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胼胝体孤立性发育不全与出生后正常智力发育:一例报告及文献综述

Isolated agenesis of the corpus callosum and normal general intelligence development during postnatal life: a case report and review of the literature.

作者信息

Guadarrama-Ortiz Parménides, Choreño-Parra José Alberto, de la Rosa-Arredondo Tania

机构信息

Department of Neurosurgery, Centro Especializado en Neurocirugía y Neurociencias México (CENNM), Tlaxcala & Manzanillo, Roma Sur, 06760, Mexico City, Mexico.

出版信息

J Med Case Rep. 2020 Feb 12;14(1):28. doi: 10.1186/s13256-020-2359-2.

Abstract

BACKGROUND

Agenesis of the corpus callosum can occur isolated or as part of a complex congenital syndrome. Patients with isolated agenesis of the corpus callosum may present with severe intellectual disability, although a proportion of affected individuals develop normal intelligence. However, even in patients with no apparent deficits, subtle neuropsychological alterations may occur as the cognitive demand increases with age. Hence, patients with this deffect require a strict follow-up during their postnatal life. Thus, physicians require a better knowledge of the cognitive features of agenesis of the corpus callosum to improve their approach to this cerebral malformation. Here, we report an illustrative case of a school-age child with isolated agenesis of the corpus callosum and normal intelligence. We also provide a literature review about the postnatal screening of neurocognitive deficits in patients with agenesis of the corpus callosum.

CASE PRESENTATION

An 8-year-old Hispanic boy with total agenesis of the corpus callosum attended for medical follow-up. The defect was identified during the neonatal period by cranial ultrasonography and brain computed tomography scan. However, he did not present any craniofacial or non-cerebral malformation suggestive of a congenital syndrome. Furthermore, he showed no neuropsychiatric disorder or intellectual disability during his early childhood. At the age of 4, he was subjected to a control brain magnetic resonance imaging that showed total agenesis of the corpus callosum and colpocephaly. At his arrival, a neurological examination was normal with no signs of intracranial hypertension. His intelligence quotient was unaltered and he scored normal in the Mini-Mental State Examination test. The literature reviewed here suggested that patients with agenesis of the corpus callosum require a strict neurocognitive follow-up during postnatal life, as they may present neuropsychological deficits during adolescence, when development of the corpus callosum is completed and there is maximum reliance on this structure. Thus, our patient was scheduled for future annual neurocognitive testing.

CONCLUSIONS

Isolated agenesis of the corpus callosum is not innocuous, and patients with this defect require a strict neurocognitive follow-up. We provide an informative reference tool useful for the postnatal neuropsychological screening of patients with isolated agenesis of the corpus callosum.

摘要

背景

胼胝体发育不全可单独出现,也可作为复杂先天性综合征的一部分出现。孤立性胼胝体发育不全的患者可能存在严重智力残疾,尽管一部分受影响个体智力发育正常。然而,即使在没有明显缺陷的患者中,随着年龄增长认知需求增加,也可能出现细微的神经心理改变。因此,患有这种缺陷的患者在出生后需要严格随访。因此,医生需要更好地了解胼胝体发育不全的认知特征,以改进对这种脑畸形的治疗方法。在此,我们报告一例学龄期孤立性胼胝体发育不全且智力正常儿童的典型病例。我们还提供了关于胼胝体发育不全患者神经认知缺陷产后筛查的文献综述。

病例介绍

一名患有完全性胼胝体发育不全的8岁西班牙裔男孩前来接受医学随访。该缺陷在新生儿期通过头颅超声和脑部计算机断层扫描被发现。然而,他没有出现任何提示先天性综合征的颅面或非脑部畸形。此外,他在幼儿期没有表现出任何神经精神障碍或智力残疾。4岁时,他接受了一次对照脑部磁共振成像检查,结果显示完全性胼胝体发育不全和脑室扩大。他前来就诊时,神经系统检查正常,没有颅内高压的迹象。他的智商未改变,在简易精神状态检查表测试中得分正常。此处回顾的文献表明,胼胝体发育不全的患者在出生后需要严格的神经认知随访,因为他们在青春期可能出现神经心理缺陷,此时胼胝体发育完成,对该结构的依赖达到最大程度。因此,我们的患者被安排在未来每年进行神经认知测试。

结论

孤立性胼胝体发育不全并非无害,患有这种缺陷的患者需要严格的神经认知随访。我们提供了一个有用的参考工具,有助于对孤立性胼胝体发育不全患者进行产后神经心理筛查。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a912/7014647/43d835abeb93/13256_2020_2359_Fig1_HTML.jpg

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