Parry-Romberg syndrome and Rasmussen encephalitis: possible association. Clinical and neuroimaging features.
Parry-Romberg syndrome (PRS) is a sporadic disease of unknown etiology with typical onset in childhood or in young adults. It is characterized by a slow and progressive atrophy affecting one side of the face, the skin, the subcutaneous tissue, the muscles, the cartilages, and the underlying bony structures. The neurological symptoms usually include focal epilepsy, migraine, and unilateral brain lesions on the same side as the atrophy. A common neuroimaging finding of the syndrome is white matter high signal intensity on brain magnetic resonance (MR) imaging. Rasmussen encephalitis (RE) is a rare and chronic inflammatory disease of the brain that begins in the first decade of life and more rarely in adolescents and adults. It usually involves one hemisphere with focal cortical inflammation. Neurologic symptoms are intractable seizures and progressive hemiplegia. Both PRS and RE are often associated with other inflammatory or autoimmune disorders and only 1 case of both syndromes has been reported in literature. We report the clinical and neuroradiological findings in a 6-year-old boy, presenting with focal hemifacial and arm motor seizures and progressive facial hemiatrophy. Serial MR imaging studies revealed progressive brain hemispheric signal alterations and atrophy. This would thus suggest acoexistence of PRS and RE.
Longo
Daniela
D
Department of Radiology, Division of Neurology, Bambino Gesù Children's Hospital IRCCS, Rome, Italy. daniela.longo@opbg.net
Paonessa
Amalia
A
Specchio
Nicola
N
Delfino
Luciana Nogueira
LN
Claps
Dianela
D
Fusco
Lucia
L
Randisi
Francesco
F
Genovese
Elisabetta
E
Vigevano
Federico
F
Fariello
Giuseppe
G
D016880:Anisotropy; D002648:Child; D003937:Diagnosis, Differential; D004569:Electroencephalography; D004660:Encephalitis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D005150:Facial Hemiatrophy / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
D005938:Glucocorticoids; D016756:Immunoglobulins, Intravenous; D008775:Methylprednisolone