Authors: Flaherty, Alice W.; Rost, Natalia S.
Title: Massachusetts General Hospital Handbook of Neurology, The, 2nd Edition
Copyright 2007 Lippincott Williams & Wilkins
> Table of Contents > Child Neurology > Neurocutaneous Syndromes
Neurocutaneous Syndromes
Table 41. Distinguishing NF1 and NF2. | ||||||||||||||||||||||||||||||||||||
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A. Neurofibromatosis Type I
(von Recklinghausen's dz):
H&P: Family history of NF1; caf -au-lait spots, neurofibromas, axillary or inguinal freckling, optic glioma, iris (Lisch) nodules, typical osseous lesion (thoracic scoliosis, anterolateral tibia bowing, pseudoarthrosis, sphenoid wing dysplasia).
Tests: MRIs for symptoms; screening MRIs less useful.
Rx: Surgery for symptomatic lesions.
B. Neurofibromatosis Type II
H&P: Acoustic schwannomas (usually bilateral, and before age 30), caf -au-lait spots, posterior lens opacities, family history of NF2.
P.147
Tests: Screening MRI can detect acoustic tumors early.
Rx: Resect acoustic schwannomas before they cause deafness.
C. Tuberous sclerosis
Autosomal dominant gene on either chromosome 9 or 11, very variable expression. Many spontaneous mutations.
H&P: Characteristic triad of seizures, retardation, and facial adenofibromas (misnamed adenoma sebaceum). See also hypomelanotic macules, shagreen patches (connective tissue hamartomas). Family history. Heart, pulmonary, and kidney tumors are often silent.
Tests: MRI of head shows focal cortical dysplasias (tubers) and subependymal nodules. Renal, cardiac, and pulmonary screening.
Rx: Steroids or vigabatrin for infantile spasms, ACDs for seizures; resect intraventricular tumors causing hydrocephalus.
D. Sturge-Weber syndrome (encephalotrigeminal angiomatosis)
Chromosome 3 defect, causes vascular port-wine nevus on face (usually in V1 distribution), contralateral hemiparesis and field cut, ipsilateral glaucoma, seizures, retardation.
E. Incontinentia pigmenti (Bloch-Sulzberger syndrome) and hypomelanosis of Ito
Erythema/bolus lesions only in girl (X-linked dominant) and hypopigmented lesions, respectively. Both in dermatome distribution and associated with seizures, microcephaly, and mental retardation.
F. Von Hippel-Lindau dz
Dominant gene defect on chromosome 3. Not really a neurocutaneous disorder, but we had to stick it somewhere.
H&P: Sx of hemangioblastomas, usually in posterior fossa, in second to fourth decade. Also see retinal hemangiomas, renal cell carcinomas, pheochromocytomas.
Rx: Early surgery for cerebral or spinal cord tumors, laser or cryosurgery for retinal tumors, frequent screening exams.