Lissencephaly is a migrational disorder that results in abnormal gyration and cortical lamination. Type 1 lissencephaly is characterized by absent or reduced number of gyri giving the brain a smooth appearance, while type 2 lissencephaly (cobblestone lissencephaly) is described as over-migration of neurons or neuronal precursors beyond the glia-pial limitans giving rise to a cobblestone appearance of the cerebral hemispheres. Both types of lissencephaly are typically thought of as congenital anomalies secondary to genetic defects while cases of lissencephaly due to acquired injury is rare. The few examples that do exist in the literature mainly describe changes in keeping with type 1 lissencephaly. We present here an unusual case of a fetus with brain structural changes consistent with cobblestone lissencephaly with concurrent CMV (cytomegalovirus) meningoencephalitis. Our patient is a 23-week-old stillborn fetus of a 28-year-old G1P0 mother who underwent elective termination of this pregnancy after ultrasound and fetal MRI revealed multiple brain anomalies. Post-mortem examination of the fetus revealed evidence of CMV infection involving multiple systemic organs and the brain. Evidence of malformative lesions included cobblestone appearance of the cerebral hemispheres, enlarged lateral ventricles, and focal polymicrogyria. Normal diploid complement for chromosomes 13, 18, and 21 was revealed by rapid aneuploidy testing. While single case reports of CMV with features in keeping with type 1 lissencephaly have been described in the literature, to the authors' knowledge this is the first example of cobblestone lissencephaly observed in the context of congenital CMV infection.

Developmental signaling pathways act in stage and tissue dependent relation and misactivation can drive tumor formation. The RNA-binding protein LIN28A binds to mRNA and miRNA and thereby affects the protein turnover and maintains stemness. LIN28A is overexpressed in embryonal brain tumors which show low correlation between transcriptome and proteome signatures. Additionally, stabilizing CTNNB1 mutations activating the WNT pathway have been reported in brain tumors with LIN28A overexpression. The aim of this study was to coactivate these oncogenic proteins during embryonal brain development and investigate the histomorphology of the cerebral cortex in relation to proteome levels with spatial resolution using the nanosecond infrared laser system for nano-volume sampling. The combination of both oncogenic factors in vivo did not lead to brain tumour formation during embryonal development but resulted in disturbed lamination and impaired cell migration in the murine cerebral cortex. Spatially resolved proteome analysis of the cortices revealed unique layer signatures across ablated layers. Moreover, the extracellular matrix receptors RPSA and ITGB1 were spatially disturbed comparing the mouse models and accompanied by a porous pial border and overmigration of neural cells. Cajal-Retzius cells were misplaced in deeper cortex regions without affecting general REELIN levels. Additionally, the glycosylated levels of α-dystroglycan were reduced. Taken together, the interplay of LIN28A and CTNNB1 resulted in a cortical migration disorder showing histomorphological and molecular similarities to human cobblestone lissencephaly (type 2) disorder. This highlights novel implications of the oncogene LIN28A in extracellular matrix integrity. Fukuyama congenital muscular dystrophy (FCMD) is characterized by hypotonia, symmetric generalized muscle weakness, and brain malformations including, classically, cobblestone lissencephaly with cerebral and cerebellar dysplasia. There is a spectrum of severity and mild, typical, and severe phenotypes are recognized. Disease onset typically occurs in early infancy with poor suck/swallow, weak cry, and floppiness. Serum creatine kinase (CK) levels are usually in the thousands (10-60 times higher than normal). Motor development peaks at around age five to six years and thereafter regresses as muscle atrophy progresses. In the typical case, sitting without support or sliding along the floor on the buttocks may be the peak motor function. Deep tendon reflexes are diminished or absent after early infancy. Affected individuals have contractures of the hips, knees, and interphalangeal joints. Later-onset features include a myopathic facial appearance, pseudohypertrophy of the calves and forearms, motor and speech delays, intellectual disability, seizures, ophthalmologic abnormalities including visual impairment and retinal dysplasia, and progressive cardiac involvement after age ten years. Swallowing disturbance occurs in individuals with severe FCMD and in individuals older than age ten years, leading to recurrent aspiration pneumonia and death. The diagnosis of FCMD is established in a proband with biallelic pathogenic variants in FKTN identified by molecular genetic testing. Treatment of manifestations: Physical therapy and stretching exercises, treatment of orthopedic complications; mobility assistance devices such as long leg braces and wheelchairs; use of noninvasive respiratory aids or tracheostomy; prompt treatment of respiratory tract infections; anti-seizure medications; medical and/or surgical treatment for gastroesophageal reflux; gastrostomy tube placement when indicated to assure adequate caloric intake; cardiomyopathy treatment per cardiologist. Surveillance: Monitor gastrointestinal function and for signs/symptoms of gastroesophageal reflux; for orthopedic complications including foot deformities and scoliosis; for myocardial involvement by chest radiography, EKG, and echocardiography in individuals older than age ten years; and respiratory function in individuals with advanced disease. FCMD is inherited in an autosomal recessive manner. If both parents are known to be heterozygous for an FKTN pathogenic variant, each sib of an affected individual has at conception a 25% chance of being affected, a 50% chance of being an asymptomatic carrier, and a 25% chance of being unaffected and not a carrier. Once the FKTN pathogenic variants have been identified in an affected family member, carrier testing for at-risk family members and prenatal/preimplantation genetic testing are possible.

Walker-Warburg Syndrome is a genetically heterogeneous disease with autosomal recessive inheritance characterized by brain and eye deformities, profound mental retardation, congenital muscular dystrophy, and early death. This case study demonstrates a mutation on chromosome 12q14 in the TMEM5 gene (RXYLT1; 605862), which encodes a transmembrane protein with glycosyltransferase function. We present a case of a full-term male baby delivered by Cesarean section due to macrocephaly. At birth, the newborn had hypotonia and respiratory distress, requiring mechanical ventilation. On examination the patient was found to have macrocephaly, generalized hypotonia, hyporeflexia, and retinal degeneration. Genetic testing revealed a homozygous variant in the RXYLT1 gene, consistent with the diagnosis of autosomal recessive muscular dystrophy-dystroglycanopathy (congenital with brain and eye anomalies) type A10. The patient underwent a ventriculoperitoneal shunt and received supportive management. WWS is a fatal disease, and most affected children do not survive beyond the age of 3. Prenatal screening, ultrasonography and magnetic resonance imaging can aid in the detection and confirmation of abnormal brain development in WWS cases.

Cobblestone lissencephaly (C-LIS) (TYPE II) is a rare and severe neuronal migration disorder characterized by a smooth brain surface with overmigrated neurons and abnormal formation of cerebral convolutions or gyri during fetal development, resulting in a cobblestone appearance. C-LIS is associated with eye anomalies and muscular dystrophy. This case report presents a detailed clinical and neuroimaging analysis of a patient diagnosed with cobblestone lissencephaly (Type II). It reviews pertinent literature to enhance our understanding of this complex condition. We report a case of a 6-year-old female child with cobblestone lissencephaly (C-LIS) (Type II) severe developmental delays, hypotonia, and recurrent intractable seizures. Magnetic resonance imaging (MRI) revealed a characteristic cobblestone appearance on the brain surface, indicative of abnormal neuronal migration. In addition to the classic findings of Type II Cobblestone lissencephaly, the patient displayed ventriculomegaly and cerebellar hypoplasia, contributing to the overall neurological impairment observed. The literature review highlights the genetic basis of cobblestone lissencephaly, emphasizing the involvement of genes associated with glycosylation processes and basement membrane integrity. Neuroimaging findings, including MRI and computed tomography scans, are crucial for accurate diagnosis and prognostication. Early identification of cobblestone lissencephaly allows for appropriate counseling and management strategies. However, the prognosis remains guarded, and interventions primarily focus on supportive care and seizure management. This case report contributes to the knowledge of cobblestone lissencephaly, shedding light on the clinical spectrum and neuroimaging features associated with this rare disorder. To clarify the underlying genetic mechanisms and possible therapeutic pathways for better patient outcomes, more investigation is necessary.

Biallelic pathogenic variants in LAMB1 have been associated with autosomal recessive lissencephaly 5 (OMIM 615191), which is characterized by brain malformations (cobblestone lissencephaly, hydrocephalus), developmental delay, and epilepsy. Pathogenic variants in LAMB1 are rare, with only 11 pathogenic variants and 11 patients reported to date. Here, we report on a 6-year-old patient from a consanguineous family with profound developmental delay, microcephaly, and a history of a perinatal cerebrovascular event. Brain magnetic resonance imaging (MRI) showed cerebellar cystic defects, signal intensity abnormalities, and a hypoplastic corpus callosum. Trio-exome analysis revealed a homozygous in-frame deletion of Exons 23 and 24 of LAMB1 affecting 104 amino acids including the epidermal growth factor (EGF)-like units 11 and 12 in Domain III. To our knowledge, this is the first reported in-frame deletion in LAMB1. Our findings broaden the clinical and molecular spectrum of LAMB1-associated syndromes.