Grand-Kaine-Fulling Syndrome

Rare form of cerebroretinal vasculopathy with characteristic subcortical degenerative lesions.

Retinal Vasculopathy with Cerebral Leukodystrophy; Cerebroretinal Vasculopathy.

Genetic disorder first described by M.G. Grand et al. in 1988.

No known international incidence.

Autosomal dominant inheritance. The responsible gene has been mapped to 3p21.3-p21.1.

Histopathologic analysis of brain tissue in affected persons demonstrated white matter “necrosis” without vasculitis.

Based on the clinical findings of visual impairment and neurologic signs. Disease is characterized by progressive subcortical contrast-enhancing lesions with surrounding edema, mimicking tumors and often leading to biopsies in numerous patients. The association of retinopathy, Raynaud syndrome, migraine, and kidney involvement should raise suspicion of this condition.

Features involve the eyes (retinal changes such as vasculopathy, exudates, or hemorrhage, visual loss, cataract, glaucoma, buphthalmos) and central nervous system (structural anomalies, speech defect, hemiparesis, seizures). Leg pain and weakness are frequent. Punctate vasculitic skin lesions can be observed.

Evaluate neurologic function (clinical, CT, MRI, EEG, epilepsy control). Evaluate visual impairment (clinical, ophthalmologic consult).

Visual impairment and speech difficulties may make the operating area a scary environment for these patients. Sedative and/or anxiolytic premedication may therefore be helpful. Lubrication and protection of the eyes are required for patients with buphthalmos.

Consider interaction between antiepileptic treatment and anesthetic drugs. Avoid drugs that can increase intraocular pressure or those that may trigger seizures.

Vascular Retinopathy with Cerebral and Renal Involvement, Raynaud and Migraine Phenomena Syndrome: Allelic to Grand Kaine Fulling syndrome.