Andersen-Tawil syndrome physical examination: Difference between revisions

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Latest revision as of 02:06, 18 February 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2]

Overview

Patients with Andersen-Tawil syndrome usually appear shorter than normal. Physical examination of patients with Andersen-Tawil syndrome is usually remarkable for hypoplastic mandible, micrognathia, broad nose, low set ears and clinodactyly.

Physical Examination

Appearance of the Patient

Patients with Andersen-Tawil syndrome usually appear shorter than normal.

HEENT

Findings may include:

Hypoplastic mandible or small mandible
Micrognathia
Low-set ears
Broad nose may be seen
Dental abnormalities: Lax jaw and poor dentition.
Hypertelorism (widely spaced eyes) may be noted on physical examination of the patients with Andersen-Tawil syndrome

Facial dysmorphia. The mouth is small(purple arrow), the ears have low implantation(yellow arrow) and the nose ridge is broad(blue arrow). Case courtesy by Stéphane Burtey et al^[1]

Dental abnormalities in patient with Andersen-Tawil syndrome. Case courtesy by Rui Fan et al^[2]

Heart

Palpitations
Syncope is usally seen in the first or second decade of the life of the patient
Andersen-Tawil syndrome patients have a unique cardiac finding on ECG

Neuromuscular

Periodic paralysis:^[3]^[4]^[5]^[6]^[7]
- The most important clinical manifestation of Andersen-Tawil syndrome patients is periodic paralysis
- Periodic paralysis are episodic paralysis with flaccid muscle weakness
- These periodic paralysis impairs quality of life of the patients with Andersen-Tawil syndrome
- Triggers often may be due to change in behavior or diet, and also due to the fact that alterations in serum potassium levels.

Muscle weakness:^[8]
- In patients with Andersen-Tawil syndrome the muscle weakness occurs intermittently or spontaneously
- Muscle weakness in patients with Andersen-Tawil syndrome may be occured due to prolonged rest or rest following exertion

Patients with Andersen-Tawil syndrome (ATS) may experience some neurological or neurocognitive defects.^[9]

Extremities

Clinodactyly:^[10]
- Fifth-digit clinodactyly
- Second and third toe syndactyly

Characteristic deformity of hand. A: patient's right fifth finger showing clinodactyly (arrow). B: patient mother's left fifth finger also showing clinodactyly (arrow). Case courtesy by Jung Yoon Pyo et al^[11]

References

↑ "Hypokalaemia and dysmorphia, is there a link?".
↑ "Concomitant presentation of Anderson-Tawil syndrome and myasthenia gravis in an adult patient: A case report".
↑ Levitt, Lawrence P.; Rose, Leslie I.; Dawson, David M. (1972). "Hypokalemic Periodic Paralysis with Arrhythmia". New England Journal of Medicine. 286 (5): 253–254. doi:10.1056/NEJM197202032860507. ISSN 0028-4793.
↑ Statland JM, Fontaine B, Hanna MG, Johnson NE, Kissel JT, Sansone VA; et al. (2018). "Review of the Diagnosis and Treatment of Periodic Paralysis". Muscle Nerve. 57 (4): 522–530. doi:10.1002/mus.26009. PMC 5867231. PMID 29125635.
↑ Cavel-Greant D, Lehmann-Horn F, Jurkat-Rott K (2012). "The impact of permanent muscle weakness on quality of life in periodic paralysis: a survey of 66 patients". Acta Myol. 31 (2): 126–33. PMC 3476862. PMID 23097604.
↑ Sansone VA, Ricci C, Montanari M, Apolone G, Rose M, Meola G; et al. (2012). "Measuring quality of life impairment in skeletal muscle channelopathies". Eur J Neurol. 19 (11): 1470–6. doi:10.1111/j.1468-1331.2012.03751.x. PMC 3492909. PMID 22607270.
↑ Modoni A, Bianchi ML, Vitulano N, Pagliarani S, Perna F, Sanna T; et al. (2011). "Lack of any cardiac involvement in a patient with Andersen-Tawil syndrome associated with the c.574A→G mutation in KCNJ2". Cardiology. 120 (4): 200–3. doi:10.1159/000335529. PMID 22286118.
↑ Andersen ED, Krasilnikoff PA, Overvad H (1971). "Intermittent muscular weakness, extrasystoles, and multiple developmental anomalies. A new syndrome?". Acta Paediatr Scand. 60 (5): 559–64. doi:10.1111/j.1651-2227.1971.tb06990.x. PMID 4106724.
↑ Nguyen HL, Pieper GH, Wilders R (2013). "Andersen-Tawil syndrome: clinical and molecular aspects". Int J Cardiol. 170 (1): 1–16. doi:10.1016/j.ijcard.2013.10.010. PMID 24383070.
↑ Tawil R, Ptacek LJ, Pavlakis SG, DeVivo DC, Penn AS, Ozdemir C; et al. (1994). "Andersen's syndrome: potassium-sensitive periodic paralysis, ventricular ectopy, and dysmorphic features". Ann Neurol. 35 (3): 326–30. doi:10.1002/ana.410350313. PMID 8080508.
↑ "Ventricular Tachyarrhythmias in a Patient with Andersen-Tawil Syndrome".

Template:WikiDoc Sources

[1] "Hypokalaemia and dysmorphia, is there a link?".

[2] "Concomitant presentation of Anderson-Tawil syndrome and myasthenia gravis in an adult patient: A case report".

[LevittRose1972-3] Levitt, Lawrence P.; Rose, Leslie I.; Dawson, David M. (1972). "Hypokalemic Periodic Paralysis with Arrhythmia". New England Journal of Medicine. 286 (5): 253–254. doi:10.1056/NEJM197202032860507. ISSN 0028-4793.

[pmid29125635-4] Statland JM, Fontaine B, Hanna MG, Johnson NE, Kissel JT, Sansone VA; et al. (2018). "Review of the Diagnosis and Treatment of Periodic Paralysis". Muscle Nerve. 57 (4): 522–530. doi:10.1002/mus.26009. PMC 5867231. PMID 29125635.

[pmid23097604-5] Cavel-Greant D, Lehmann-Horn F, Jurkat-Rott K (2012). "The impact of permanent muscle weakness on quality of life in periodic paralysis: a survey of 66 patients". Acta Myol. 31 (2): 126–33. PMC 3476862. PMID 23097604.

[pmid22607270-6] Sansone VA, Ricci C, Montanari M, Apolone G, Rose M, Meola G; et al. (2012). "Measuring quality of life impairment in skeletal muscle channelopathies". Eur J Neurol. 19 (11): 1470–6. doi:10.1111/j.1468-1331.2012.03751.x. PMC 3492909. PMID 22607270.

[pmid22286118-7] Modoni A, Bianchi ML, Vitulano N, Pagliarani S, Perna F, Sanna T; et al. (2011). "Lack of any cardiac involvement in a patient with Andersen-Tawil syndrome associated with the c.574A→G mutation in KCNJ2". Cardiology. 120 (4): 200–3. doi:10.1159/000335529. PMID 22286118.

[pmid4106724-8] Andersen ED, Krasilnikoff PA, Overvad H (1971). "Intermittent muscular weakness, extrasystoles, and multiple developmental anomalies. A new syndrome?". Acta Paediatr Scand. 60 (5): 559–64. doi:10.1111/j.1651-2227.1971.tb06990.x. PMID 4106724.

[pmid24383070-9] Nguyen HL, Pieper GH, Wilders R (2013). "Andersen-Tawil syndrome: clinical and molecular aspects". Int J Cardiol. 170 (1): 1–16. doi:10.1016/j.ijcard.2013.10.010. PMID 24383070.

[pmid8080508-10] Tawil R, Ptacek LJ, Pavlakis SG, DeVivo DC, Penn AS, Ozdemir C; et al. (1994). "Andersen's syndrome: potassium-sensitive periodic paralysis, ventricular ectopy, and dysmorphic features". Ann Neurol. 35 (3): 326–30. doi:10.1002/ana.410350313. PMID 8080508.

[11] "Ventricular Tachyarrhythmias in a Patient with Andersen-Tawil Syndrome".

[1]

[2]

[3]

[4]

[5]

[6]

[7]

[8]

[9]

[10]

[11]

@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Andersen-Tawil syndrome}}
-{{CMG}}; {{AE}} {{CP}}; {{RT}}
+{{CMG}}; {{AE}} {{VKG}}
 == Overview ==
-Patients with Andersen-Tawil syndrome usually appear normal. Physical examination of patients with Andersen-Tawil syndrome is usually remarkable for hypoplastic mandible, micrognathia, broad nose , low set ears and clinodactyly.
+Patients with [[Andersen-Tawil syndrome]] usually appear shorter than normal. Physical examination of patients with [[Andersen-Tawil syndrome]] is usually remarkable for [[hypoplastic]] [[mandible]], [[micrognathia]], broad [[nose]], low set [[Ear|ears]] and [[clinodactyly]].
 ==Physical Examination==
@@ Line 10: / Line 9: @@
 === Appearance of the Patient ===
-* Patients with Andersen-Tawil syndrome usually appear normal.
+* Patients with [[Andersen-Tawil syndrome]] usually appear shorter than normal.
-====Head====
+*
+====HEENT====
 Findings may include:
-* Hypoplastic mandible
+*[[Hypoplastic]] [[mandible]] or small mandible
 * [[Micrognathia]]
+*[[Low-set ears]]
+*Broad [[nose]] may be seen
+*[[Dental]] abnormalities: Lax jaw and poor dentition.
+* [[Hypertelorism]] (widely spaced eyes) may be noted on physical examination of the patients with [[Andersen-Tawil syndrome]]
-====Eyes====
+[[File:Facial dysmorphia.gif|alt=Facial dysmorphia|thumb|Facial dysmorphia. The mouth is small(purple arrow), the ears have low implantation(yellow arrow) and the nose ridge is broad(blue arrow). Case courtesy by Stéphane Burtey et al<ref>{{Cite web|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4421201/|title=Hypokalaemia and dysmorphia, is there a link?|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>|center|640x640px]]<br />
-* [[Hypertelorism]] may be noted on physical examination.
-====Nose====
+[[File:Dental abnormalities.jpg|alt=Dental abnormalities|center|thumb|Dental abnormalities in patient with Andersen-Tawil syndrome. Case courtesy by Rui Fan et al<ref>{{Cite web|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5038206/|title=Concomitant presentation of Anderson-Tawil syndrome and myasthenia gravis in an adult patient: A case report|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref> |602x602px]]<br />
-* Broad nose may be seen.
-====Ears====
+=== '''Heart''' ===
-* Low set ears may be present.
-====Extremities====
+*[[Palpitations]]
-* [[Clinodactyly]] may be present.
+*[[Syncope]] is usally seen in the first or second decade of the life of the patient
+*[[Andersen-Tawil syndrome]] patients have a unique cardiac finding on [[The electrocardiogram|ECG]]
+===Neuromuscular===
+* Periodic paralysis:<ref name="LevittRose1972">{{cite journal|last1=Levitt|first1=Lawrence P.|last2=Rose|first2=Leslie I.|last3=Dawson|first3=David M.|title=Hypokalemic Periodic Paralysis with Arrhythmia|journal=New England Journal of Medicine|volume=286|issue=5|year=1972|pages=253–254|issn=0028-4793|doi=10.1056/NEJM197202032860507}}</ref><ref name="pmid29125635">{{cite journal| author=Statland JM, Fontaine B, Hanna MG, Johnson NE, Kissel JT, Sansone VA | display-authors=etal| title=Review of the Diagnosis and Treatment of Periodic Paralysis. | journal=Muscle Nerve | year= 2018 | volume= 57 | issue= 4 | pages= 522-530 | pmid=29125635 | doi=10.1002/mus.26009 | pmc=5867231 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29125635  }}</ref><ref name="pmid23097604">{{cite journal| author=Cavel-Greant D, Lehmann-Horn F, Jurkat-Rott K| title=The impact of permanent muscle weakness on quality of life in periodic paralysis: a survey of 66 patients. | journal=Acta Myol | year= 2012 | volume= 31 | issue= 2 | pages= 126-33 | pmid=23097604 | doi= | pmc=3476862 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23097604  }}</ref><ref name="pmid22607270">{{cite journal| author=Sansone VA, Ricci C, Montanari M, Apolone G, Rose M, Meola G | display-authors=etal| title=Measuring quality of life impairment in skeletal muscle channelopathies. | journal=Eur J Neurol | year= 2012 | volume= 19 | issue= 11 | pages= 1470-6 | pmid=22607270 | doi=10.1111/j.1468-1331.2012.03751.x | pmc=3492909 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22607270  }}</ref><ref name="pmid22286118">{{cite journal| author=Modoni A, Bianchi ML, Vitulano N, Pagliarani S, Perna F, Sanna T | display-authors=etal| title=Lack of any cardiac involvement in a patient with Andersen-Tawil syndrome associated with the c.574A→G mutation in KCNJ2. | journal=Cardiology | year= 2011 | volume= 120 | issue= 4 | pages= 200-3 | pmid=22286118 | doi=10.1159/000335529 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22286118  }}</ref>
+** The most important clinical manifestation of [[Andersen-Tawil syndrome]] patients is [[periodic paralysis]]
+** Periodic paralysis are episodic [[paralysis]] with [[flaccid]] [[muscle weakness]]
+**These [[periodic paralysis]] impairs quality of life of the patients with [[Andersen-Tawil syndrome]]
+**Triggers often may be due to change in behavior or diet, and also due to the fact that alterations in serum [[potassium]] levels.
+*[[Muscle weakness]]:<ref name="pmid4106724">{{cite journal| author=Andersen ED, Krasilnikoff PA, Overvad H| title=Intermittent muscular weakness, extrasystoles, and multiple developmental anomalies. A new syndrome? | journal=Acta Paediatr Scand | year= 1971 | volume= 60 | issue= 5 | pages= 559-64 | pmid=4106724 | doi=10.1111/j.1651-2227.1971.tb06990.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4106724  }}</ref>
+** In patients with [[Andersen-Tawil syndrome]] the [[muscle weakness]] occurs intermittently or spontaneously
+**[[Muscle weakness]] in patients with [[Andersen-Tawil syndrome]] may be occured due to prolonged rest or rest following exertion
+* Patients with [[Andersen-Tawil syndrome]] (ATS) may experience some [[Neurology|neurological]] or [[Neurocognitive deficit|neurocognitive]] defects.<ref name="pmid24383070">{{cite journal| author=Nguyen HL, Pieper GH, Wilders R| title=Andersen-Tawil syndrome: clinical and molecular aspects. | journal=Int J Cardiol | year= 2013 | volume= 170 | issue= 1 | pages= 1-16 | pmid=24383070 | doi=10.1016/j.ijcard.2013.10.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24383070  }}</ref>
+===Extremities===
+*[[Clinodactyly]]:<ref name="pmid8080508">{{cite journal| author=Tawil R, Ptacek LJ, Pavlakis SG, DeVivo DC, Penn AS, Ozdemir C | display-authors=etal| title=Andersen's syndrome: potassium-sensitive periodic paralysis, ventricular ectopy, and dysmorphic features. | journal=Ann Neurol | year= 1994 | volume= 35 | issue= 3 | pages= 326-30 | pmid=8080508 | doi=10.1002/ana.410350313 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8080508  }}</ref>
+** Fifth-digit [[clinodactyly]]
+** Second and third toe [[syndactyly]]
+[[File:Clinodactyly.jpg|alt=clinodactyly|center|thumb|699x699px|Characteristic deformity of hand. A: patient's right fifth finger showing clinodactyly (arrow). B: patient mother's left fifth finger also showing clinodactyly (arrow). Case courtesy by Jung Yoon Pyo et al<ref>{{Cite web|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3569570/|title=Ventricular Tachyarrhythmias in a Patient with Andersen-Tawil Syndrome|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>]]
+<br />
 ==References==
 {{Reflist|2}}
@@ Line 34: / Line 59: @@
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 {{WikiDoc Sources}}
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 [[Category:Electrophysiology]]
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