Sturge-Weber syndrome or encephalotrigeminal angiomatosis is a phakomatosis. It is characterised by facial port wine stains and pial angiomas.
Demographics and clinical presentation
The diagnosis is usually obvious on account of a congenital facial cutaneous haemangioma (also known as port wine stain or facial naevus flammeus). This feature is almost always present and usually involves the ophthalmic division (V1) of the trigeminal nerve 4. Only rarely (~ 5%) is intracranial involvement present without associated cutaneous naevus1-2. In the majority of cases (72%) the naevus is unilateral and ipsilateral to the intracranial abnormality.
The most common clinical manifestation is with childhood seizures, present in 71-89% of cases 2 that are often refractory to medical therapy 1. These usually begin in the first few years of life and are often associated with developmental delay and hemispheric symptoms including hemiplegia / hemiparesis and / or hemianopsia.
Approximately a third of patients have choroidal or scleral angiomatous involvement, which may be complicated with retinal detachment, buphthalmos or glaucoma 1.
It is sporadic with no definite identifiable hereditary component 5.
The leptomeningeal haemangioma results in a vascular steal affecting the subjacent cortex and white matter producing localised ischaemia. The majority of cases (~ 80%) have unihemispherical involvement.
It is a type of craniofacial arteriovenous metameric syndrome (CAMS)
Skull x-rays were historically useful and capable of identifying the gyriform calcification of the subcortical white matter although they no longer play a significant role in the diagnosis or management of this condition. The finding usually becomes evident between 2 and 7 years of age 2.
- detects subcortical calcification at an earlier age than plain film and can also demonstrate associated parenchymal volume loss
- appearance liken to 'tram-track' in nature
- calvarial and regional sinus enlargement may be evident
- ipsilateral choroid plexus may be enlarged
- in severe cases a Dyke-Davidoff-Masson appearence may be seen
- T1 - signal of affected region largely normal, with anatomic volume loss evident at older age
T1 C+ (Gd)
- prominent leptomeningeal enhancement in affected area
- much later in life the angioma may 'burn out' losing enhancement 1
- enlarged ipsilateral choroid plexus
T2 - low signal in white matter subjacent to angioma representing
- postulated accelerated myelination in neonate 1
- calcification later in life
- abnormal deep venous drainage seen as flow voids
- GE / SWI / EPI - sensitive to calcification, seen as regions of signal drop out
- MR spectroscopy - decreased NAA 7
DSA - angiography
In most cases (82%) angiography is abnormal and demonstrates absent superficial cortical veins with abnormal and enlarged deep venous drainage 2.
Treatment and prognosis
Treatment revolves primarily around seizure control, with surgical resection only indicated rarely in refractory cases. Ophthalmological examination is also essential to identify and treat ocular involvement 4.
Sturge-Weber syndrome was first described by Sturge in 1879, followed by Weber and Volland in 1912 who described the intracranial calcification. Radiographic identification of cerebral calcification was first described by Dimitri in 1922 2-3.
- William Allen Sturge - English physician (1850-1919) 3
- Frederick Parkes Weber - English physician (1863-1962) 3
- Vincente Dimitri - Austrian dermatologist (1885-1955) 3
- cerebral arteriovenous malformation (AVM)
- cutaneous haemangioma–vascular complex syndrome 8
- healed cortical infarct
- tuberous sclerosis (Bourneville-Pringle disease)
- ataxia telangiectasia
- Sturge-Weber syndrome (encephalotrigeminal angiomatosis)
- von Hippel-Lindau disease (retinocerebellar angiomatosis)
- incontinentia pigmenti (Bloch-Sulzberger syndrome)
- basal cell naevus syndrome (Gorlin-Goltz syndrome)
- Wyburn-Mason syndrome (Bonnet-Dechaume-Blanc syndrome)
- encephalocraniocutaneous lipomatosis
- hypomelanosis of Ito
- Nijmegen breakage syndrome
- epidermal naevus syndrome
- neurocutaneous melanosis
- progressive facial hemiatrophy (Parry-Romberg syndrome)
- PHACE syndrome
- Cowden syndrome
- 1. Reiser MF. Magnetic Resonance Tomography. Springer Verlag. (2007) ISBN:354029354X. Read it at Google Books - Find it at Amazon
- 2. Wyllie E, Gupta A, Lachhwani DK. The treatment of epilepsy, principles & practice. Lippincott Williams & Wilkins. (2006) ISBN:0781749956. Read it at Google Books - Find it at Amazon
- 3. Sturge-Weber syndrome from whonamedit.com, the dictionary of medical eponyms. Sturge-Weber syndrome
- 4. Hay WW, Hayward AR, Levin MJ et-al. Current pediatric diagnosis & treatment. McGraw-Hill/Appleton & Lange. (2002) ISBN:0071383840. Read it at Google Books - Find it at Amazon
- 5. Menkes JH, Sarnat HB, Maria BL. Child neurology. Lippincott Williams & Wilkins. (2006) ISBN:0781751047. Read it at Google Books - Find it at Amazon
- 6. Burgener FA, Kormano M. Differential diagnosis in computed tomography. Thieme. (1996) ISBN:0865775478. Read it at Google Books - Find it at Amazon
- 7. Moore GJ, Slovis TL, Chugani HT. Proton magnetic resonance spectroscopy in children with Sturge-Weber syndrome. J. Child Neurol. 1998;13 (7): 332-5. doi:10.1177/088307389801300705 - Pubmed citation
- 8. Pascual-castroviejo I, Viaño J, Moreno F et-al. Hemangiomas of the head, neck, and chest with associated vascular and brain anomalies: a complex neurocutaneous syndrome. AJNR Am J Neuroradiol. 1996;17 (3): 461-71. AJNR Am J Neuroradiol (abstract) - Pubmed citation
- 9. Wong-you-cheong JJ, Woodward PJ, Manning MA et-al. From the Archives of the AFIP: neoplasms of the urinary bladder: radiologic-pathologic correlation. Radiographics. 26 (2): 553-80. doi:10.1148/rg.262055172 - Pubmed citation
- 10. Pascual-castroviejo I, Viaño J, Moreno F et-al. Hemangiomas of the head, neck, and chest with associated vascular and brain anomalies: a complex neurocutaneous syndrome. AJNR Am J Neuroradiol. 1996;17 (3): 461-71. AJNR Am J Neuroradiol (abstract) - Pubmed citation
Synonyms & Alternative Spellings
|Synonyms or Alternative Spelling||Include in Listings?|
|Dimitri’s hemangiomatosis syndrome||✓|
|Sturge-Parkes Weber-Dimitri syndrome||✗|
|Lawford’s meningocutaneous syndrome||✓|