
  • 3 Friedman S, Saraclar M. The high frequency of congenital heart disease in oculo-auricolo-vertebral dysplasia (Goldenhar's syndrome).  J Pediatr. 1974;  85 873-874
  • 4 Gardner R J, Coleman L T, Mitchell L A, Smith L J, Harvey A S, Scheffer I E, Storey E, Nowotny M J, Sloane R A, Lubitz L. Near-total absence of the cerebellum.  Neuropediatrics. 2001;  32 62-68
  • 5 Gibson J N, Sillence D O, Taylor T K. Abnormalities of the spine in Goldenhar's syndrome.  J Pediatr Orthop. 1996;  16 344-349
  • 6 Gilthorpe J D, Papantoniou E, Chédotal A, Lumsden A, Wingate R JT. The migration of cerebellar rhombic lip derivatives.  Development. 2002;  129 4719-4728
  • 7 Golder N W. Cranial defects in the Goldenhar syndrome.  AJMG. 1983;  14 435-443
  • 8 Guilleminault C, McQuitty J, Ariagno R, Challamel M J, Korobkin R, McLeod R E. Congenital central alveolar hypoventilation syndrome in six infants.  Pediatrics. 1982;  70 684-694
  • 9 Guilleminault C, Robinson A. Central sleep apnea.  Neurol Clin. 1996;  14 611-628
  • 10 Guynet P G, Koshiya N, Huangfu D, Verberne A JM, Riley T N. Central respiratory control in A5 and A6 pontine noradrenergic neurons.  Am J Physiol. 1993;  264 1035-1044
  • 11 Hanly P J. Mechanisms and management of central sleep apnea. Review.  Lung. 1992;  170 1-17
  • 12 Hess O M, Steurer J, Goebel N H, Kuhlmann U, Krayenbuhl H P. Goldenhar syndrome.  Schweiz Med Wochenschr. 1979;  109 19-23
  • 13 Lumsden A, Krumlauf R. Patterning the vertebrate neuraxis.  Science. 1996;  274 1109-1115
  • 14 Maeoka Y, Yamamoto T, Ohtani K, Takeshita K. Pontine hypoplasia in a child with sensorineural deafness.  Brain Dev. 1997;  19 436-439
  • 15 Mamourian A C, Miller G. Neonatal pontomedullary disconnection with aplasia or destruction of the lower brain stem: A case of pontoneocerebellar hypoplasia?.  Am J Neuroradiol. 1994;  15 1483-1485
  • 16 Martin T J, Sanders M H. Chronic alveolar hypoventilation: a review for the clinician.  Sleep. 1995;  18 617-634
  • 17 Özdemir Ö, Arda K, Turhan H, Tosun Ö. Goldenhar's syndrome.  Asian Cardiovasc Thoracic Annals. 2002;  10 267-269
  • 18 Pasqualetti M, Rijli F M. The plastic face.  Nature. 2002;  416 493-494
  • 19 Sarnat H B, Benjamin D R, Siebert J R, Kletter G B, Cheyette S R. Agenesis of the mesencephalon and metencephalon with cerebellar hypoplasia: putative mutation in the EN2 gene - report of 2 cases in early infancy.  Pediatr Dev Pathol. 2002;  5 54-68
  • 20 Sener R N. Congenital cleft in the pontomedullary junction.  J Comp Ass Tom. 2003;  27 544-546
  • 21 Smith D W. Facio-auricular spectrum. Jones K Smith's Recognizable Patterns of Human Malformation. 4th ed. Philadelphia; Saunders 1988: 584-587
  • 22 Smith J C, Ellenberger H H, Ballanyi K. et al . Pre-Botzinger complex: a brainstem region that may generate respiratory rhythm in mammals.  Science. 1991;  254 726-729
  • 23 Towfighi J, Marks K, Palmer E, Vannucci R. Möbius syndrome. Neuropathologic observations.  Acta Neuropathol (Berl). 1979;  48 11-17

Dr. Enrico Bertini

Unit of Molecular Medicine
Ospedale Bambino Gesù

Piazza S. Onofrio 4

00165 Rome

Italy

Email: ebertini@tin.it

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