Neuropathological analysis of an adult case of the Cornelia de Lange syndrome.

Cornelia de Lange syndrome (CDLS) is a rare multisystemic malformative syndrome of uncertain etiology characterized by severe psychomotor and mental retardation. Here we report the neuropathological analysis of a 35-year-old patient who displayed the classical clinical symptomatology of CDLS. A congenital dysgenesis of the brain was evident including abnormal convolution patterns of the cerebral gyri, frontal lobe hypoplasia and focal lack of myelination in layers V and VI of the left temporal cortex. In addition, there were vascular scars in the CA2-3 region of the left hippocampus and in the right parietal cortex as well as a few neurofibrillary tangles in the CA fields of the hippocampus and in the entorhinal cortex. In contrast to previous reports, there were no midline cerebral dysgenesis and no ectopic neuron formations in the present case. Neuronal loss and gliosis were also absent in all cortical and subcortical areas. Our observations suggest that the main neurodevelopmental deficits in CDLS occur during the late phase of gestation. Conversely, early neurodegenerative changes are not characteristic of CDLS. In the light of previous studies in younger CDLS patients, the vascular and degenerative lesions observed in the present case may be secondary to his severe congenital heart abnormalities and self-injury behavior, respectively.