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    Go to the top of the page   ID: 20040114091117 Original case in english  More links about this topic on Pubmed (PubMed Reader)
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    | The Authors | Discussion | Write a Comment to this Case |
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    Neurofibromatosis Type I
    Ina Sorge. Neurofibromatosis Type I. PedRad [serial online] vol 4, no. 1.
    URL: www.PedRad.info/?search=20040114091117


     
     Pediatric Radiology CasesImages to this case: There are MRI-images available for this case. [ MRI ] View all modalities [ All ]   
     Pediatric Radiology CasesAuthor/s:

    Ina Sorge (Universitätsklinik Leipzig)  

     
     Pediatric Radiology CasesEmail Address:

    Viewable for logged on visitors (Log on)  

     
     Pediatric Radiology CasesAge:

    11 Years  

     
     Pediatric Radiology CasesGender:

    Male  

     
     Pediatric Radiology CasesRegion-Organ:

    Head-Brain and brain nerves  

     
     Pediatric Radiology CasesMost likely etiology:

    neoplastic  

     
     Pediatric Radiology CasesHistory:

    11 year-old boy, slight developmental redardation, otherwise neurologically unnoticeable. Multiple Cafe-au-Lait spots.  

     
     Pediatric Radiology CasesPathomorphology or Pathophysiology of this disease :

    Neurofibromatosis von Recklinghausen has a frequency of 1 of 2000-3000 births. The symptoms develop often during childhood, but the full scope of the illness is often first seen after puberty. Thereby, the clinical picture can be very variable.

    Here, only the cerebral findings are stated:
    About in 60% of the patients in childhood and adolescence show large signal intense areas on T2-weighted sequences (otherwise known as undetermined bright objects, UBO). These often are mistaken for astrocytomas. Their true nature is not known. The decrease in frequency with increasing age suggests a brain development disorder or retardation. The changes in the basal ganglia are found relatively often. They disappear oftentimes spontaneously.
    A large number of patients show true (also histologically proven) hamartomas in various CNS-regions in MRI. If these attribute to the patient's generally lower intelligence is not clear. About a third of the patients have an optic glioma, which has also been described by various authors.  

     
     Pediatric Radiology CasesRadiological findings:


    MRI 1 <- view MRI 1

    MRI 1: T2-Flair-Sequence: Hyperintense signal changes on both sides in the area of the basal ganglia - right more than left.



    MRI 2 <- view MRI 2

    MRI 2: T2-Flair-Sequence: Hyperintense white matter changes on the right temporal side.



    MRI 3 <- view MRI 3

    MRI 3: T2-TSE-Sequence: Hyperintense signal changes analog to the Flair-sequence



    MRI 4 <- view MRI 4

    MRI 4: T2-TSE weighted of the same region as in MRI 2.



    MRI 5 <- view MRI 5

    MRI 5: T1-SE-sequence after contrast administration: Enhancement of a lesion on the right temporally.



    MRI 6 <- view MRI 6

    MRI 6: T1-SE-Sequence after contrast administration: Obvious thickened and contrast enhancing right optic nerve (red arrow) in comparison to the unremarkable opposite side.

     

     
     Pediatric Radiology CasesDiagnosis confirmation:

    Genetics  

     
     Pediatric Radiology CasesWhich DD would be also possible with the radiological findings:

    Astrocytoma  

     
     Pediatric Radiology CasesCourse / Prognosis / Frequency / Other :

    Cafe-au-Lait spots are characteristic of this disease. Somewhat later, neurofibromas of the skin and nerve endings are seen, which may lead to paralysis and muscle atrophies.
    Multiple optic gliomas can lead to visual field defects and blindness in one eye or lead to visual defects of both eyes, if they extend behind the chiasm. Optic gliomas behind the chiasm can shift the 3rd ventricle and cause increased intracranial pressure.
    15% of patients have epilepsy, 10% show mental retardation.
    Treatment: Neurofibromas or other tumors related to neurofibromatosis, should only be removed if they cause functional deficits and/or severe cosmetic problems. A surgical procedure with a non-radical removal can actually increase the growth rate. A malignant transformation is rare.
    Generally, one must assume that 50% of the children of a patient with neurofibromatosis are also affected.  

     
     Pediatric Radiology CasesComments of the author about the case:

    N/A  

     
     Pediatric Radiology CasesFirst description / History:

    The first observations of a neurofibromatosis date back to the 13th century. However, only one of Virchow's students, Friedrich Daniel von Recklinghausen recognized the relationship between "multiple fibromas" and "multiple neuromas" of the skin and announced it at the 25th anniversary of the Berlin's Institute for Pathology in 1882.  

     
     Pediatric Radiology CasesLiterature:

    1. Medline: Medline
    Gutjahr, P.
    Neurofibromatose von Recklinghausen Typ 1: eine interdisziplinäre Herausforderung www.medizinimdialog.com

    Feldmann R, Weglage J (2003)
    Signalanhebungen in der T2-gewichteten Schädel-MRT bei Neurofibromatose-Patienten im Langzeitverlauf. In: Bernert G (Hrsg.) Aktuelle Neuropädiatrie 2003. Novartis, Nürnberg: 70-73

    3. Medline: Medline
    DeBella K., Poskitt K., Szudek J. et al.:
    Use of "unidentified bright objects" on MRI for diagnosis of neurofibromatosis in children. Neurology, 2000; 54: 1646 - 1651  

     
     Pediatric Radiology CasesKeywords:

    Neurofibromatosis, Type I, Hamartoma, Cafe-au-Lait spots, optic glioma, neurofibroma, child, childhood, pediatric radiology  

     
     Pediatric Radiology Cases Cite this article:

    Ina Sorge. Neurofibromatosis Type I. PedRad [serial online] vol 4, no. 1.
    URL: www.PedRad.info/?search=20040114091117  

     
     Pediatric Radiology Cases Read similar articles: with corresponding keywords
    in the same field: Head-Brain and brain nerves
    or in the region: Head
    or in the tissue/organ: Brain and brain nerves
    or with the etiology: neoplastic
     
     Pediatric Radiology CasesImages to this case: There are MRI-images available for this case. [ MRI ] View all modalities [ All ]   
     
    Neurofibromatosis Type I
    Ina Sorge. Neurofibromatosis Type I. PedRad [serial online] vol 4, no. 1.
    URL: www.PedRad.info/?search=20040114091117


     

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    Neurofibromatosis Type I
    Other cases by these authors:

    Search Ina Sorge in Medline Ina Sorge (8)   

    Neurofibromatosis Type I  
     
    Neurofibromatosis Type I
    Ina Sorge. Neurofibromatosis Type I. PedRad [serial online] vol 4, no. 1.
    URL: www.PedRad.info/?search=20040114091117


     

    Which diagnosis have other collegues guessed?


    • Astrocytoma
      Votes: 0 (0 %)


    • ADEM
      Votes: 0 (0 %)


    • Neurofibromatosis Type I
      Votes: 19 (100 %)


    • Multifocal encephalitis
      Votes: 0 (0 %)



        Total answers: 19

     
    Neurofibromatosis Type I
    Ina Sorge. Neurofibromatosis Type I. PedRad [serial online] vol 4, no. 1.
    URL: www.PedRad.info/?search=20040114091117


     

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    Neurofibromatosis Type I
    Ina Sorge. Neurofibromatosis Type I. PedRad [serial online] vol 4, no. 1.
    URL: www.PedRad.info/?search=20040114091117


     




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