Friday, 18 August 2017

Fukuyama Congenital Muscular Dystrophy MRI

Hypotelorism, convergent squint
Delayed milestones.

MRI study of brain shows:
Bilateral symmetric frontal lobar Poly micro gyria.
Diffuse cerebral cortical atrophy with mild dilatation of lateral ventricles.
Bilateral Cerebral Periventricular as well as sub cortical white matter show symmetric confluent T2 hyperintensity with white matter paucity suggestive of hypo myelination.
Marked atrophy of Brainstem particularly Pons, hypo plasia with a typical midline cleft.
Bilateral cerebellar hemispheres show multiple T2 hyperintense small cysts with micro folia attributed to an associated cerebellar dysplasia, Polymicrogyria with mild hypo plasia of cerebellar vermis. Postero fossa normal sized.
Bilateral Basal ganglia and thalami spared.

Imaging findings are typical of Fukuyama Congenital Muscular Dystrophy.

Reference : American Society of Neuroradiology : Fukuyama Congenital Muscular Dystrophy

Fukuyama Congenital Muscular Dystrophy

Heterogeneous group of inherited disorders characterized by myopathy and hypotonia at birth. 
Rarely occurs outside the Japanese population.
Autosomal recessive inheritance; gene locus identified on chromosome 9.
The disease onset typically occurs in early infancy. Initial symptoms may include a poor suck, weak cry, floppiness, symmetrical generalised muscle weakness and hypotonia. Facial myopathy may also be seen and increases with age. Developmental and speech delay occur in all individual with FCMD. Other symptoms include seizures, clinical features related to cardiomyopathy, and cardiac failure. Survival beyond 20 years is uncommon, and death usually occurs following respiratory complications.
The diagnosis of FCMD is usually established by clinical features, characteristic findings on neuroimaging, and serum CK concentration. Molecular genetic testing, when available, is usually performed to confirm the diagnosis.
Key Diagnostic Features are cerebral and cerebellar polymicrogyria with accompanying cysts, and mild ventricular dilatation. Uncommonly, agenesis of septum pellucidum can be seen.
Rx: Supportive therapy.