NYSTAGMUS AND BEYOND: A RARE OCULAR MOTILITY DISORDER

Authors

  • Rehan Naqaish Shifa college of medicine, Islamabad.
  • Naqaish Sadiq Rawal Medical College and Rawal Institute of health sciences, Islamabad.
  • Zauha Salam Women Medical College, Abbottabad.
  • Abdus Salam Arif Women Medical College, Abbottabad.
  • Ateeb Parvez Holy family hospital, rawalpindi.

Abstract

Joubert syndrome is a rare autosomal recessive disorder predominantly involving the cerebellar vermis and brain stem. It is characterized clinically by global developmental delay, abnormal ocular movements, hypotonia, ataxia, intellectual disability and neonatal breathing abnormalities. Due to its uncommon and unconventional presentation, its diagnosis is usually delayed.  Diagnosis of this atypical disease essentially relies upon the atypical finding of the “molar tooth” sign on Magnetic Resonance Imaging (MRI). We report a case of a 5-year-old boy who presented with abnormal eye movements, regression of milestones and developmental delay. MRI investigation revealed the distinctive molar tooth sign and bat wing shaped 4th ventricle. It requires high levels of clinical suspicion and holistic approach to such children who present with delayed milestones and abnormal eye movements, to reach at early detection and diagnosis of such rare pathologies.Keywords: autosomal recessive; molar tooth sign; Joubert syndrome

Author Biographies

Rehan Naqaish, Shifa college of medicine, Islamabad.

5th year medical student

Naqaish Sadiq, Rawal Medical College and Rawal Institute of health sciences, Islamabad.

Professor Ophthalmology

Zauha Salam, Women Medical College, Abbottabad.

House officer

Abdus Salam Arif, Women Medical College, Abbottabad.

Professor Ophthalmology

Ateeb Parvez, Holy family hospital, rawalpindi.

House officer

References

Joubert M, Eisenring JJ, Robb JP, Andermann F. Familial agenesis of the cerebellar vermis. A syndrome of episodic hyperpnea, abnormal eye movements, ataxia, and retardation. Neurology 1969;19(9):813–25.

Rehman Iu, Bett Z, Husen Y, Akhtar AS, Khan FA. The ‘molar tooth sign’ in Joubert syndrome. J Pak Med Assoc 2009;59(12):851–3.

Parisi MA, Doherty D, Chance PF, Glass IA. Joubert syndrome (and related disorders) (OMIM 213300). Eur J Hum Genet 2007;15(5):511–21.

Choh SA, Choh NA, Bhat SA, Jehangir M. MRI findings in Joubert syndrome. Indian J Pediatr 2009;76(2):231–5.

Abdallat W, H Qasem, R Shefa. Joubert syndrome: a case report. J Res Med Sci 2006;13(2):49–51.

Parisi M, Glass I. Joubert Syndrome. In: Adam MP, Ardinger HH, Pagon RA, Wallace SE, Bean LJ, Stephens K, et al., editors. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle; 1993-2017.

Karakas E, Cullu N, Karakas O, Calik M, Boyaci FN, Yildiz S, et al. Joubert syndrome: the clinical and radiological findings. J Pak Med Assoc 2014;64(1):91–4.

Bin Dahman HA, Bin Mubaireek AH, Alhaddad ZH. Joubert syndrome in a neonate: case report with literature review. Sudan J Paediatr 2016;16(1):53–7.

Published

2018-09-01

Most read articles by the same author(s)