Brushfield spots

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The Brushfield spots are the spots between the inner and outer red circles. Brushfield eyes magnified.jpg
The Brushfield spots are the spots between the inner and outer red circles.

Brushfield spots are small, white or greyish/brown spots on the periphery of the iris in the human eye due to aggregation of connective tissue, a normal constituent of the iris stroma. The spots are named after the physician Thomas Brushfield, who first described them in his 1924 M.D. thesis. [1]

Brushfield spots are a characteristic feature of the chromosomal disorder Down syndrome or trisomy 21. They occur in 35–78% of newborn infants with Down syndrome. [2] Brushfield spots tend to be obscured by pigmentation of the anterior border layer of the iris in patients with darker irides. Hence, they are much more likely to be observed in children with lightly pigmented eyes. Brushfield spots are more commonly found in Down syndrome patients of European descent than similarly affected children of Asian heritage. [3]

Brushfield spots comprise focal areas of iris stromal hyperplasia, surrounded by relative hypoplasia.

Similar spots described by Krückmann [4] and Wolfflin [5] are found in individuals without Down syndrome. Termed Krückmann-Wolfflin bodies, these spots typically are less well defined, fewer in number and more peripherally located than the Brushfield spots of trisomy 21. [6]

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The red reflex refers to the reddish-orange reflection of light from the back of the eye, or fundus, observed when using an ophthalmoscope or retinoscope. The reflex relies on the transparency of optical media and reflects off the fundus back through media into the aperture of the ophthalmoscope. The red reflex is considered abnormal if there is any asymmetry between the eyes, dark spots, or white reflex (Leukocoria).

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<span class="mw-page-title-main">Trisomy 22</span> Medical condition

Trisomy 22 is a chromosomal disorder in which three copies of chromosome 22 are present rather than two. It is a frequent cause of spontaneous abortion during the first trimester of pregnancy. Progression to the second trimester and live birth are rare. This disorder is found in individuals with an extra copy or a variation of chromosome 22 in some or all cells of their bodies.

PHACE syndrome is a medical condition involving the uncommon association between large infantile hemangiomas, usually of the face, and birth defects of the brain, heart, eyes, skin and/or arteries. PHACE is an acronym that stands for the medical names of the parts of the body it often impacts:

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Tetrasomy X, also known as 48,XXXX, is a chromosomal disorder in which a female has four, rather than two, copies of the X chromosome. It is associated with intellectual disability of varying severity, characteristic "coarse" facial features, heart defects, and skeletal anomalies such as increased height, clinodactyly, and radioulnar synostosis. Tetrasomy X is a rare condition, with few medically recognized cases; it is estimated to occur in approximately 1 in 50,000 females.

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Trisomy X, also known as triple X syndrome and characterized by the karyotype 47,XXX, is a chromosome disorder in which a female has an extra copy of the X chromosome. It is relatively common and occurs in 1 in 1,000 females, but is rarely diagnosed; fewer than 10% of those with the condition know they have it.

References

  1. Wallis, Hugh R.E. "The Significance of Brushfield's Spots in the Diagnosis of Mongolism in Infancy", Archives of Disease in Childhood, 1951 December; 26 (130): 495-500. Retrieved on 21 March 2009.
  2. Sanez, R.B. (January 1999), "Primary care of infants and young children with Down syndrome", American Family Physician, vol. 59, no. 2, p. 381, archived from the original on 2011-06-06, retrieved 2007-10-18
  3. Kim, J.H.; et al. (November 2002), "Characteristic ocular findings in Asian children with Down syndrome", Nature, vol. 16, no. 6, pp. 710–714, doi: 10.1038/sj.eye.6700208 , PMID   12439664
  4. Krückmann, E. (1907), "Die Erkrankungen des Uvealtractus und des Glaskopers Regenbogenhaut", in Graefe, A. von; Saemisch, T. (eds.), Handbuch der gesamten Augenheilkunde, vol. 5, pp. 1–11
  5. Wolfflin, E. (1902), "Ein klinischer Beitrag zur Kenntniss der Structur der Iris", Arch. F. Augenh, 45: 1–4
  6. Donaldson, DD (1961), "The Significance of Spotting of the Iris in Mongoloids: Brushfield Spots", Arch. Ophthalmol., 65 (1): 26–31, doi:10.1001/archopht.1961.01840020028007