[Neuhauser syndrome: the facial dysmorphic phenotype]. / Síndrome de Neuhauser: su fenotipo facial dismórfico.

Neuhauser syndrome is an extremely rare genetic disease, most cases are sporadic by spontaneous mutation, but there are cases of autosomal recessive genetic transmission; the specific cause is unknown and has no diagnostic test. The disease is clinically characterized by primary megalocornea, congenital hypotonia, mental retardation of varying degree and delayed psychomotor development. The diagnosis in childhood is usually performed by oculo-neurological criteria. The patients have a peculiar face by specific craniofacial anomalies: round face, wide prominent forehead, hypertelorism, broad nasal bridge, bulbous nose, wide philtrum nasolabial wide, thin elongated mouth, big and protuded ear "cup", jaw undersized (micrognathia) and abnormal posterior positioning of the mandible (retrognathia).The use of facial dysmorphism helps to delineate the phenotype and achieve the punctuation required for the diagnosis, allowing early management and prevention of complications.

El síndrome de Neuhauser es una enfermedad genética extremadamente rara. La mayoría de los casos son esporádicos y se deben a una mutación espóntanea, pero también existen casos de transmisión genética autosómica recesiva; se desconoce la causa específica y no tiene actualmente ninguna prueba diagnóstica. La enfermedad se caracteriza clínicamente por megalocórnea primaria, hipotonía congénita, retardo mental de grado variable y retraso en desarrollo psicomotor. El diagnóstico se realiza generalmente en la infancia con base en los criterios clínicos óculo-neurológicos. Los pacientes tienen un rostro peculiar por anomalías craneofaciales especiales: rostro redondo, frente amplia prominente, hipertelorismo, puente nasal amplio, nariz bulbosa, filtrum nasolabial amplio, boca delgada alargada, oreja grande en "taza" y protuyente; mentón en micrognatia y retrognatia. Utilizar este dismorfismo facial delinea el fenotipo del síndrome y ayuda a lograr la puntuación requerida para el diagnóstico de certeza, lo cual permite un manejo temprano para prevenir complicaciones.

Piebaldismo, albinismo parcial en cabello y piel / Piebaldism, partial albinism in the hair and the skin

El piebaldismo es una enfermedad congénita, autosómica dominante que afecta el cabello y la piel, y se manifiesta por un mechón de pelo hipocrómico (poliosis), generalmente localizado en zona frontal; además, en la piel hay zonas de despigmentación e hipomelanosis. La causa es la ausencia de melanocitos en las áreas afectadas por mutación en el protooncogén KIT (receptor tirosinasa kinasa) con tirosinasa mutada en los melanoblastos. Se reporta el caso de una niña de 4 meses de edad, con un mechón hipocrómico frontal y grandes manchas acrómicas en la cara, el tronco y las extremidades, en una distribución casi simétrica, presentes desde el nacimiento, y muy características de esta enfermedad. El diagnóstico diferencial se realizó con síndrome Waardenburg, albinismo oculocutáneo con afección ocular y el síndrome Griscelli-Prunieras, que es un albinismo que se acompaña de inmunodeficiencia

Piebaldism is a congenital dominant autosomal disease affecting the hair and the skin. It appears as a hypochromic hair highlight (poliosis) generally located in the front in addition to depigmented skin areas and hypomelanosis. The cause is lack of melanocytes in the affected areas due to protoncogen KIT (kinase tyrosinase receptor) mutation, being tyrosinase mutated in melanoblasts. This is the case of a 4 months-old girl who presented a frontal hypochromic highlight and large inborn achromic spots in her face, her thorax and extremities, which are almost symmetrically distributed and very characteristic in this disease. The differential diagnosis was made by using Waardenburg syndrome, oculocutaneous albinism with ocular effect and Griscelli-Prunieras syndrome that is an immunodeficiency-accompanied albinism

Pitt-Hopkins syndrome: Mental retardation, psychomotor and developmental delays with facial dysmorphism.

The Pitt-Hopkins syndrome is a very rare and severe genetic disease characterized by mental retardation, psychomotor and developmental delays with facial dysmorphism. It was first described in 1978 in patients with mental retardation and crisis of intermittent hyperventilation. The genetic cause is haploinsufficiency of the TCF4 (transcription factor 4) gene that affects the neurodevelopment in both sexes; the majority of patients have spontaneous molecular defects by point mutations or deletions in chromosome 18 at the region 18q21. The syndrome is characterized by neurological abnormalities that affect the motor coordination and balance, in patients with mental and developmental delays. The phenotype includes a peculiar face by specific craniofacial anomalies: prominent square forehead, deep-set eyes with ocular hypertelorism; prominent large nose beaked and broad flat nasal bridge; mouth wide and large, thick fleshy lips, tented bow-shaped upper lip and everted lower lip; cup-shaped ears with dysplastic broad overfolded helix. We review the literature and the photographs of 44 published patients from 2007 to 2012, to resume the principal features of craniofacial anomalies, attempting to delineate the syndrome phenotype and score the specific dysmorphism than help to achieve the early clinical diagnosis.

[Holt-Oram syndrome associated with facial anomalies. A case report]. / Síndrome Holt-Oram asociado con anomalías faciales. Informe de un caso.

Cardiomyelic syndromes have skeletal malformations of the upper limb and congenital heart disease, and are related to mutations in transcription factors with T-Box domains. Holt-Oram syndrome is characterized by upper-extremity malformations involving the radial, thenar, or carpal bones and congenital heart defects. It is inherited in an autosomal dominant manner, a mutation in TBX5 gene located on chromosome 12 (12q24.1) is associated with variable phenotypes. This is an unusual case of a patient with Holt-Oram syndrome associated with facial anomalies: hemifacial microsomia on the right side, forehead prominent and tall, hypertelorism, depressed nasal bridge, low set ears and micrognathia. The presentation broadens the clinical spectrum with delineation of facial dysmorphic features.

Síndrome Weaver: crecimiento postnatal acelera edad ósea avanzada / Weaver syndrome: postnatal overgrowth with increased bone maturation

El síndrome Weaver es una rara enfermedad de etiología desconocida, caracterizada por un crecimiento postnatal acelerado, con facies distintiva. Reporte de un lactante con crecimiento incrementado y edad ósea acelerada, con retraso psicomotor moderado, hipertonía con limitación en movimientos de extremidades y cara peculiar característica. Caso clínico de carácter esporádico sin transmisión genética; primer caso reportado en Latinoamérica y número 28° mundial.

Weaver syndrome is an extremely rare disease with unknown etiology, characterized by an accelerated postnatal growth, and special face. A case of male infant with overgrowth, increased bone maturation, moderate psychomotor retardation, hypertonic with limited movements of the limbs, and craniofacial anomalies. This is a patient with sporadic transmission, without genetic inheritance. First case reported in Latin America and number 28th world-wide.

Síndrome de Neuhauser: megalocórnea, retardo mental e hipotonía / Neuhauser syndrome: megalocornea, mental retardation and hypotonia

Introducción. El síndrome de Neuhauser es una rara enfermedad autosómica recesiva caracterizada por megalocórnea, retardo mental e hipotonía. Actualmente con delineación sindromática clínica, se ignora su mecanismo genético y carece de prueba diagnóstica específica. Caso clínico. Lactante de 18 meses con cara peculiar, hipotonía, síndrome convulsivo, afección en ambos ojos con glaucoma congénito y megalocórnea; presentando retardo mental y del desarrollo importantes. La evaluación dismorfológica permitió lograr el diagnóstico clínico. Conclusión. Sólo existen 36 casos reportados en la literatura, este reporte sería el primero publicado en Latinoamérica y ayudaría al enfoque clínico de pacientes con megalocórnea, retardo mental e hipotonía.

Introduction. Neuhauser syndrome is an extremely rare genetic recessive disorder characterized by megalocornea, mental and motor retardation and hypotonia. Nowadays, this syndrome has been clinically delineated but its genetic mechanism remains unknown, and there is no specific diagnostic test. Case report. An 18-month old female infant with characteristic facial dysmorphic traits; congenital glaucoma, megalocornea in both eyes and hypotonia; seizures, mental and motor retardation. Dysmorphologic evaluation allowed the clinical diagnosis. Conclusion. There are only 36 cases reported in the literature. This case is the first published in Latin America, and may be helpful in the clinical assessment of patients with megalocornea, mental and motor retardation and hypotonia.