Three new patients with congenital unilateral facial nerve palsy due to chromosome 22q11 deletion.

We report three unrelated patients with congenital facial nerve palsy and chromosome 22q11 deletion, a condition hitherto poorly recognized. In the first case, facial palsy was associated with aortic coarctation, ductus arteriosus, and ostium secundum atrial septal defect. In the second case, facial palsy was associated with ostium secundum atrial septal defect, obstruction of the ureteropelvic junction, double ureteropelvic-calicial system, and distal metaphyseal widening of the forearm and leg bones. In both cases, facial palsy was the presenting feature. In the third case, an ostium secundum atrial septal defect was also present, but involvement of cranial nerves III, VI, and VIII, in addition to hypoplastic structures of cerebellar and cerebral peduncles, were the predominant features. There were no inherited deletions within chromosome band 22q11 and the de novo deletions detected in each case belonged to the paternally derived chromosome 22. Association of facial nerve palsy and congenital heart disease versus cardiofacial syndrome are different only on clinical grounds, so both conditions can be genetically identical and form part of the spectrum of defects associated with chromosome 22q11 deletions. We recommend investigation for chromosome 22q11 deletions in patients with complete nerve facial palsy.

Congenital ocular motor apraxia associated with myopathy, external hydrocephalus and NADH dehydrogenase deficiency.

Congenital ocular motor apraxia (COMA), first described by Cogan [Trans Am Acad Ophthalmol Otolaryngol 1952;56:853-862], is a rare disorder characterized by impairment of voluntary and optically induced horizontal eye movements and compensatory head thrust. The causes and pathogenesis of COMA are poorly understood. It frequently occurs in association with other neurologic abnormalities including non-progressive congenital disorders of the central nervous system (CNS), various systemic diseases and chromosomal alterations. Here, we report the case of a 6-month-old girl with psychomotor retardation, myopathy and clinical features of COMA, associated with external hydrocephalus and mitochondrial dysfunction (partial deficiency of the respiratory-chain enzyme NADH dehydrogenase). In view of this finding, we recommend that tests to characterize patients with COMA should include determination of blood levels of lactic and pyruvic acid.

Congenital myopathy with type II muscle fiber hypoplasia.

An unusual congenital neuromuscular disease characterized by atypically small type II muscle fibers is reported. The patients were a 9-year-old boy and a 3-year-old boy, both of whom showed motor retardation with proximal muscle wasting and hypotonia. Muscle biopsy revealed hypoplastic type II fibers and normal type I fibers. The observed hypoplasia seems to be a primary alteration.