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Zaki, M. S., A. Abdel-Aleem, G. Abdel-Salam, S. E. Marsh, J. L. Silhavy, A. J. Barkovich, M. E. Ross, S. N. Saleem, W. B. Dobyns, and J. G. Gleeson, "The molar tooth sign A new Joubert syndrome and related cerebellar disorders classification system tested in Egyptian families", Neurology, vol. 70, no. 7: Lippincott Williams & Wilkins, pp. 556–565, 2008. Abstract

Joubert syndrome and related cerebellar disorders (JSRD) are a group of recessive congenital ataxia conditions usually showing neonatal hypotonia, dysregulated breathing rhythms, oculomotor apraxia, and mental retardation. The pathognomonic finding in JSRD is the unique molar tooth sign (MTS) on brain imaging. There is a tremendously broad spectrum of signs and symptoms mainly including kidney, retina, and liver disease, along with polydactyly and facial dysmorphisms. Here we propose a new diagnostic classification within JSRD that includes four major subtypes. To test this classification, we performed a systematic recruitment and genetic evaluation from a single referral center in Egypt. Thirteen families were identified, four showed evidence of linkage to one of the four known genetic loci, three showed novel AHI1 mutations, and nine were excluded from known loci. Each family could be classified into one of the four subtypes. This classification may thus be useful in the evaluation of patients with JSRD.

GLOSSARY: BUN = blood urinary nitrogen; COACH = cerebellar vermis hypo/aplasia-oligophrenia-ataxia-ocular coloboma-hepatic fibrosis; CORS = cerebello-oculo-renal syndrome; CVH = cerebellar vermis hypoplasia; DAS = Dekaban-Arima syndrome; DWM = Dandy-Walker malformation; JSRD = Joubert syndrome and related cerebellar disorders; LCA = Leber congenital amaurosis; lod = logarithm of odds score; MKS = Meckel-Gruber syndrome; MTS = molar tooth sign; NPH = nephronophthisis; NRC = National Research Center; OFD-VI = oro-facio-digital syndrome type VI; PCH = pontocerebellar hypoplasia; RHO = rhombencephalosynapsis; SLS = Senior-Loken syndrome.

Zaki, M. S., S. N. Saleem, W. B. Dobyns, A. J. Barkovich, H. Bartsch, A. M. Dale, M. Ashtari, N. Akizu, J. G. Gleeson, and A. M. Grijalvo-Perez, "Diencephalic–mesencephalic junction dysplasia: a novel recessive brain malformation", Brain, vol. 135, no. 8: Oxford University Press, pp. 2416–2427, 2012. Abstract

We describe six cases from three unrelated consanguineous Egyptian families with a novel characteristic brain malformation at the level of the diencephalic–mesencephalic junction. Brain magnetic resonance imaging demonstrated a dysplasia of the diencephalic–mesencephalic junction with a characteristic ‘butterfly’-like contour of the midbrain on axial sections. Additional imaging features included variable degrees of supratentorial ventricular dilatation and hypoplasia to complete agenesis of the corpus callosum. Diffusion tensor imaging showed diffuse hypomyelination and lack of an identifiable corticospinal tract. All patients displayed severe cognitive impairment, post-natal progressive microcephaly, axial hypotonia, spastic quadriparesis and seizures. Autistic features were noted in older cases. Talipes equinovarus, non-obstructive cardiomyopathy and persistent hyperplastic primary vitreous were additional findings in two families. One of the patients required shunting for hydrocephalus; however, this yielded no change in ventricular size suggestive of dysplasia rather than obstruction. We propose the term ‘diencephalic–mesencephalic junction dysplasia’ to characterize this autosomal recessive malformation.

Zaki, M. S., G. M. H. Salam, S. N. Saleem, W. B. Dobyns, M. Y. Issa, S. Sattar, and J. G. Gleeson, "New recessive syndrome of microcephaly, cerebellar hypoplasia, and congenital heart conduction defect", American Journal of Medical Genetics Part A: Wiley Online Library, 2011. Abstract
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