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      <h1 class="highwire-cite-title" id="page-title">Asymptomatic Interhypothalamic Adhesions in Children</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">M.T. Whitehead</span> and <span class="highwire-citation-author" data-delta="1">G. Vezina</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">April 2016,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">37 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(4) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">E35; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A4703 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-14378--61297193024" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">M.T. Whitehead </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>Department of Neuroradiology
Children's National Medical Center
Washington, DC</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.T.%2BWhitehead%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Whitehead%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AM.T.%2BWhitehead%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0001-5077-693X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M.T. Whitehead</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">G. Vezina </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>Department of Neuroradiology
Children's National Medical Center
Washington, DC</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=G.%2BVezina%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Vezina%20G&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AG.%2BVezina%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-1999-336X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for G. Vezina</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article fulltext-view "><span class="highwire-journal-article-marker-start"></span><p id="p-1">We have several comments regarding the article “Asymptomatic Interhypothalamic Adhesions in Children.”<sup><a id="xref-ref-1-1" class="xref-bibr" href="#ref-1">1</a></sup> We agree with the main message of the article: Referable hypothalamic–pituitary axis symptoms are rare in patients with interhypothalamic adhesions. However, because symptoms can be present on occasion, it is prudent to exclude endocrinopathy on clinical grounds. We have encountered a few cases of patients with interhypothalamic adhesions and pituitary axis disturbances, one associated with Kallmann syndrome<sup><a id="xref-ref-2-1" class="xref-bibr" href="#ref-2">2</a></sup>; 2 with septo-optic dysplasia; and 1, with abnormal weight gain.</p><p id="p-2">We agree with the authors' theory that interhypothalamic adhesions may be the result of “incomplete hypothalamic cleavage, failed apoptosis, or abnormal neuronal migration” and acknowledge the association with “gray matter heterotopia.” Therefore, additional midline abnormalities would be expected. However, the authors did not identify additional abnormalities in most patients. Nonetheless, concurrent gray matter heterotopia was present in 40%, a considerably large percentage of patients, and they proposed that heterotopia associated with interhypothalamic adhesions may be part of an unknown genetic disorder.</p><p id="p-3">All portions of the brain, including the midline, must be carefully examined in patients with interhypothalamic adhesions because they represent a potential marker for brain malformation. Additional midline anomalies/abnormalities are quite common in our experience.<sup><a id="xref-ref-2-2" class="xref-bibr" href="#ref-2">2</a><a id="xref-ref-3-1" class="xref-down-link" href="#ref-3"><span>⇓</span></a>–<a id="xref-ref-4-1" class="xref-bibr" href="#ref-4">4</a></sup> These may be subtle and insignificant (hypoplasia of the falx, underrotated hippocampi, and so forth) or obvious and potentially of great consequence (malformations of brain development).<sup><a id="xref-ref-2-3" class="xref-bibr" href="#ref-2">2</a><a id="xref-ref-3-2" class="xref-down-link" href="#ref-3"><span>⇓</span></a>–<a id="xref-ref-4-2" class="xref-bibr" href="#ref-4">4</a></sup> Indeed, review of Fig 1 demonstrates subtle midline anomalies not mentioned in the article, including hypogenesis or volume loss of the splenium (Figs 1<em>A</em> and <em>E</em>) and a partially fenestrated, persistent cavum septum pellucidum (Fig 1<em>D</em>).<sup><a id="xref-ref-1-2" class="xref-bibr" href="#ref-1">1</a></sup> In normal brains, the callosal splenium is typically equal to or larger in caliber than the genu. While a cavum septum pellucidum is a normal variation, it is uncommon in the general population beyond the neonatal period.</p><p id="p-4">We strongly believe that the midline should be closely scrutinized for additional anomalies/abnormalities in patients with an interhypothalamic adhesion. Only after the brain has been carefully examined and signs/symptoms have been carefully considered can an interhypothalamic adhesion be considered an incidental and isolated finding.</p><div class="section ref-list" id="ref-list-1"><h2 class="">REFERENCES</h2><ol class="cit-list ref-use-labels"><li><span class="ref-label">1.</span><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1. in text" id="ref-1">↵</a><div class="cit ref-cit ref-journal" id="cit-37.4.E35.1" data-doi="10.3174/ajnr.A4602"><div class="cit-metadata"><ol class="cit-auth-list"><li>
</li><li><span class="cit-auth"><span class="cit-name-surname">Ahmed</span>  <span class="cit-name-given-names">FN</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Stence</span>  <span class="cit-name-given-names">NV</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Mirsky</span>  <span class="cit-name-given-names">DM</span></span></li></ol><cite>. <span class="cit-article-title">Asymptomatic interhypothalamic adhesions in children</span>. <abbr class="cit-jnl-abbrev">AJNR Am J Neuroradiol</abbr> <span class="cit-pub-date">2015</span> 
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<span class="cit-day">3</span>. <span class="cit-comment">[Epub ahead of print]</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.3174/ajnr.A4602</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>26635283</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.3174/ajnr.A4602&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=26635283&amp;link_type=MED&amp;atom=%2Fajnr%2F37%2F4%2FE35.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">2.</span><a class="rev-xref-ref" href="#xref-ref-2-1" title="View reference 2. in text" id="ref-2">↵</a><div class="cit ref-cit ref-journal" id="cit-37.4.E35.2" data-doi="10.1155/2013/197415"><div class="cit-metadata"><ol class="cit-auth-list"><li>
</li><li><span class="cit-auth"><span class="cit-name-surname">Whitehead</span>  <span class="cit-name-given-names">MT</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Angel</span>  <span class="cit-name-given-names">JD</span></span></li></ol><cite>. <span class="cit-article-title">Interhypothalamic adhesion in a 9-month-old male with cleft palate</span>. <abbr class="cit-jnl-abbrev">Case Rep Radiol</abbr> <span class="cit-pub-date">2013</span>;<span class="cit-vol">2013</span>:<span class="cit-fpage">197415</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.1155/2013/197415</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>24368961</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1155/2013/197415&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=24368961&amp;link_type=MED&amp;atom=%2Fajnr%2F37%2F4%2FE35.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">3.</span><a class="rev-xref-ref" href="#xref-ref-3-1" title="View reference 3. in text" id="ref-3">↵</a><div class="cit ref-cit ref-journal" id="cit-37.4.E35.3" data-doi="10.3174/ajnr.A3987"><div class="cit-metadata"><ol class="cit-auth-list"><li>
</li><li><span class="cit-auth"><span class="cit-name-surname">Whitehead</span>  <span class="cit-name-given-names">MT</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Vezina</span>  <span class="cit-name-given-names">G</span></span></li></ol><cite>. <span class="cit-article-title">Interhypothalamic adhesion: a series of 13 cases</span>. <abbr class="cit-jnl-abbrev">AJNR Am J Neuroradiol</abbr> <span class="cit-pub-date">2014</span>;<span class="cit-vol">35</span>:<span class="cit-fpage">2002</span>–<span class="cit-lpage">06</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.3174/ajnr.A3987</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>24874532</span></cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpuciI7czo1OiJyZXNpZCI7czoxMDoiMzUvMTAvMjAwMiI7czo0OiJhdG9tIjtzOjE5OiIvYWpuci8zNy80L0UzNS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><span class="ref-label">4.</span><a class="rev-xref-ref" href="#xref-ref-4-1" title="View reference 4. in text" id="ref-4">↵</a><div class="cit ref-cit ref-journal" id="cit-37.4.E35.4" data-doi="10.1155/2015/748413"><div class="cit-metadata"><ol class="cit-auth-list"><li>
</li><li><span class="cit-auth"><span class="cit-name-surname">Whitehead</span>  <span class="cit-name-given-names">MT</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Lee</span>  <span class="cit-name-given-names">B</span></span></li></ol><cite>. <span class="cit-article-title">Neuroimaging features of San Luis Valley syndrome</span>. <abbr class="cit-jnl-abbrev">Case Rep Radiol</abbr> <span class="cit-pub-date">2015</span>;<span class="cit-vol">2015</span>:<span class="cit-fpage">748413</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.1155/2015/748413</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>26425383</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1155/2015/748413&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=26425383&amp;link_type=MED&amp;atom=%2Fajnr%2F37%2F4%2FE35.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li></ol></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2016 by American Journal of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 37</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 4 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Apr 2016 </div></div>
      
      
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